title: Transforming long-term care pain management in north america: the policy-clinical interface.
abstract: BACKGROUND
  The undertreatment of pain in older adults who reside in long-term care (LTC) facilities has been well documented, leading to clinical guideline development and professional educational programs designed to foster better pain assessment and management in this population. Despite these efforts, little improvement has occurred, and we postulate that focused attention to public policy and cost implications of systemic change is required to create positive pain-related outcomes.
  
  
  OBJECTIVE
  Our goal was to outline feasible and cost-effective clinical and public policy recommendations designed to address the undermanagement of pain in LTC facilities.
  
  
  METHODS
  We arranged a 2-day consensus meeting of prominent United States and Canadian pain and public policy experts. An initial document describing the problem of pain undermanagement in LTC was developed and circulated prior to the meeting. Participants were also asked to respond to a list of relevant questions before arriving. Following formal presentations of a variety of proposals and extensive discussion among clinicians and policy experts, a set of recommendations was developed.
  
  
  CONCLUSIONS
  We outline key elements of a transformational model of pain management in LTC for the United States and Canada. Consistent with previously formulated clinical guidelines but with attention to readily implementable public policy change in both countries, this transformational model of LTC has important implications for LTC managers and policy makers as well as major quality of life implications for LTC residents.
authors.affiliation: Department of Psychology & Centre on Aging and Health, University of Regina, Regina, SK, Canada. hadjistt@uregina.ca
authors.forename: Thomas
authors.initials: T
authors.lastname: Hadjistavropoulos
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Marchildon
authors.forename: Perry G
authors.initials: PG
authors.lastname: Fine
authors.forename: Keela
authors.initials: K
authors.lastname: Herr
authors.forename: Howard A
authors.initials: HA
authors.lastname: Palley
authors.forename: Sharon
authors.initials: S
authors.lastname: Kaasalainen
authors.forename: François
authors.initials: F
authors.lastname: Béland
mesh_terms: D000368:Aged; D006801:Humans; D008134:Long-Term Care; D009656:North America; D010146:Pain / Q000453:epidemiology; D059408:Pain Management; D011640:Public Policy; D012866:Skilled Nursing Facilities / Q000592:standards*