Musculoskeletal pain stakeholder engagement and partnership development: determining patient-centered research priorities.

BACKGROUND: Musculoskeletal (MSK) pain is a global public health problem with increased societal burden. Increased attention has focused toward patient and other stakeholder perspectives when determining future MSK pain research priorities, however infrastructure and capacity building within the community are needed for individuals and organizations to participate in patient-centered outcomes research. The purpose of this manuscript is to describe our collaborative experiences with several MSK pain stakeholders and processes to identify a top priority research topic. METHODS: Lunch meetings and formalized workshops were used to develop infrastructure for engaging patients and other stakeholders with early capacity building for partners to identify MSK pain research ideas based on their personal experiences. Additional capacity building and engagement through literature searching further prepared partners to contribute informed decisions about MSK pain research topics and subsequent selection of an important research question. RESULTS: Several key deliverables (e.g., Governance Document, Communication Plan) were developed and completed over the course of this project to provide partnership structure. Other key deliverables included a list of preliminary comparative effectiveness research ideas (n = 8) and selection of shared decision making for MSK pain as the top priority research topic with patient partners identifying pain self-efficacy as an important outcome domain. CONCLUSIONS: Our patient partners provided the catalyst for identifying shared decision making as a high priority research topic based on a wide spectrum of stakeholder perspectives and unique experiences. Patient partners were primarily identified using a single rehabilitation health system and clinician partners were heavily weighted by physical therapists which may have introduced selection bias.

To what extent does poor health precede welfare?

BACKGROUND: It is well known that individuals receiving social assistance have more health problems than those with higher incomes. In this paper, we estimate the proportion of social assistance recipients who were on welfare following a drop in health status. METHODS: The study population consisted of Saskatchewan adults who had been continuously off social assistance for 12 consecutive months followed by 6 months on social assistance. Health status was measured by the use of physician services. We examined changes in physician service rates during the 18-month period. RESULTS: Forty-nine percent of individuals in the study population had increases in the number of physician services over the 18-month period. For these individuals, 53% of the increase in service use occurred during the 12 months prior to receiving social assistance. CONCLUSIONS: Deteriorating health, as measured by increased physician service use, seems to be one factor that precedes many people's receipt of welfare. A focus on improving health status may be one way to keep people off welfare.

An investigation of the impact of supplementary health benefits for low-income families in Saskatchewan.

OBJECTIVES: To examine the changes in health service use by recipients of Family Health Benefits, a supplementary benefits program that was introduced to lower-income, working families in Saskatchewan beginning in July 1998. These benefits reduced or eliminated fees for prescription drugs and for chiropractic, optometric and dental services. METHODS: The study population included program beneficiaries between July 1998 and January 2000. Administrative data maintained by Saskatchewan Health were used to capture information on changes in benefits coverage and use of hospital, physician, prescription drug, chiropractic and optometric services from 1997 to 2000. Demographic characteristics of the study population were described. Utilization rates were compared for periods prior to and following introduction of the program. RESULTS: Almost three quarters of Family Health Benefit beneficiaries had not had any form of prior supplementary health coverage in the previous year. A large proportion of these beneficiaries lived in rural Saskatchewan. Distinct demographic characteristics were observed for rural and urban beneficiaries. While utilization of physician and hospitalization services was lower following the introduction of the program, utilization of prescription drugs, and both chiropractic and optometric services increased. CONCLUSIONS: The reduction in user fees for non-insured services resulted in an increased use of these health services, suggesting that user fees can act as a barrier to the use of medical services by low-income families.