Assessment, diagnosis, and treatment of patients with high-impact chronic pain – guideline adherence in five specialized multidisciplinary pain centers in Denmark
Rune Frederiksen, Henrik Bjarke Vaegter, Mads U. WernerAbstract
Objectives
The audit explores adherence to the Danish Health Authorities’ recommendations of assessment, diagnosis, and treatment domains in five tertiary multidisciplinary pain centers in three of five regions in Denmark.
Methods
We conducted a systematic clinical audit of medical records from 100 patients with high-impact chronic pain (HICP), sampling 20 records at each center. A structured checklist, based on national guidelines, examined the documentation prevalence across bio-psycho-social issues, pain mechanism identification, and treatment, including non-pharmacological and pharmacological interventions, and discharge planning. Guideline adherence and inter-center variations were examined. Data are presented as median (IQR).
Results
The patient age was 51 (42–59) years, and 63 % were females. The median treatment duration was 35 (17–50) weeks, with 14 (6–23) healthcare contacts involving 3.1 (2.7–4.0) healthcare professions per patient. Documentation of the target issues in the medical records was as follows: physical examination 37 % (1–17/center), psychological factors 65 % (5–20/center), socio-economic factors 98 % (19–20/center), pain mechanisms 66 % (3–17/center), non-pharmacological treatments 89 % (14–20/center), group treatment 57 % (3–17/center), analgesic consumption at referral 96 % and at discharge 83 %, add-on pharmacological treatments 69 % (8–18/center), opioid use at referral 38 % (4–11/center), and weaning off during treatment 18 % (2–6/center), non-evidence-based pharmacological treatments 21 % (0–12/center), prospective treatment plans in discharge reports 14 % (2–4/center), and overall assessment of patients’ satisfaction with treatment outcomes 40 % (3–11/center).
Conclusions
While socio-economic and psychological assessments, and multidisciplinary, non-pharmacological treatments seemed adequately documented, a wide inter-center variation in the documentation of physical examination, diagnostic, pharmacological, and discharge procedures was observed. Standardizing documentation practices is essential to improve consistency and quality of care in Danish multidisciplinary pain centers.