January 9, 2012

MSK Initiative2nd Webinar

Low Back Pain

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Agenda

Webinar Housekeeping Project Update Tools Discussion Patient Self Management Evaluation Forms Feedback and Discussion

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Webinar Housekeeping

Audio and Visual Sound Chat Function Save

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Attendees

Doctors:

Herb, Jane, Mona, Helene, David

Facilitators:

Julia, Bruce, Brenda, Liza, Pam, Laura

Impact BC Host:

Christina, Lisa

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Project Update Discussion

Tool Kit– Explore the Tool Kit (Algorithm)– Test all tools as they fit your patient/practice– Provide Feedback on all tools– Send feedback form to PSP Central Weekly– Discuss project with coach support

www.gpscbc.ca/psp_msk

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Clinical Practice Tools – used at point of care and tools we want tested during trial period

Reference Tools – checklists and other materials that can be looked up in hard copy binder or in electronic format as physician interest and time permit

Patient Tools – to be completed by patient either jointly with GP, in the waiting room, or at home. These tools should be tested via GP pilot or with patient focus groups

Teaching Tools – optional for use in the learning / teaching sessions as aids

Inventory of MSK TOOLS & their classification

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Tuesday December 6, 2011 • Patient Questionnaire

• Red Flags

• Yellow Flags

• Assessment of Pain and Function

Patient History

Monday January 9, 2011•DN4

•Opioid Manager

•RACE

•Green Light

•Patient Self-Management Tools

•Personal Action Plan

•Low Back Patient Handout

Monitoring and Management

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Discussion Questions

1. Tell us how you implemented the tools into your practice ?

Patient Tools ? Clinical Tools ? Reference Tools? Teaching Tools ?

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Tools

Diagnostic Screening: DN4

Clinical Management: Opioid Manager RACE Green Light

Patient Self-Management: Personal Action Plan LBP Handout

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Low Back Pain

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DN4 Questionnaire

Utility:

To estimate the probability of Neuropathic Pain

Method: 4 Questions

Score: Yes=1, No= 0 /10 Points

If the patients score is equal to or greater than 4, the test is positive. (sensitivity: 82.9%; specificity: 89.9%)

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Opioid Manager

Assessment Patient Goals Opioid Risk Overdose Risk Initiation Checklist Selection Approach

Management Trial

Dosage Chart

Maintenance and Monitoring Chart

When and How to Stop

Drug related Behaviour

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RAPID ACCESS TO CONSULTATIVE EXPERTISE

Timely Telephone Advice Within 2 hours Assistance with care plan Continued Family Practice Management

Monday-Friday 8-5pm

604-696-2131 or 1-877-696-2131

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Giving Patients Green Light Advice

1. Stay Active -Usual Activities

2. Reassurance and Explanation

3. Pain Control

4. Return to Work

5. Ongoing management

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Follow-Up Visits:

Pain Worst Least Average Right Now

Function • Appreciate variation of pain intensity• Social/Physical/ Mood/ Work• Delve into various functional examples• Opportunity for educational intervention

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Patient Self Management

“The tasks that an individual must undertake to live well with one or more chronic conditions. These tasks include gaining confidence to deal with medical management, role management, and emotional management"

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Patient Self- Management Support

“ The systematic provision of education

and supportive interventions by health care staff to increase patients’ skills and confidence in managing their health problems, including regular assessment of progress and problems, goal setting, and problem-solving support.”

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Healthy

Communities and

Supportive Family, Friends, and

Caregivers

Honor

culture

Develop shared

understanding

Use Self-management Support Core Techniques:

Goal Setting, Action Planning,

Problem solving, Follow-up

Stepped Care for Self-management Support

Provide Advanced Approaches

(MI, Case Mgmt, PST, Group Interactions, etc.)

Offer Expert

Methods

Promote active

self-management

Based on the work of the Indian Health Service Improving Patient Care Self-management Support Workgroup and Division of Diabetes Treatment Program with input from the British

Columbia Ministry of Health Services Patients as Partners Committee and ImpactBC, 2011.

Brief Action Planning (B.A.P.)

“Is there anything you would like to do for your health

In the next week or two?”

“How confident (on a scale from 0 to 10) do you

feel about carrying out your plan?”

“When would you like to check in with me to

review how you are doing with your plan?”

Steven Cole, et. al.

SMART Behavioral Contracting Elicitation of Commitment Statement

If Confidence >7

Brief Action Planning (B.A.P.)

“Is there anything you would like to do for your health

In the next week or two?”

“How confident (on a scale from 0 to 10) do you

feel about carrying out your plan?”

“When would you like to check in with me to

review how you are doing with your plan?”

Steven Cole, et. al.

SMART Behavioral Contracting Elicitation of Commitment Statement

If Confidence <7, problem solve barriers

Behavioral

Menu

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Personal Action Plan

1.What is about your current health that worries you ?

2. How do you feel about this ?

3. What can you personally do about this issue ?

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National Resources: NGOs

Exercising with Arthritis

Managing pain

Eating healthy

Preventing fatigue

Protecting joints

Arthritis medications and working with your healthcare team

Dealing with stress and depression

Problem-solving

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Feedback Forms

Complete for each patient interaction, multiple tools per patient

Fax in every Friday Easy Evaluation Tick Sheet Open Boxes to add tools that are in the Tool

kit but not selected for testing Composite trends to be fed forward to

support group

Feedback Form

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Summary

1. Connect with your Support Physician

2. We need more data !

3. Keep the comments coming.

4. Your participation is appreciated.

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Next Webinar Date for Low Back Pain

Tuesday, March 6: 5 – 6:00 pm