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ST P! CHRONIC BACK PAIN

ST P! CHRONIC BACK PAIN. S elf-management and T imely Intervention: An O pportunity for the P revention of Chronic Back Pain. Meherzin Das Chartered Clinical Psychologist, DHUFT Clinical Lead, Dorset Pain Management Unit

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ST P! CHRONIC BACK PAIN

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  1. ST P!CHRONIC BACK PAIN Self-management and Timely Intervention: An Opportunity for the Prevention of Chronic Back Pain

  2. STOP! CHRONIC BACK PAIN

  3. Meherzin Das Chartered Clinical Psychologist, DHUFT Clinical Lead, Dorset Pain Management Unit Visiting Fellow, Bournemouth University Barbara Oldale Senior Occupational Therapist Caroline Carr Service User Advisor Christopher Phillips Patient Advisor STOP! CHRONIC BACK PAIN

  4. STOP! CHRONIC BACK PAIN

  5. 1.Our challenge : local and national conditions STOP! CHRONIC BACK PAIN

  6. PAIN “An unpleasant sensory and emotional experience associated with real or potential tissue damage, or described in terms of such damage...” -International Association for the Study of Pain • Musculo-skeletal pain – BACK PAIN • Neuropathic pain • Post-surgical pain • Idiopathic pain STOP! CHRONIC BACK PAIN

  7. THE HORRIFYING CURRENT SITUATION • 7.8 million people in UK suffer from chronic pain. • 3.3 m people p.a. with first episode back pain don’t recover... • Actual cost to the NHS is over £1 billion p.a. (Manadiakis, 2000) • 4.6 m GP appointments + 796,000 pain management appointments each year (Belsey 2002) • 25% of all appointments are cancelled or missed by patients • £584 million for medication which includes wastage for non-compliance (2007) STOP! CHRONIC BACK PAIN

  8. TRADITIONAL CARE PATHWAY FOR PEOPLE IN CHRONIC NON-MALIGNANT PAIN STOP! CHRONIC BACK PAIN

  9. CONSTANTLY WORKING AT IMPROVEMENT .... STOP! CHRONIC BACK PAIN

  10. 2. So here’s what we did .... STOP! CHRONIC BACK PAIN

  11. PARTNER ORGANISATIONS THROUGH THE DORSET PAIN SOCIETY Poole Hospital NHS Foundation Trust: Dorset Pain Management Unit Self-help group of the Dorset Pain Management Unit Physiotherapy Department Bournemouth University: School of Health and Social Care Dorset HealthCare University NHS Foundation Trust (DHUFT): Orthopaedic Treatment Service Buckland Centre Volunteer Service University Department of Mental Health Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust: Physiotherapy Department NHS Dorset Providence Surgery, Bournemouth Pfizer BHLive STOP! CHRONIC BACK PAIN

  12. DOWNWARD SPIRAL OF CHRONIC PAIN Increased visits to clinics Physical pain Fear and anxiety Depression, hopelessness, helplessness Anger, frustration Reduced activity Diminishing self-confidence Trapped in one’s body Physical Deconditioning Poor quality of sleep, neglect eating, fatigue, sex Social isolation Loss of occupation Changing role within family Reduced well-being STOP! CHRONIC BACK PAIN

  13. 3 CENTRES, 3 LOCATIONS 1 2 3 STOP! CHRONIC BACK PAIN

  14. PATIENT WITH PERSISTENT BACK PAIN, 3-12 MONTHS AFTER ONSET REFERRAL BY GP, ESP, PHYSIOTHERAPIST STP CHRONIC BACK PAIN PROJECT ASSESSMENT TRIAGE PSYCHOLOGICAL ASSESSMENT BIOLOGICAL ASSESSMENT SOCIAL / OCCUPATIONAL ASSESSMENT Unresolved psychological issues Further investigation/ physical intervention Employment support:: OT and PROGRESS TO PMP NOT PRESENT PROGRESS TO PMP PRESENT Refer to IAPT Exit STOP REQUIRED Refer to Rheumatology Exit STOP NOT REQUIRED PROGRESS TO PMP PAIN MANAGEMENT PROGRAMME WEB-BASED SUPPORT PAIN ADVICE LINE PERSONAL COACH STOP! CHRONIC BACK PAIN PAIN REDUCTION - DISCHARGE

  15. STOP! CHRONIC BACK PAIN

  16. SUPPORTED SELF-MANAGEMENTTIER 1 : WEB SUPPORT STOP! CHRONIC BACK PAIN

  17. SUPPORTED SELF-MANAGEMENT TIER 2 TIER 3 OUR INNOVATIVE PAIN CHAIN PAIN ADVICE LINE EACH ONE REACH ONE STAFF-MANNED TELEPHONE LINE STOP! CHRONIC BACK PAIN

  18. WHAT WERE WE HOPING TO ACHIEVE THROUGH EARLY INTERVENTION? • The Individual with pain • Reduced disability – physical + emotional • Enhanced quality of life • The Clinical Team • Collaborative working • Better self-management, earlier in the journey • The Commissioners • Decreased dependence on health/social services • Affordable health economy through prevention of chronicity STOP! CHRONIC BACK PAIN

  19. 3.Measurement and outcomes STOP! CHRONIC BACK PAIN

  20. OUTCOME DATA • CLINICAL OUTCOMES • COST EFFECTIVENESS – HEALTH ECONOMY • QUALITATIVE FEEDBACK STOP! CHRONIC BACK PAIN

  21. STOP! CHRONIC BACK PAIN

  22. OUR RESULTS STOP! CHRONIC BACK PAIN

  23. OUTCOME DATA • CLINICAL OUTCOMES • COST EFFECTIVENESS – HEALTH ECONOMY: YUHASS questionnaire • QUALITATIVE FEEDBACK STOP! CHRONIC BACK PAIN

  24. Total Number of Appointments for each type of HCP across 30 patients in 3 months STOP! CHRONIC BACK PAIN

  25. Appointment costs per patient in 3 months, one bar per patient STOP! CHRONIC BACK PAIN

  26. Total Appointment Cost per profession across 30 patients in 3 months STOP! CHRONIC BACK PAIN

  27. Number of medicines used by each patient STOP! CHRONIC BACK PAIN

  28. Type of paid household help used in 3 months STOP! CHRONIC BACK PAIN

  29. OUTCOME DATA • CLINICAL OUTCOMES • COST EFFECTIVENESS – HEALTH ECONOMY • QUALITATIVE FEEDBACK: forms, interviews STOP! CHRONIC BACK PAIN

  30. “I thought that the actual programme was very good. It covered a lot of things, we had questions raised and they were addressed, I think they got it spot on with the content.” Programme participant • “The pain chain was lovely. It worked well for me – it’s still a pleasure to work with my coach”. Programme participant “As a service user I was thrilled to have a chance to promote the patients' perspective and work with health professionals who impressed me throughout with their compassion, professionalism and determination to meet their patients’ needs.Caroline, Service User Advisor “Life has changed. Can move around better. Still some pain. But I’ve now got a part time job.” Programme participant STOP! CHRONIC BACK PAIN

  31. STOP! CHRONIC BACK PAIN

  32. 4.Sharing Our learning STOP! CHRONIC BACK PAIN

  33. GOLD STARS FOR OUR SERVICE USERS Inspiring courage Determination, resilience Capacity for hard work Commitment to sessions Willingness to participate, to risk ... .....to change and a hearty dose of humour! STOP! CHRONIC BACK PAIN

  34. OUTSTANDING ACHIEVEMENTS Earlier intervention = psychoneurobiological plasticity ! Statistically significant results: emotional/physical disability pain catastrophising Enhanced quality of life Half the time =half the cost! Non-clinical settings YUHASS: monitor costs: Prescription HCP Appointments Personal costs Social/welfare costs STOP! CHRONIC BACK PAIN

  35. 2. Recruitment 3. Inclusion criteria 4. Systems: admin, IT, finance... 1. Health economist 8. Realistic time frame STP! 5. Freeing staff to run the project 7. Patient volunteers 6. Changes in staff team STOP! CHRONIC BACK PAIN

  36. DURATION OF OVER-ALL PAIN DURATION OF CURRENT EPISODE RECRUITMENT 6 - 36 months: 8 pts 37 mths – 35 years: 27 pts 2 – 36 months: 30 pts 37 mths – 25 years: 5 pts PSST... WHERE IS THE ‘LOST PATIENT’ ? STOP! CHRONIC BACK PAIN

  37. ACCESSIBILITY = Matching service to need MIND BODY HOLISTIC support – e.g. employment Prevention PREVENTIONPREVENTION STOP! CHRONIC BACK PAIN

  38. 5.Spread STOP! CHRONIC BACK PAIN

  39. SPREADING THE MESSAGE : PAN DORSET PAIN SERVICES STOP! CHRONIC BACK PAIN

  40. Do your work with mastery The Buddha Like the moon, come out from behind the clouds Shine

  41. THANK YOU .... to ....... the real stars ..... our patients ..... our fantastic team ..... Springfield Consultancy ..... HEALTH FOUNDATION STOP! CHRONIC BACK PAIN

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