Table 2.

Pillars of the Ontario comprehensive pain strategy (working group 2011 white paper).²⁴

Pillar	Definition
1. Oversight body	Body responsible for providing supervision, policy development, governance structure, monitoring, and reporting
2. Patient focused	Ensuring timely comprehensive assessment and management of the whole patient Ensuring that the patient’s needs and best interests are considered in each step of the care continuum
3. Primary care focused	Ensuring that the cornerstone of chronic pain prevention and management, the primary care physician, is supported and that his or her involvement is reflected in each step of the care continuum
4. Interdisciplinary care	Team-based care The patient is seen by the right practitioner at the right time in the right place
5. Chronic disease management framework	Care for CNCP should be managed within the framework developed to guide the effective prevention and management of chronic diseases
6. Reasonable access to the care continuum	Patients and physicians should be able to receive the care and assistance required in a timely manner
7. Stepped-up care in a care continuum	Self-help Seamless and timely transition from primary care to secondary and tertiary care as needed Develop and update care pathways Interdisciplinary in all stages
8. Continuous quality improvement	Define quality indicators, set system-wide improvement goals, and evaluate progress toward these goals
9. Evidence based	Synthesize best available evidence Set research agenda Create system-wide capabilities for relevant data collection Develop and translate guidelines into useful point of care tools
10. Accountability	Common framework for community and hospital clinics Outcome measures Evidence-based best practices
11. Consistency	Must meet established criteria (providers and centers) Develop unified policies and standards of care Develop standardized education and accreditation for programs, clinics, and providers
12. Prevention and early intervention	Provide prevention and early intervention (by implementing strategies to lessen transition from acute to chronic pain)
13. Education for patients and providers	Provide education for patients and providers (by introducing standardized pain curriculum in undergraduate and graduate training of health providers [medical and nonmedical] and ongoing education for practicing providers on best practices)
14. Data information (registry, research, supports)	Make provisions for data information (registry, research, supports) by underpinning future improvements, development of standards, prevention strategies, etc.; with system organization that provides a knowledge base for research; utilizing technology (telemedicine) to reach underserviced areas; providing warm and hot (telephone) consultation between primary care and pain specialists; and creating a single referral portal
15. Appropriate and sustainably resourced	Appropriately and sustainably resourced (so that providers and clinics have the right funding and resources required)

CNCP = chronic noncancer pain.