Shehnaz Fatima Lakha

BACKGROUND Objective measurement of physician workload is essential for understanding how clinical and administrative activities are distributed in primary care and evaluating changes associated with digital technologies. However, measurement approaches differ in the activities they capture and often require substantial manual observation and coding. OBJECTIVE This scoping review aimed to map the methods and metrics used to objectively measure physician workload in primary care using primary data and identify components of workload measurement potentially suitable for automation. METHODS Following Joanna Briggs Institute guidance and the PRISMA extension for Scoping Reviews, we searched MEDLINE via PubMed, Scopus, Web of Science, and CINAHL for English-language, peer-reviewed studies published between January 1, 2016, and June 30, 2026. Reference lists and forward citations were also searched. Eligible studies reported objective workload measures derived from direct observation, recordings, study-specific digital activity capture, or prospectively timestamped activity records. Studies based exclusively on subjective measures or secondary analyses of routinely collected electronic health record (EHR) audit logs were excluded. Reviewers independently screened studies, and data extracted by one reviewer were verified by two others. Findings were synthesized descriptively without formal risk-of-bias appraisal. RESULTS Thirteen studies across six countries were included. Eight used direct observation, and 12 reported at least one time-based measure. Measures captured consultation and direct patient care, EHR and documentation activities, task volume and workflow, and total working time, including work outside scheduled hours. Task counts, sequences, transitions, and operational failures provided information beyond activity duration. Two studies examined AI-assisted documentation. Measurement remained heavily dependent on manual activity classification and temporal coding. Differences in task definitions, observation boundaries, and outcome measures limited comparability across studies. Potential automation targets included activity classification, identification of task boundaries and workflow transitions, and calculation of workload metrics from observational data. These applications represented proposed methodological extensions rather than validated approaches. CONCLUSIONS Objective workload measurement in primary care remains dominated by time-based indicators that requires substantial human effort. Standardized task definitions and reporting are needed to improve comparability. Future research should evaluate whether automated coding can reduce measurement effort while preserving temporal accuracy and clinical context, using independently human coded observations as reference standards and retaining human oversight for ambiguous activities.

Background: Health care professional–generated vignettes are commonly used to illustrate and analyze patient experiences, shaped through clinical reflection to support provider understanding, training, and practice improvement. However, the subjective interpretation of narratives and the time-consuming manual process limit this approach. As an alternative, patients could record video blogs (vlogs) of their experiences, which can then be transformed into vignettes using GenAI and carefully designed prompts. Objective: This study aims to compare the feasibility and utility of 2 different vignette creation methods, manual and ChatGPT-3.0, from user-generated vlogs about living with chronic pain. Methods: Short commentary videos were recorded by a person living with chronic pain of unknown origin. These were transcribed and used to create vignettes. From 64 videos, three 1-minute clips were selected, each representing a key life stream: university student, international traveler, and patient with chronic pain, based on prior thematic analysis. In total, 3 vignettes were created for each creation method (manual and AI-generated). Each vignette incorporated a profile description, 3 selected user-generated video clips representing the participant’s 3 life streams, researcher-generated analytic commentary for each clip (produced by a researcher with 15 years of experience in manual vignette creation for clinical use), and a brief summary of each video. A comparison between manually constructed and AI-generated vignettes evaluated coherence, contextual accuracy, narrative depth, and utility in health communication and user experience research. Additionally, the person responsible for generating the raw videos (Participant X) provided commentary on this process as a cocreator of a new method, offering critical insights into the authenticity, emotional resonance, and perceived usefulness of each vignette format. Results: This study demonstrates that manual and ChatGPT vignette creation methods are feasible approaches for analyzing and representing user-generated vlogs about living with chronic pain. Each method offers distinct utility: manual vignettes provide rich, nuanced narratives capturing emotional and social complexities, while ChatGPT-generated vignettes offer efficient, concise summaries with some loss of detail. Participant X’s reflections reinforced these findings. Conclusions: ChatGPT-generated vignettes, when combined with human review, offer the potential for an efficient and scalable approach to capturing the experiences of patients with chronic pain. These vignettes could support training, communication, and sharing of patient insights.

Introduction: Gaps in the health system make it difficult for older adults to have their communication needs and wants heard for that necessary communication to happen. In this study, we investigate attitudes of community-based healthcare professionals (HCPs) regarding the potential utility of a digital technology platform. This platform was designed to enable older adults receiving HCP services in a community setting to provide qualitative narrative impressions and evaluations of their needs and how these needs were addressed by the services. MyHealthMyRecord (MHMR) technology is being designed to provide a digital video-scrapbook for recording and sharing healthcare-related information, observation, and qualitative narratives. Methods: HCPs were recruited in collaboration with SE Health, a large community-care provider based in Toronto, Canada. Using a user-centered and inclusive design approach, HCPs in community care were asked to comment on the use of the MHMR platform by their patients and to examine a platform prototype. Each session, which lasted approximately 60 min, involved a 40-min semistructured face-to-face interview, followed by a demonstration of the system. Data were analyzed using the Consensual Qualitative Research analysis. Results: A convenience sample of 7 HCPs, all comfortable with digital technology, participated in the study. The analysis identified 11 themes, with all participants recognizing the value of the MHMR platform in enhancing their capacity to provide services, particularly in tracking to relevant events between patients’ visits. Conclusions: The HCPs appreciated how the MHMR platform could be used to enhance community health service delivery through valid, reliable, and responsive Person/Patient-Reported Outcomes. It was appreciated that such data could be useful in improving community care experiences while also being useful at a system-wide learning level.

Introduction Sodium pentobarbital (SP), a short- to intermediate-acting barbiturate, has limited information in the existing literature. The objectives of this study are to describe (a) the effect of intravenous (IV) SP infusion on pain and sensory abnormalities, and (b) its utility in the diagnosis and management of patients with chronic pain. Methods A narrative review of barbiturate applications for chronic pain was followed by a pragmatic study of 176 consecutive patients admitted to an inpatient pain unit (2004–2009). We collected demographic information upon admission, diagnoses retrieved from chart review, and pain ratings and sensory abnormalities at baseline and after blinded infusion of normal saline (NS) followed by SP. Results The study group consisted of 83 men and 93 women (mean age 41 ± 11 years); the mean NS dose was 7.8 ± 2.3 (range 2–10 ml), the SP dose was 223.8 ± 88 mg (range 40–420), and the numeric rating scale (NRS) baseline pain score was 6.0 ± 2. The mean reduction in NRS reached both statistical and clinical significance in 150 responders to either NS/SP or SP only. Collectively, we found (a) an extremely high rate of response to IV SP irrespective of the underlying pathology, (b) greater response for pain than for sensory abnormalities (sensory gains or deficits), (c) greater response for sensory gain than for sensory deficit, and (d) greater response for allodynia than for pinprick hyperalgesia. Illustrative case reports are also presented. Discussion IV SP infusion is a diagnostic tool that assists in elucidating pain generators and the nature of sensory abnormalities (central vs. peripheral), with effects similar to those of IV sodium amytal. The test cannot be viewed as a tell-all diagnostic modality and must be used in conjunction with clinical judgment, investigations, and psychological reports.

Objectives: Early case report studies and anecdotes from patients, medical colleagues, and social media suggest that patients may present to chronic pain clinics with a number of complaints post COVID-19 infection or vaccination. The aim of this study is to systematically report on a consecutive series of chronic pain patients seen in a community-based pain clinic, who acquired symptoms after COVID-19 infection or vaccination. Methods: This retrospective cross-sectional descriptive study identified all patients seen at the clinic over a 4-month period (January–April 2022) with persistent symptoms after COVID-19 infection, vaccination, or both. Information was collected on sex, gender, age, details of vaccination, new pains, or exacerbation of old pain plus the development of novel symptoms. Results: The study identified 21 community dwellers (17 females and 4 males; F/M 4.25/1; age range 22–79 years; mean age 46.3 years), with symptoms attributed to COVID-19 infection or vaccination. Several patients suffered exacerbation of previous pains or developed novel pains, as well as high levels of anxiety and mood disorders. A review of the existing literature provides support for the spectrum of symptoms displayed by the study group. Conclusions: Information collected in this study will add to the body of COVID-19-related literature and assist particularly community practitioners in recognizing and managing these conditions.

Background: Chronic pain is a highly prevalent health problem especially in rural regions. There is a dearth of comprehensive pain management programs particularly in rural areas. Aim: The objectives of this paper are to describe the evolution of an interprofessional chronic pain team employing a patient-centered model of care with a biopsychosocial approach, and health services metrics. Method: This descriptive case study approach includes an overview of the Chronic Pain Management Program (CPMP) services at St. Joseph Care Group in Thunder Bay, NW Ontario; the process involved in the development of an interprofessional chronic pain team employing a patient-centered model of care with a biopsychosocial approach; and metrics of the program’s operations. Results: Established in 1998, CPMP has evolved to become inter-professional, providing consultations and management, with partial funding by the Ontario Ministry of Health and Long term Care that has allowed expansion of services. The CPMP currently provides three distinct program streams as follows: a) Intensive 6-week, four half-days/week, outpatient program that offers an interdisciplinary team approach in groups and individual format; b) PACE-IT (Pain Assessment Collaborative Education Inter-professional Therapy), 8-week long, half-day/ week, interprofessional treatment program, in person; and c) Individual format for one-on-one services for patients not fitting in either the 6-Week or PACE-IT programs. In addition, Additional services provide virtual consultations and didactic videoteleconference sessions on opioid stewardship and pain management to health providers. Health services outcomes, research, and educational opportunities across the Northwestern Ontario Region, challenges and future needs are discussed. Conclusion: The CPMP’s model of care can serve as a foundation for expert chronic pain care delivery across rural Canada, and as template for similar institutionally-based and publicly funded pain clinics.

Aim To compare demographic and pain characteristics of older (≥ 65) vs younger (< 65) chronic non-cancer pain patients referred to a community pain clinic in the Greater Toronto Area (GTA), Ontario, Canada. Methods This is a retrospective study of 644 consecutive new patients with pain seen during 2016–2017 (older group n = 126; younger group n = 518). Demographic characteristics, Brief Pain Inventory pain ratings, and diagnosis were obtained using retrospective chart review. Patients were classified into group I (pure biomedical pathology), group II (mixed biomedical causes and psychological factors) and group III (no detectable physical pathology but psychological factors were considered important). Results Older patients comprised 19.6% of the overall population (higher than the average GTA older population). Regarding older vs younger group, male/female ratio was 1:1.3 vs 1:1.7 respectively, while 71% of the older patients were foreign born vs 37% of the younger group (p < 0.001). Low back was the most prevalent pain site for both groups; 70% of the older patients were classified as group I vs 35% of the younger patients (p < 0.0001), and only 6% as group III (vs 18% of the younger population, p < 0.05). Conclusion The study points to considerable differences between younger and older patients with pain with the latter presenting with significant biomedical pathology but lesser psychopathology. The results are comparable to those obtained from a university pain clinic as well as a rural Northern Ontario clinic. Implications of the study for planning of pain care are discussed.

Background: Chronic pain management multi/interdisciplinary programs attempt to address all elements of the biopsychosocial model. The primary objective of this retrospective study (based on practice-based audit) was to determine the effectiveness of a patient-centered, comprehensive and intense interdisciplinary pain management program in a publicly funded community-based pain clinic in the Greater Toronto Area. Method: This retrospective longitudinal study was conducted on 218 carefully selected sequential chronic pain patients, with 158 completing a 3–4-month interdisciplinary program between January 2016 and December 2018. Data collected upon exit, at 6 months and 12 months post-discharge included demographic information, pain characteristics, emotional/functional status obtained by validated instruments and global impression of change (GIC). Additionally, social health outcomes (return to work or school) were retrieved through retrospective chart review. Means of pre-and post-program variables were compared to assess changes of each patient’s “journey”. Results: Physical and mental/ emotional health outcomes at exit, 6 months and 12 months post-discharge, showed initial and sustained, statistically and clinically significant improvement from pre-treatment levels, with GIC (much/very much improved) reported as 77%, 58% and 76%, respectively. Additionally, a substantial positive change in social health outcomes was noted particularly in patients on disability (29%), part time workers gaining full time employment (55%), and students (71%) who improved their level of schooling. Conclusion: The study showed that careful patient selection in a community-based publicly funded interdisciplinary pain management program can produce significant improvement in pain, physical, mental/emotional health and social function, with sustained long-term outcomes.

Introduction Little information exists regarding the characteristics of patients with chronic non-cancer pain (CNCP) attending Canadian pain clinics. The study describes the demographics, pain characteristics and the diagnostic classification profile of such patients attending a university-affiliated community-based pain clinic in the Greater Toronto Area. Methods Retrospective descriptive study based on 644 unique consecutive CNCP patients assessed between January 2016 and December 2017. Results The female/male ratio was 1.6:1; 80% were younger than 65 years; 43% held some form of employment (full-time, part-time or self employment); median pain duration was 3 years; car accidents and medical conditions accounted for 28 and 27% of pain onset, respectively; 34% had four or more distinct areas of pain; and low back pain (LBP) was the most prevalent site (66%), but was the sole site of pain in less than a third of these patients. Age was positively associated with LBP prevalence. Self-reported health service utilization (visits to the emergency room, pain physician or psychologist) increased with patient psychopathology. Cannabis was used by 15% of the cohort and opioids by 34.5%, with only one in six opioid users exceeding 90 mg of morphine equivalent dose per day. Comparison of our data to three previously published studies from other Canadian pain clinics demonstrated both similarities and substantial differences between the populations. Conclusion Our study highlights regional differences between CNCP population phenotypes. Recognition of biomedical, psychological and socio-environmental factors affecting pain should be considered for patient stratification and rational approaches to treatment, as “one size treatment does not fit all”.