Mapping care pathways and estimating the number and cost of musculoskeletal chronic pain patients to inform the development and implementation of a new service

Abstract

Background: Patients living with chronic pain are typically resource intensive, their care requirements are long term and referral to secondary care is not always expeditious. To provide more appropriate, accessible and cost-effective care, Tower Hamlets Primary Care Trust reviewed the needs of the patients, their current care and the numbers requiring treatment for non-malignant chronic pain, initially starting with musculoskeletal pain. Method: We estimated the number of people with chronic pain being treated outside general practice by the NHS in Tower Hamlets. A working group established set criteria to define a chronic pain patient. We surveyed appropriate clinicians to determine the approximate number of patients who fitted our inclusion criteria, the approximate number of follow-up appointments they required and their care pathways. Secondly, we estimated the cost of care for chronic pain patients using NHS national tariff and reference cost data. We also took a convenience sample of chronic pain patients and recorded their history of care. Findings: The routes and pathways of care are complex and multiple. We estimate between 4.0% and 5.5% of new patients in rheumatology, orthopaedics, occupational therapy and musculoskeletal physiotherapy and up to 90% in the pain clinic are people living with chronic pain. The cost of this care ranged from £296 for a course of physiotherapy to £1911 for a patient seen in physiotherapy, orthopaedic and the pain clinics. Conclusion: There is no facility in current management information services that identifies people being treated for non-specific chronic pain; therefore, estimating both the numbers and costs for treating these people is difficult. National tariff and notional cost data provide estimates only, of an 'average patient'; the real cost of these patients is unknown.

Improving the self-management of chronic pain: COping with persistent Pain, Effectiveness Research in Self-management (COPERS)

“…We also involved general practices as clinicians estimated that around 10% of GP consultations in Tower Hamlets were for chronic pain. 204 One of the general practices was chosen because around 90% of patients were Sylheti speaking (in other local practices the equivalent figure was around 50%).…”

Prevalence and impact of chronic widespread pain in the Bangladeshi and White populations of Tower Hamlets, East London

“…We measured health impact using the EQ-5D score [12], divided into three groups for analysis: best possible health (patients scoring 1, reference group), medium health (patients scoring from 0.50 to less than 1) and poor health (patients scoring less than 0.50). The bimodal, left-skewed distribution of EQ-5D means modelling as a continuous variable [13, 14] is complicated, and we preferred a method more easily accessible to readers. To assess the health impact of chronic pain, we fitted an ordered logistic regression model to the grouped EQ-5D scores, with standard errors robust to clustering and chronic pain as a predictor.…”

Non-drug management of chronic low back pain

“…NHS care for chronic low back pain typically involves eventual referral from a generalist to a specialist; few multidisciplinary chronic pain clinics exist, and patients with chronic pain are often referred from one specialist to another 50. However, direct access to physiotherapy for common musculoskeletal conditions such as low back pain is increasing 51.…”