Structure quality in outpatient care of chronic pain patients

Background: Outcome quality of medical treatment depends on structure quali ty of the treatment facility. In the present study we tried evaluate struct ural parameters of outpatient treatment facilities relating to management o f headache, low ba ck pain and cancer pain. Methods: 109 outpatient treatment facilities (104 offices, 3 outpatient dep artments of hospitals, 2 pain ambulances of hospitals) in middle franconia, one of the larger Bavarian administrative division (population: 1,6 Mio.), have been evaluated by questionaries. Questions examined certain structura l conditions of the treatment facility as compared to german guidelines for outpatient treatment of pain patients (,,Schmerztherapievereinbarung"). Results: Only one treatment facility worked within an interdisciplinary set ting. Less than 25% (median) of total patients of an outpatient treatment f acility suffered from acute or chronic headache, low back pain or cancer pa in. 38% of physicians participated regularly on pain conferences. Establish ed methods for diagnosis and documentation of patients suffering from chron ic headache, chronic back pain and cancer pain were regularly used by 16%, 12% and 10% of physicians, respectively. Regular interdisciplinary cooperat ion in the management of patients with chronic headache, chronic back pain and cancer pain was indicated by 28%, 24% and 41% of physicians, respective ly. However, personal discussion of patient related problems took place in less than 5% of physicians. Although a considerable number of different the rapies (included as standard therapy for outpatient management of chronic p ain in the ,,Schmerztherapievereinbarung") can be applied in each outpatien t treatment facility (median:5), psychological therapy for management of ch ronic headache, chronic back pain and cancer pain was used regularly by 5%, 2% and 7% of physicians, respectively. Scoring of all examined structural parameters provides a measure for the quality of the parameters of a certai n outpatient treatment facility as compared to that of an optimal outpatien t facility for pain treatment (quality score=100%). However, 75% of era min ed outpatient treatment facilities reached quality scores only up to 43%. Conclusions: There are considerable structural deficits in outpatient treat ment facilities involved in management of patients suffering from chronic h eadache, chronic back pain and cancer pain. Realisation of standards accord ing to the ,,Schmerztherapievereinbarung" needs organisation of an interdis ciplinary network between the different specialities necessary for pain man agement. Interdisciplinary cooperation should be supported by the official organization of the medical selfgovernment in germany - the Kassenarztliche Vereinigung- which has to assure optimal conditions for outpatient treatme nts.