Lessons learned from the chronic pain clinic: a qualitative study of the perspectives of healthcare providers.

Aim: The chronic pain clinic (CPC) was established to address chronic non-cancer pain and opioid-related harm. Materials & methods: Employing community participatory research design First Nation Metis representatives, clinicians and a researcher collectively agreed to document lessons learned from healthcare providers' perspective, 1 year post-clinic-implementation. 17 individual interviews were conducted. Results: Thematic analysis revealed that a multidisciplinary team offered client-centered care, education, counseling and multimodal treatment options. Medication reviews and case management ensured patient safety. Communication and education of community providers enhanced pain management capacity ensuring safe opioid prescribing. Evidence-based best practices were implemented through system-level monitoring. Access to Indigenous healing strategies provided culturally responsive spiritual care upon request. Conclusion: The multidisciplinary and multimodal CPC care model effectively manages chronic non-cancer pain.

Patient perspectives from the multi-disciplinary chronic pain clinic: a qualitative study.

Aim: The chronic pain clinic (CPC) is a multi-disciplinary program that incorporates pharmacological and non-pharmacological methods, including First Nations healing strategies, to manage pain, improve functioning and reduce opioid misuse among patients with chronic pain in Regina, Canada. Materials & methods: The care experiences of ten current clients were explored using a narrative interview approach. Results: The CPC provides high-quality and safe care for effective chronic pain management. Clients noted pain reduction and improvements in sleep, mobility, functionality, and mood. First Nation clients emphasized the importance of traditional healing strategies. Conclusion: This unique comprehensive multi-modal approach which incorporates First Nations healing strategies is effective in supporting the unique needs of local clients.

Health promotion needs of women living in rural areas: an exploratory study.

OBJECTIVES: To describe the types of health-promoting activities currently engaged in by women who live in rural communities, to explore perceived barriers and facilitators to staying healthy in rural communities, and to examine how these factors may differ for women throughout their adult life. DESIGN: Qualitative pilot study. PARTICIPANTS AND SETTING: Women aged 18 years and older living in a small rural community in Saskatchewan. METHOD: Eight focus groups were conducted with a total of 44 participants who had been stratified into 3 age groups. Content analysis of the focus group transcripts was undertaken. MAIN FINDINGS: Older women were more likely to report that they engage in a balance of activities to promote their physical and mental health. Middle and younger aged women, however, were more likely to engage in activities to promote their physical health, with less emphasis on their mental health. Among the 3 age groups, exercise and nutrition-related activities were most commonly reported. Social support and the "rural way of life" were the most commonly reported community supports available to these women. Younger women were more likely to discuss family commitments as a barrier to maintaining physical fitness,and older women discussed the impact that loneliness and lack of appropriate exercise options had on healthy living in their community. CONCLUSION: The interviews provided a chance for a group of rural women to paint their own picture of promoting and maintaining their health in their own community. The activities engaged in by women to maintain their health, and the barriers and facilitators to staying healthy were different for women of different ages. It is useful for health planners to understand how women's health promotion needs vary across their adult life span.

Outcomes of bupropion therapy for smoking cessation during routine clinical use.

BACKGROUND: Knowledge pertaining to the effectiveness of smoking cessation treatments and patient characteristics that may affect success may enable smokers and clinicians to select individualized treatment for each patient and ultimately increase the success rate of smoking cessation in general. OBJECTIVE: To evaluate the effectiveness of bupropion as a smoking cessation agent when used in routine clinical practice. METHODS: This was a prospective, observational study with a one year follow-up period. Adult smokers presenting to community pharmacies in British Columbia, Canada, with an index prescription for bupropion for smoking cessation (N = 205) were eligible. The primary outcome was the biochemically validated 12 month point abstinence (PA) rate from smoking. Secondary outcomes included the frequency of adverse events, patterns of bupropion use in routine clinical practice, and possible predictors of bupropion effectiveness. RESULTS: The validated 12 month PA rate was 21.0%. Of subjects who reported taking at least one dose of bupropion, 70.4% (126/179) experienced at least one adverse event and 29.6% (53/179) reported stopping the drug due to adverse effects. Greater length of time on bupropion (OR 0.98) and a lower cigarette pack-year history (OR 1.05) were associated with an increase in the odds of smoking cessation. CONCLUSIONS: Subjects receiving bupropion in a real-life setting exhibited a similar abstinence rate at 12 months as has been observed in the active drug groups of placebo-controlled clinical trials. However, the patterns of use and discontinuation rate due to adverse events differed substantially from those observed in early efficacy studies.

Perioperative use of warfarin and aspirin in cataract surgery by Canadian Society of Cataract and Refractive Surgery members: survey.

PURPOSE: To survey the members of the Canadian Society of Cataract and Refractive Surgery (CSCRS) and identify their practices regarding the perioperative use of warfarin and acetylsalicylic acid (aspirin) in cataract surgery. SETTING: Private practice, Regina, Saskatchewan, Canada. METHODS: Members of the CSCRS were faxed a questionnaire that examined their perioperative management of patients being treated with warfarin and aspirin. RESULTS: Of the 110 eligible participants, 82 returned a completed questionnaire, representing a response rate of 74.5%. Warfarin or aspirin was routinely stopped prior to cataract surgery by 25.6% of the respondents. The majority of surgeons who discontinued these medications reported doing so 3 to 7 days prior to surgery and resumed their use 1 to 2 days postoperatively. Topical anesthesia and clear corneal incisions were preferred by the higher volume surgeons. These surgeons were also less likely to discontinue either warfarin or aspirin preoperatively. CONCLUSIONS: The majority of the Canadian Society of Cataract and Refractive Surgery members do not stop either warfarin or aspirin for cataract surgery during the perioperative period.

Complementary therapy use by cancer patients. Physicians' perceptions, attitudes, and ideas.

OBJECTIVE: To explore family physicians' perceptions of their cancer patients' use of complementary therapy. DESIGN: Qualitative pilot study. SETTING: British Columbia and Alberta. PARTICIPANTS: Rural and urban family physicians. METHOD: Five focus groups were conducted with a total of 28 participants. Content analysis of focus group transcripts. MAIN FINDINGS: Eight themes were identified: definition of complementary therapies, importance of holistic health, role of evidence, attitudes toward complementary therapies, perceptions of cancer patients' use of complementary therapies, patient-physician communication, perceptions of family physicians' role with respect to complementary therapies, and concerns about complementary therapies. Family physicians believed that many of their patients were using complementary therapies and that patients and physicians needed to communicate about this practice. CONCLUSION: The study increased understanding of physicians'perspectives on communication about complementary therapies and exposed issues that need to be addressed through education and research.

Assessment of communication barriers in community pharmacies.

This study identified previously reported facilitators and barriers to pharmacist-client communication and then evaluated their impact on the observed communication behaviors of pharmacists. Pharmacists (n = 100) completed a seven-page questionnaire collecting information on 11 variables that had been organized according to the Policy, Regulatory and Organizational Constructs in Educational and Ecological Development (PROCEDE) model as predisposing, enabling, or reinforcing of pharmacist communication with their clients. Demographic variables also were included. "Communication quality" served as the study's dependent variable, whereas pharmacist responses served as the independent variables. Communication quality scores for each pharmacist were obtained from the analysis of 765 audiorecordings of verbal exchanges occurring between the study pharmacists and their consenting clients during 4-hour, on-site observation periods. Four of the variables examined in the study were found to share a unique relationship with communication quality (pharmacists' attitude, year of graduation, adherence expectations, and outcome expectations). Hierarchical multiple regression analysis revealed that the variables measured in the questionnaire accounted for 23% of the variance in communication quality scores. Plausible explanations for why the study was unable to capture more of the variance in its proposed relationships and future areas for research are provided.