hello. this presentation has been prepared to run on powerpoint 97. to advance through the show...
TRANSCRIPT
Hello.This presentation has been prepared to run on PowerPoint 97.To advance through the show click the left mouse button anywhere inside the active screen. Your keyboard’s arrow keys are also enabled and offer the advantage of being able to go backwards as well as forwards.Several additional slides have been included beyond those shown at the RACGP conference as these may contain information that is of use.Please contact me for clarification or discussion of issues raised.NB This presentation was prepared to be given as a lecture.
Simon Strauss07 55313810E-mail [email protected] www.pain-education.com
Click your left mouse button on the next slide to begin
Do short courses on Pain Management
provoke changes in General Practitioners’ pain patient
management?
Presented bySimon Strauss adviser
Medical Pain Education
One in three Australian households has
one or more members with a pain complaint
usually (80%) managed by a General Practitioner.
From: The Prevalence of Pain Complaints in a General Population: An Australian Study. Brisbane.1986. Fiona Guthrie , Fred Nicolosi and Simon Strauss
Little data seems to have been published on:
Educational intervention influences General Practitioners’ pain management
The actual management of pain patients in the General Practice setting
And whether or not
Objectives
1. To collect sentinel data on General Practitioners’ management of Initial Pain Consultations
2. Assess changes, if any, made following differing brief educational interventions.
Overview MPE’s Practice Assessment Activities
Sentinel Data58 medical practitioners628 Initial Pain Consults
Postal (Pain Tools)
20 medical practitioners247 Initial Pain Consults
PostMyofascial Seminar34 medical practitioners339 Initial Pain Consults
Post Acupuncture Seminar
44 medical practitioners535 Initial Pain Consults
Knowledge AcquisitionAssessed by
formal written Examination
Maintenance of
Changes39 medical practitioners
followed at 4 months
Knowledge AcquisitionAssessed by
formal written Examination
Overview -Extended for non-lecture attendees.
Knowledge acquisition and maintenance of provoked changes are not included in this presentation.
The postal group undertook an educational activity designed to increase usage of Pain Assessment Tools.
The postal group and the sentinel groups provide a useful view of what happens in the ‘wild’.
Many of the myofascial seminar attendees were extensively involved in chronic pain management prior to attending.
Usage of Pain Assessment Tools
Investigation Rates
Initial / Presenting Pain Consultations
Referral Rates
Script Generation Rates
This presentation details the
In the context of o
Usage of Pain Assessment ToolsSentinel Group
0
2
4
6
8
10
12
14
16
Sentinel 58 GPs-628 Audits
% of Initial PainConsults
Data acquired prior to attending a Medical Pain Education acupuncture or myofascial pain management seminar
Usage of Pain Assessment ToolsPostal Group
66
68
70
72
74
76
78
80
82
McGill VAS PainDiagram
Postal 20 GPs -247 Audits
Postal group received written educational material on the usage of VAS, McGill and Pain Diagrams
% of Initial PainConsults
Usage of Pain Assessment Tools Pre - Post Myofascial Seminar
34 GPs 339 Audits
0
10
20
30
40
50
60
70
80
Pre-Seminar Post-Seminar
McGill
VAS
Pain Diagram
% of Initial PainConsults
Usage of Pain Assessment Tools
Pre - Post Acupuncture Seminar 44 GPs 535 audits
0
10
20
30
40
50
60
70
80
Pre-Seminar Post-Seminar
McGill
VAS
Pain Diagram
% of Initial PainConsults
The following slides represent the ‘worst case’ figures
That is, they reflect the number of initial pain consultations that resulted in the
ordering of one or more investigations/scripts/referrals.
Therefore they cannot be used to give the actual numbers of x-rays ordered.
Investigation Rates
43 44
12.6
16
2.84.6 5 5.6
13.3
21.3
0
5
10
15
20
25
30
35
40
45 Sentinel 58 GPs -628 Audits
Postal 20 GPs -247 Audits% of
Initial PainConsults
Investigation Rate Pre - Post Myofascial Seminar
34 GPs 339 Audits 29.1
12
7
1
12
27
15
7
56.6
0
5
10
15
20
25
30
Pre-Seminar Post-Seminar
X-Ray
CT scan
Ultrasound
MRI
Blood test
No clear trend
% of Initial PainConsults
Investigation Rate Pre-Post Acupuncture Seminar
44 medical practitioners 535 Audits49
13
3 4
13
32
97
2
7
0
5
10
15
20
25
30
35
40
45
50
Pre-Seminar Post-Seminar
X-Ray
CT scan
Ultrasound
MRI
Blood test
Pre-Post Investigations rates
X-rays -35%, CT -31%, MRI -50% and Serology -46%
% of Initial PainConsults
Referral rates
26 26
75
1
5
1112
68
56
3
6
0
5
10
15
20
25
30
Sentinel
Postal
% of Initial PainConsults
Referral rates Pre-Post Myofascial Seminar
34 GPs 339 Consults
0
5
10
15
20
25
Pre-Seminar Post-Seminar
Physio
Physician
Psychologist
Orthopaedic Surgeon
Neurosurgeon
Rheumatologist
Counselling
% of Initial PainConsults
A mixed bag
Referral Rates Pre-Post Acupuncture Seminar
44 medical practitioners 535 consults 29
10
1
16
9
6
3
14
3
2
9
34
2
0
5
10
15
20
25
30
Pre-Seminar Post-Seminar
Physio
Physician
Psychologist
Orthopaedic
Neurosurgeon
Rheumatologist
Counselling
Physiotherapy referrals -52%, Physician -70%, Orthopaedic -44%,
Neurosurgeon -66%, Rheumatologist -34%, Counselling -33%
% of Initial PainConsults
Script Rates
50
62
41
30
7 610 12
1 2 0 1
0
10
20
30
40
50
60
70
Sentinel
Postal
127 scripts per 100 Initial Pain Consultations
% of Initial PainConsults
Script Rates Pre - Post Myofascial Seminar
34 GPs 339 Audits
0
5
10
15
20
25
30
35
40
Pre Post
Analgesics
NSAI
Steroid
Antidepressant
other
Pre-Post Myofascial seminarAnalgesics +20%, NSAIs -16%, Steroids +18%, Antidepressants +220%
% of Initial PainConsults
Script Rates Pre - Post Acupuncture Seminar
44 medical practitioners 535 consults 60
42
7
1619
38
32
4
9
16
0
10
20
30
40
50
60
Pre Post
Analgesics
NSAI
Steroid
Antidepressant
other
Pre-Post Acupuncture seminarAnalgesics -38%, NSAIs -24%, Steroids -44%, Antidepressants - 49%
% ofConsults
Conclusions Comparison of sentinel and pre to post educational
activity data reveals that General Practitioners’ pain patients’ management is modifiable by short educational interventions.
The extent of the changes provoked seems to be affected by the nature of the educational material presented.
The proposition that the provoked changes could lead to decreased health care costs has not been proven but seems to be attractive.
Medical Pain Education
31 Charlton Street.
Southport. Qld. 4215
Tel: 07 5531 3810, Fax: 07 5532 6199
URL: www.pain-education.com E-Mail: [email protected]