title: Priority interventions to improve the management of chronic non-cancer pain in primary care: a participatory research of the ACCORD program.
abstract: OBJECTIVE
  There is evidence that the management of chronic non-cancer pain (CNCP) in primary care is far from being optimal. A 1-day workshop was held to explore the perceptions of key actors regarding the challenges and priority interventions to improve CNCP management in primary care.
  
  
  METHODS
  Using the Chronic Care Model as a conceptual framework, physicians (n=6), pharmacists (n=6), nurses (n=6), physiotherapists (n=6), psychologists (n=6), pain specialists (n=6), patients (n=3), family members (n=3), decision makers and managers (n=4), and pain researchers (n=7) took part in seven focus groups and five nominal groups.
  
  
  RESULTS
  Challenges identified in focus group discussions were related to five dimensions: knowledge gap, "work in silos", lack of awareness that CNCP represents an important clinical problem, difficulties in access to health professionals and services, and patient empowerment needs. Based on the nominal group discussions, the following priority interventions were identified: interdisciplinary continuing education, interdisciplinary treatment approach, regional expert leadership, creation and definition of care paths, and patient education programs.
  
  
  CONCLUSIONS
  Barriers to optimal management of CNCP in primary care are numerous. Improving its management cannot be envisioned without considering multifaceted interventions targeting several dimensions of the Chronic Care Model and focusing on both clinicians and patients.
authors.affiliation: Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada ; Équipe de recherche en soins de première ligne, Centre de santé et de services sociaux de Laval, Laval, QC, Canada ; Centre de recherche, Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada ; Sanofi Aventis Endowment Chair in Ambulatory Pharmaceutical Care, Faculty of Pharmacy Université de Montréal and Centre de santé et de services sociaux de Laval, QC, Canada.
authors.forename: Lyne
authors.initials: L
authors.lastname: Lalonde
authors.affiliation: Centre de recherche, Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada ; Department of Anesthesiology Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.
authors.forename: Manon
authors.initials: M
authors.lastname: Choinière
authors.affiliation: Centre de recherche, Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Martin
authors.affiliation: Centre de recherche, Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada.
authors.forename: Lise
authors.initials: L
authors.lastname: Lévesque
authors.affiliation: Équipe de recherche en soins de première ligne, Centre de santé et de services sociaux de Laval, Laval, QC, Canada ; Centre de recherche, Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada ; Department of Family Medicine and Emergency, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.
authors.forename: Eveline
authors.initials: E
authors.lastname: Hudon
authors.affiliation: Équipe de recherche en soins de première ligne, Centre de santé et de services sociaux de Laval, Laval, QC, Canada.
authors.forename: Danielle
authors.initials: D
authors.lastname: Bélanger
authors.affiliation: Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada ; Sanofi Aventis Endowment Chair in Drug Utilization, Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Perreault
authors.affiliation: Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, QC, Canada.
authors.forename: Anaïs
authors.initials: A
authors.lastname: Lacasse
authors.affiliation: Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada ; AbbVie Corporation, St-Laurent, QC, Canada.
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Laliberté
keywords: chronic pain; community-based participatory research; health service accessibility; patient-centered care; primary health care