The project includes an evaluation of the costs and outcomes of a transitional pain service for high risk orthopedic patients compared to standard treatment. The patients (N=1000) will be randomized into active intervention personalized plan (PP) including a close collaboration between the patient, his/her general practitioner, and specialists at the trauma centre, versus control. Included in the active intervention we will perform a pharmacogenetic analysis to facilitate improved pharmacologic therapy of common post-traumatic health problems like pain, anxiety and depression. The sub-population of patients who still use opioids 6 weeks after discharge will be included in an additional interventional study of Acceptance and Commitment Therapy (ACT) compared with control. ACT is an intervention that targets chronification of pain. The interventions (PP-ACT) will be compared to each other and to treatment as usual. Today, treatment as usual means that the patients are discharged from the hospital with sparse information; the GP receives a letter from the specialist with a summary of data from the hospital stay accompanied by a list of prescribed drugs at discharge. A cost-effectiveness analysis will be performed by taking a societal perspective.
The analyses include trauma victims, but chronic pain and reduced HQoL are general health problems and the identification of risk factors for undesirable health pathways will also be relevant and applicable for other patient groups including cancer and major surgery patients. Systematic communication with patients, patient organizations, family care givers, and healthcare professionals is established.