Evaluation of the Relationship Between Geographic Proximity and Treatment for People Referred to a Metropolitan Multidisciplinary Pain Clinic

Abstract

Abstract Objective: This study examined which patient characteristics are associated with travelling further to attend a metropolitan, publicly-funded pain management service, and whether travel distance was associated with differences in treatment profile, duration, and percentage of appointments attended.

Design: Cross-sectional observational cohort study.

Method: Patients aged < =70 years with a single referral between January 2014 and June 2018, who had not died within 12-months of their first appointment, with a usual place of residence were included (N = 1684; mean age=47.2 years, 55.5% female). Travel distance was calculated using the HERE Routing API based on historical travel times for each scheduled appointment.

Results: Median travel time was 27.5 minutes (Q1:12.5, Q3:46.2). Ordinal regression showed that women had 20% lower odds of travelling further but people who were overweight or obese (OR = 1.4-2.3), unemployed (OR = 1.27), or taking higher opioid dosages (OR = 1.79-2.82) had higher odds of travelling further. People travelling >60 minutes had fewer treatment minutes (median=143 minutes) and a smaller proportion attended group programs versus medical appointments only (n = 35, 17.0%) than people living within 15 minutes (median=440 minutes; n = 184 attended group programs, 32.6%). People living 16-30 minutes from the clinic missed the highest proportion of appointments.

Conclusions: While people travelling further for treatment may be predominantly seeking medical treatment, particularly opioid medications, the present findings highlight the need to further explore patient triage and program models of care to ensure that people living with persistent disabling pain can access the same quality and duration of care regardless of where they live.