Chronic Pain Identification Through Using Electronic Records (C-PICTURE)

Summary

Chronic pain (pain lasting >3 months) is increasingly recognised as a significant public health issue and clinical priority for Scottish Government. However, because there exists no way to reliably identify those with chronic pain, an accurate economic analysis of its burden cannot be undertaken. The negative impact chronic pain has on individuals, their families, their communities, and the healthcare system makes it important that resource allocation, and prevention and management of this condition are guided by the best available research and evidence. Accurately identifying people with chronic pain in large population-level datasets, especially with routinely collected healthcare data, is a prerequisite to better understand chronic pain and its impact. Reliable, robust methodology is needed to accurately understand the distribution, determinants, and impact of chronic pain, for policy design, service development and research. Despite this need, currently there is no simple, reliable way to routinely identify people living with chronic pain in Scotland. This is a major problem: without large (and expensive) bespoke studies, we cannot routinely identify who has chronic pain in the community where most patients are managed, what their needs are, and how needs are best met.

The core aim of C-PICTURE, therefore, is to test, refine and validate a chronic pain case identification algorithm, comprising a series of diagnostic codes and prescribing data, which could be used to this end.  The initial iteration of the algorithm will be run in general practice (GP) software systems, which will generate the ‘test’ dataset.  Thereafter, the accuracy of the initial iteration of the algorithm will be assessed, and the algorithm will be refined considering findings from survey and qualitative work with patients registered with these GP practices.  The final iteration of the algorithm will be assessed, using statistical techniques, to ensure its accuracy in identifying people living with chronic pain.

Once validated, the algorithm, could be used to understand the prevalence of chronic pain in Scotland (and internationally), influence policy development and service planning, improve pain management and outcomes for people with chronic pain and facilitate more robust future research studies in pain medicine by reducing sampling error.

Study Plan

The C-PICTURE study will go through four stages of data collection, these stages don’t occur chronologically but could happen anytime. The data is a mix of qualitative and quantitative from healthcare records, patients, and healthcare providers. A summary of the stages is to follow.  

Phase A: Medical notes review 

During this stage, following approval and governance guidelines, a total of 1200 medical review notes will be reviewed for relevant medical conditions, prescribed medicine and free text. 

Phase B: Survey

During this stage, people will receive an invitation letter from their GP practice, a summary of the participant information sheet, a telephone support form, an opt-out form and the questionnaires. They will have access to the full participant information sheet. A reminder letter will also be sent to those who did not opt-out and did not complete the questionnaire. 

• Participant Information Sheet
• Summary Participant Information Sheet

Phase C: qualitative studies

Semi-structured interviews with healthcare providers and people with chronic pain will be conducted by the research team. In addition, a focus group with the “seldom heard” will be carried out as well.

Phase D: The SPIRE (Scottish Primary Care Information Resource) report 

This will be extracted from the GP practices for only those who did not opt out of SPIRE.

Data from all stages will be used to refine the algorithm to help identify patients with chronic pain.