Lessons learned from examination of Canadian medico-legal cases related to interventional therapies for chronic pain management.

PURPOSE: Chronic pain is a common condition affecting almost one in five Canadians. One of the methods used to treat chronic pain is injection therapies. While they are considered relatively safe procedures, they do carry inherent risk that can result in adverse events. Our goal was to investigate these patient safety events to identify themes that could be used to shape practice guidelines and standards and improve patient safety. METHODS: We looked at closed civil legal actions and regulatory college complaints associated with injection therapies for chronic pain in the Canadian Medical Protection Association database from 2015 to 2019. Injury was defined as that arising from, or associated with, plans or actions taken during the provision of health care, rather than an underlying disease or injury. RESULTS: Of the 91 cases identified, the most common reported complications were neurologic-related symptoms, injury, and infection. Fifty-eight percent (53/91) of patients experienced health care-related harm that had a negative effect on their health or quality of life. Peer experts were critical of the clinical care provided in 74% (67/91) of the cases. Provider-related (60%, 40/67), team-related (75%, 50/67), and system-related factors (21%, 14/67) were identified as contributing factors in these cases. Common examples of provider-related factors were deficiencies in clinical decision-making (48%, 19/40), failure to follow established procedures (43%, 17/40), and situational awareness (38%, 15/40). Common examples of team-related factors were deficiencies in medical record keeping (80%, 40/50) and communication breakdowns (56%, 28/50). All system-related factors were related to inadequate office procedures. CONCLUSION: We recommend that clinicians conduct appropriate physical examinations, keep up-to-date with clinical standards, and ensure their documentation reflects their assessment, the patient's condition, and the treatment rationale.

RéSUMé: OBJECTIF: La douleur chronique est une affection courante qui touche près d'une personne sur cinq au Canada. Les traitements par injections constituent l'une des méthodes utilisées pour traiter la douleur chronique. Bien que ces thérapies soient considérées comme des interventions relativement sécuritaires, elles comportent des risques inhérents qui peuvent entraîner des événements indésirables. Notre objectif était d'examiner ces événements liés à la sécurité des patient·es afin de cerner les thèmes qui pourraient être utilisés pour façonner les lignes directrices et les normes de pratique et améliorer la sécurité des patient·es. MéTHODE: Nous avons examiné les poursuites civiles fermées et les plaintes aux ordres de réglementation associées aux traitements par injection pour la douleur chronique dans la base de données de l'Association canadienne de protection médicale entre 2015 et 2019. Était considérée comme blessure toute lésion découlant de ou associée à des plans mis en place ou des mesures prises pendant la prestation de soins de santé, plutôt que comme une maladie ou une blessure sous-jacente. RéSULTATS: Sur les 91 cas identifiés, les complications les plus fréquemment signalées étaient des symptômes, des blessures et des infections neurologiques. Cinquante-huit pour cent (53/91) des patient·es ont subi des préjudices liés aux soins de santé qui ont eu un effet négatif sur leur santé ou leur qualité de vie. Les expert·es ont critiqué les soins cliniques fournis dans 74 % (67/91) des cas. Les facteurs liés aux prestataires (60 %, 40/67), à l'équipe (75 %, 50/67) et au système (21 %, 14/67) ont été identifiés comme des facteurs contributifs dans ces cas. Les exemples courants de facteurs liés aux prestataires comportaient les lacunes dans la prise de décision clinique (48 %, 19/40), le non-respect des procédures établies (43 %, 17/40) et la conscience situationnelle (38 %, 15/40). Les lacunes dans la tenue des dossiers médicaux (80 %, 40/50) et les problèmes de communication (56 %, 28/50) comptaient parmi les exemples courants de facteurs liés à l'équipe. Tous les facteurs identifiés comme étant systémiques étaient liés à des procédures administratives inadéquates. CONCLUSION: Nous recommandons aux cliniciennes et cliniciens de réaliser des examens physiques appropriés, de se tenir au courant des normes cliniques et de s'assurer que leur documentation reflète leur évaluation, l'état du/de la patient·e et la justification du traitement.

What's in a Name? Terminology Preferences Among Patients Receiving Methadone Treatment.

BACKGROUND: Despite recognition of the importance of substance use disorder (SUD) terminology, few studies examine terminology preferences among patients with SUDs. OBJECTIVE: To examine preferences of patients with opioid use disorder (OUD) concerning the terminology used by addiction counselors. DESIGN: From January 1, 2019, to February 28, 2020, participants were recruited consecutively from 30-day treatment review sessions at outpatient methadone treatment programs in the Northeastern United States to complete a cross-sectional survey. PARTICIPANTS: Participants were English-speaking adult patients with OUD enrolled in methadone treatment. MAIN MEASURES: Participants completed 7-point Likert-type scales from 1 ("Strongly Disagree") to 7 ("Strongly Agree") to rate their preferences for (a) the presenting problem, (b) collective nouns referring to those with the presenting problem, and (c) personal descriptors. We used univariate analysis of covariance (ANCOVA) to examine the associations between demographics (i.e., age, sex, and race) and terminology preferences and ordinal logit regression to explore the association between 12-step program partiality and preference for the term "addict." KEY RESULTS: We surveyed 450 patients with mean age of 38.5 (SD = 11.1) years; 59.6% self-identified as male, 77.6% as White, and 12.7% as Hispanic. The highest-rated preferences for presenting problem were "addiction," "substance use," and "substance abuse." The highest-rated collective noun terms were "client," "patient," and "guest." "Person with an addiction," "person with substance use disorder," and "substance-dependent person" were the highest-rated personal descriptors. There were significant differences in terminological preference based on race and age. Twelve-step program partiality was associated with greater preference for the term "addict" (F = 21.22, p < .001). CONCLUSIONS: Terminology preferences among people receiving methadone treatment aligned with existing guidelines recommending that clinicians use medically accurate and destigmatizing terminology when referring to substance use disorders and the persons who have them. Demographic differences emerged in terminological preferences, warranting further examination.