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Copyright of Canadian Journal of Pain is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective. To describe factors associated with high clinic and emergency room (ER) use among individuals with chronic pain. Design. This study is part of a larger crosssectional survey on the epidemiology of chronic pain in Canada. The current analysis was guided by the Andersen-Newman Service Utilization Model. Methods. Respondents (N=702) were grouped into high (top 10%) and low (bottom 90%) users based on the number of visits made to clinics and ERs over the past year. The two groups were compared on predisposing (e.g., pain self-efficacy and sociodemographic characteristics), enabling (e.g., income and education), and need (e.g., pain characteristics and number of comorbidities) factors as well as personal health behaviors (e.g., use of medications). Binary logistic regression analysis was used to identify characteristics associated with high use in each setting. Results. High users were defined as 30 or more clinic visits or one or more ER visits. The factors associated with high clinic use in the adjusted analysis were low pain self-efficacy (odds ratio [OR]52.60, 95% confidence interval [CI]=1.50-4.51), two or more comorbidities (OR=2.13, 95% CI=1.23-3.69), five or more pain sites (OR=2.30, 95% CI=1.28-4.14), and having an "other" pain diagnosis (OR=1.78, 95% CI=1.01-3.20). Factors that increased ER use were low pain self-efficacy (OR=2.01, 95% CI=1.28-3.15) and two or more comorbidities (OR=2.31, 95% CI=1.48-3.59), while use of alternative pain management strategies reduced ER use (OR=0.42, 95% CI=0.21-0.84). Conclusions. Longitudinal studies are needed to confirm if modifiable factors such as pain selfefficacy and use of alternative therapies reduce health care use. [ABSTRACT FROM AUTHOR]

Purpose: This study was designed to investigate the role of chronic pain in healthcare visits. The specific objectives were to document the frequency of healthcare visits and to identify characteristics associated with frequent visits.Methods: This is a secondary analysis of data from a Canadian cross-sectional study on chronic pain. One thousand two hundred and ninety-four participants were screened for chronic pain, and 741 reported having "pain or discomfort that had been experienced either all the time or intermittently for at least three months". Data regarding sociodemographics, general health, and healthcare visits were also collected. The frequency of healthcare visits was defined as at or above the 90th percentile for the group. Frequency was calculated for each setting, i.e., physicians' offices (≥ 9), emergency departments (≥ 1), and other (≥ 15). Binary logistic regression analyses were conducted to identify factors associated with frequent visits.Results: Chronic pain increased the frequency of visits to physicians (odds ratio [OR], 4.7; 95% confidence interval [CI], 2.8 to 7.9), emergency departments (OR, 1.4; 95% CI, 1.0 to 2.0), and "other" healthcare professionals (OR, 8.3; 95% CI, 4.5 to 15.5). Having ≥3 chronic conditions significantly increased the odds of frequent healthcare visits.Conclusion: Interventions aimed at reducing healthcare costs for chronic pain should target individuals living with multiple chronic conditions. Research is needed to develop and test interventions that focus on the needs of these groups. Identifying the risk factors for high healthcare use and improving self-management may reduce healthcare visits. [ABSTRACT FROM AUTHOR]

The Canadian health care system is a publicly financed system administered by ten provincial and three territorial governments. The purpose of this article is to provide an overview of the universal health care system in Canada, including its history, the health status of Canadians, health care funding and spending, and health research and data collection. Health care spending in Canada amounts to 11.6% of the country's gross domestic product and is estimated to have been $200.5 billion Canadian dollars in 2011. Hospitals account for the largest source of health care spending (29%), followed by drugs (16%) and physician spending (14%). Of the total health care spending, 70% is paid for by the public system. Due to the Canadian population being covered by the universal health care system, health data are being collected and can be used to monitor the health care system and inform evidence-based medicine. [ABSTRACT FROM AUTHOR]

Objective: To conduct feasibility and cost analysis of portable MRI implementation in a remote setting where MRI access is otherwise unavailable., Methods: Portable MRI (ultra-low field, 0.064T) was installed in Weeneebayko General Hospital, Moose Factory, Ontario. Adult patients, presenting with any indication for neuroimaging, were eligible for study inclusion. Scanning period was from November 14, 2021, to September 6, 2022. Images were sent via a secure PACS network for Neuroradiologist interpretation, available 24/7. Clinical indications, image quality, and report turnaround time were recorded. A cost analysis was conducted from a healthcare system's perspective in 2022 Canadian dollars, comparing cost of portable MRI implementation to transporting patients to a center with fixed MRI., Results: Portable MRI was successfully implemented in a remote Canadian location. Twenty-five patients received a portable MRI scan. All studies were of diagnostic quality. No clinically significant pathologies were identified on any of the studies. However, based on clinical presentation and limitations of portable MRI resolution, it is estimated that 11 (44%) of patients would require transfer to a center with fixed MRI for further imaging workup. Cost savings were $854,841 based on 50 patients receiving portable MRI over 1 year. Five-year budget impact analysis showed nearly $8 million dollars saved., Conclusions: Portable MRI implementation in a remote setting is feasible, with significant cost savings compared to fixed MRI. This study may serve as a model to democratize MRI access, offer timely care and improved triaging in remote areas where conventional MRI is unavailable.

Background : Lung cancer (LC) care is resource and cost intensive. We launched a Multidisciplinary LC Clinic (MDC), where patients with a new LC diagnosis received concurrent oncology consultation, resulting in improved time to LC assessment and treatment. Here, we evaluate the impact of MDC on health resource utilization, patient and caregiver costs, and secondary patient benefits. Methods : We retrospectively analyzed patients in a rapid assessment clinic with a new LC diagnosis pre-MDC (September 2016-February 2017) and post-MDC implementation (February 2017-December 2018). Data are reported as means; unpaired t-tests and ANOVA were used to assess for significance. We also conducted a cost analysis. Resource utilization, out-of-pocket costs, procedure-related costs, and indirect costs were evaluated from the societal perspective and presented in 2019 Canadian dollars (CAD); multi-way worst/best case and threshold sensitivity analyses were conducted. Results : We reviewed 428 patients (78 traditional model, 350 MDC). Patients in the MDC model required significantly fewer oncology visits from LC diagnosis to first LC treatment (1.62 vs. 2.68, p < 0.001), which was significant for patients with stage 1, 3, and 4 disease. Compared with the traditional model, there was no change in mean biopsies/patient (1.32 traditional vs. 1.17 MDC, p = 0.18) or staging investigations/patient (2.24 traditional vs. 2.02 MDC, p = 0.20). Post-MDC, there was an increase in invasive mediastinal staging for patients with stage 2/3 LC (15.0% vs. 60.0%, p < 0.001). Over 22 months, MDC resulted in savings of CAD 48,389 including CAD 24,167 CAD in direct patient out-of-pocket expenses. For the threshold analyses, MDC was estimated to cost CAD 25,708 per quality-adjusted life year (QALY), considered to be below current willingness to pay thresholds (at CAD 80,000 per QALY). MDC also facilitated oncology assessment for 29 non-LC patients. Conclusions : An MDC led to a reduction in patient visits and direct patient and caregiver costs.

ABSTRACTMedical issues facing the aging population are of growing concern with consequences for patients and their caregivers. This study determined the indirect and out-of-pocket costs incurred by the caregivers of elderly patients in Canadian Intensive Care Units (ICUs). Primary family caregivers were surveyed capturing out-of-pocket costs, hours of work, and hours of leisure forgone in providing patient care while the patient was in the ICU. Total costs of care per month were reported across caregiver sex, age, and geographic region. Average out-of-pocket costs were $791 (2016 Canadian dollars) in the first month of ICU care. The mean total cost to family caregivers per patient was $162 per day. Male primary caregivers had higher mean out-of-pocket costs than female caregivers. Subsidization programs covering expenses such as travel, meals, accommodation, and parking are needed to support family caregivers of elderly ICU patients who are incurring considerable out-of-pocket costs.

The objective of this study was to develop a national, prioritized research agenda for advance care planning (ACP). We first identified a list of comprehensive ACP research topics and determined priority criteria through focus groups. We next conducted a survey wherein importance weights were assigned to priority criteria and each ACP topic was rated. We combined weights and ratings into overall scores. A total of 17 ACP topics were developed and placed into four categories: patients and family members, the general public, professionals, and the healthcare system. Four main priority criteria were created: feasibility, consistency with ethical and societal values, economic considerations, and impact. Of the 100 individuals we invited to participate in the survey, 62 accepted. Prioritized topics centred largely on the impact of ACP on health resource utilization, communicating advance care planning across settings, and the preferred manner of engaging patients in ACP.