Article Figures & Data
Figures
- Figure 1.
Family physicians and patients included in study
- Figure 2.
Annual service usage by community-based family physicians among their algorithm-defined chronic pain patients from 2008-2009 to 2017-2018 in British Columbia
- Figure 3.
Percentage of community-based family physicians performing each specific procedure of interest for algorithm-defined chronic pain patients among family physicians who performed at least 1 pain-related procedure each year
Tables
- Table 1.
Comparison of 2008-2009 and 2017-2018 fiscal years of CP patient characteristics in British Columbia
CHARACTERISTIC FISCAL YEAR 2008-2009, N=852,895 2017-2018, N=946,641 Age, y, n (%) • 0-19 58,045 (6.8) 55,267 (5.8) • 20-39 186,248 (21.8) 180,198 (19.0) • 40-59 324,003 (38.0) 325,821 (34.4) • 60-79 221,911 (26.0) 308,086 (32.5) • ≥80 62,688 (7.4) 77,269 (8.2) Administrative sex, n (%)* • Female 523,709 (61.4) 573,164 (60.5) • Male 329,108 (38.6) 373,472-373,477† (39.5) • Unknown 78 (0.0) ≤5† Neighbourhood income quintile, n (%)‡ • 1 (lowest) 176,486 (20.7) 188,872 (20.0) • 2 173,657 (20.4) 191,832 (20.3) • 3 169,587 (19.9) 189,638 (20.0) • 4 164,065 (19.2) 189,745 (20.0) • 5 (highest) 157,837 (18.5) 177,159 (18.7) Health authority, n (%)§ • Interior 153,787 (18.0) 165,098 (17.4) • Fraser 302,514 (35.5) 355,162 (37.5) • Vancouver coastal 188,126 (22.1) 201,213 (21.3) • Island 153,225 (18.0) 170,844 (18.0) • Northern 53,768 (6.3) 53,979 (5.7) Chronic opioid therapy, n (%) 39,217 (4.6) 49,035 (5.2) Long-term neuropathic pain medications, n (%) 71,876 (8.4) 100,845 (10.7) Long-term NSAIDs, n (%) 40,260 (4.7) 31,956 (3.4) Cancer diagnosis, n (%)‖ 34,318 (4.0) 47,335 (5.0) No. of outpatient FP visits, mean (SD) 9.33 (7.86) 8.35 (7.37) No. of FPs seen as outpatient, mean (SD)¶ 2.73 (1.95) 2.42 (1.68) CP—chronic pain, NSAID—nonsteroidal anti-inflammatory drug.
↵* Based on consolidation file, does not represent gender or sex assigned at birth.16
↵† Number too small to report. Range reported for male sex to mask small value.
↵‡ A total of 11,263 patients in 2008-2009 and 9395 in 2017-2018 had missing neighbourhood income quintiles.
↵§ Overall, 1475 patients in 2008-2009 and 345 in 2017-2018 had missing health authorities.
↵‖ Not including basal cell and squamous cell carcinoma.
↵¶ Chronic pain patients may see more than 1 FP per fiscal year.
- Table 2.
Comparison of 2008-2009 and 2017-2018 fiscal years of community-based FP characteristics in British Columbia
CHARACTERISTIC FISCAL YEAR 2008-2009, N=4060 2017-2018, N=4796 Years in practice, % • <10 19.0 24.6 • 10-19 28.9 20.7 • 20-29 28.1 27.2 • ≥30 24.1 27.5 Practitioner gender,* % • Female 35.4 44.2 • Male 64.6 55.8 Location of FP, % • Canada 68.7 63.1 • Outside of Canada 29.4 34.5 • Unknown 1.8 2.4 Community, % • Urban (MIZ 1-3) 86.5 86.7 • Rural (MIZ 4-7) 13.5 13.3 Service volume, mean (SD) • No. of days billed 221.67 (68.21) 210.28 (68.54) • No. of days billed in outpatient location 187.71 (64.96) 174.61 (66.49) • No. of all patients seen in outpatient setting 1786.50 (1294.18) 1504.23 (1165.83) • No. of all patient contacts† in outpatient setting 4752.13 (2985.33) 4023.83 (2819.72) - Table 3.
Average relative percent change in CP service volume or management provided per FP from fiscal years 2008-2009 to 2017-2018 in British Columbia
CHARACTERISTIC FISCAL YEAR 2008-2009, N=4060 FY 2017-2018, N=4796 AVERAGE RELATIVE % CHANGE Service volume per FP, mean (SD) No. of CP patients in outpatient setting with ≥1 visit(s) for any reason
559.76 (414.35) 467.18 (353.85) −16.54 No. of CP patients in outpatient setting with ≥1 pain-related visit(s)*
256.24 (184.87) 218.71 (169.37) −14.64 Percentage of all patients with CP
31.93 (8.17) 32.54 (9.70) 2.83 Percentage of CP patients with cancer
4.30 (3.01) 5.55 (4.17) 29.00 Service usage per FP, mean (SD) Pain-related prescriptions No. of CP patients prescribed long-term† opioids
8.46 (10.16) 9.10 (11.22) 7.57 No. of CP patients prescribed long-term neuropathic pain medications
16.50 (14.24) 19.18 (17.78) 16.24 No. of CP patients prescribed long-term NSAIDs 8.83 (9.57) 5.71 (7.30) −35.33 Percentage of CP patients prescribed long-term opioids
1.90 (2.44) 2.46 (3.52) 29.47 Percentage of total dispensed days that are opioids
2.56 (2.27) 2.54 (3.96) −0.78 Percentage of CP patients prescribed neuropathic pain medications
3.59 (3.09) 4.69 (4.01) 30.64 Percentage of CP patients prescribed long-term NSAIDs
1.87 (1.91) 1.38 (1.65) −26.20 Imaging and referral requests No. of MSK imaging‡ requests for CP patients
112.67 (93.35) 105.15 (92.68) −6.67 No. of MSK US requests for CP patients
6.28 (8.59) 9.97 (11.32) 58.76 No. of referrals to pain specialists
16.00 (17.99) 20.70 (22.52) 29.37 Percentage of all imaging requests as MSK imaging requests for CP patients
44.56 (13.72) 46.60 (14.73) 4.58 Percentage of all US requests as MSK US requests for CP patients
11.62 (11.30) 17.43 (12.50) 50.00 Percentage of all referrals as referrals to pain specialists
6.08 (5.45) 7.81 (5.86) 28.45 CP—chronic pain, ICD—International Classification of Diseases, MSK—musculoskeletal, NSAID—nonsteroidal anti-inflammatory drug, US—ultrasound.
↵* Pain-related visit defined as an encounter with a pain-related ICD code.
↵† Long-term prescription defined as 90 days dispensed within any 100-day period per fiscal year.
↵‡ Musculoskeletal imaging includes x-ray scans of the limbs, temporomandibular joint, and axial skeleton (excluding skull), plus extremity US distinct from doppler or venous US.
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