do pain management programs keep working for compensable patients anne_daly achrf 2014
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ACHRF 2014TRANSCRIPT
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16/11/2014
Do pain management programs
keep working for compensable
patients? Three year follow up.
Anne Daly Pain Management &
Physiotherapy Advisor
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Introduction
Australian Pain Society
–‘Gold’ standard for pain management
–Goals
–Key points
Network Pain Management
–Background –Evaluation
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Australian Pain Society Position Statement
on Pain Management Programs
– Multidisciplinary / Interdisciplinary
– Based on a biopsychosocial understandingof persistent pain
– Cognitive behavioural paradigm
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Australian Pain Society Position Statement
on Pain Management Programs
Goals
– Improve understanding of persistent pain
– Improve function despite ongoing pain – Modify perceptions of pain and suffering
– Provide coping skills and strategies
– Promote self management
– Reinstate activities of daily living
– Reduce or modify future use
of health care services
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Australian Pain Society Position Statement
on Pain Management Programs
SUCCESS DOES NOT = PAIN REDUCTION
Pain reduction is a goal but pain elimination is not the
expected (or a reasonable) end point
OPEN COMMUNICATION IS KEY Alignment of goals between all stakeholders
TIME IS REQUIREDDesired behaviours need time to be normalised
Passive therapies work against this
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Network PMPs
– Meet the APS position statement criteria – Geographic distribution across Melbourne
– Standardised clinical outcome measures
– Education on compensation system – Agreement to focus on – Fast service
– Return to work (RTW) & communication
– Medication use and Mental health
– Future services and treatment
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Evaluation of Network Pain
– Medication utilisation
– Changes in health care utilisation
– Clinical outcome measurement
– Occupational outcomes
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Medication utilisation
Prior: 60% were prescribed medication
After: 35% were prescribed medication
Opioids and Sedatives
Neuropathics
Sustained or improved 3 years
after program completion
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Health care utilisation‘difference in costs 12 months after PM cf 12 mths before PM’
Overall -38%
GP -36%
Physiotherapy -81%
Other allied health -70%
Psychiatry 153%
Psychology 41%
Pharmacy 52%*
* Due to neuropathic medications being
unavailable on the PBS at the time
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Clinical outcome measurement:
Brief Pain Inventory: Pain Intensity
– Pain intensity drops slightly
– Not statistically significant, smaller than MDC
BUT function improves and medication
reduces without an increase in pain
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Clinical outcome measurement:
Brief Pain Inventory: Pain Interference
– 71% reported improvement
– 12% didn’t change
– Statistically significant, larger than MDC
– Enjoyment, sleep, activity, mood
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Clinical outcome measurement:
Fear Avoidance Beliefs QuestionnairePhysical:
– 74% improved
– 13% didn’t change – Statistically significant, larger than MDC
Work:
– 61% improved
– 12% didn’t change
– Statistically significant
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Occupational outcomes
Certified as unfit at assessment: – 41% were reclassified as fit for…..
Certified as fit for some duties at assessment: – 50% had increased hours and/or capacity
These changes occurred by discharge andcontinued to improve at follow up visits
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Global Impression of Change
92.5 % reported improvement
0
5
10
15
20
25
30
35
40
45
much
worse
w orse a l ittl e
worse
no
change
a littl e
better
better mu ch
better
change
%
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Client satisfaction94% were satisfied
0
10
20
30
40
50
60
70
very
unsatisfied
u n satis fied u nd ec id ed s atis fied v er y
satisfied
satisfaction
%
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Service timelines
64% were assessed within 20 businessdays of approval by agent
64% had commenced a program within15 business days of assessment
95% completed their programs
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Do pain managementprograms keep working
for compensable clients?
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Evaluation of Network Pain
Medication utilisation
Changes in health care utilisation
Clinical outcome measurement
Occupational outcomes
= EVIDENCE BASED PRACTICE