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A Narrative Account of the Fond du Lac Partnership with the Mayo CTSA

A Narrative Account of the Fond du Lac Partnership with the Mayo CTSA. W. Michael Hooten, MD Department of Anesthesiology Division of Pain Medicine.

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A Narrative Account of the Fond du Lac Partnership with the Mayo CTSA

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  1. A Narrative Account of the Fond du Lac Partnership with the Mayo CTSA W. Michael Hooten, MDDepartment of Anesthesiology Division of Pain Medicine

  2. “I know not any thing more pleasant, or more instructive, than to compare experience with expectation, or to register from time to time the difference between idea and reality. It is by this kind of observation that we grow daily less liable to be disappointed.” Samuel Johnson 1709-1784

  3. Set the bar low...

  4. Objectives • To provide a narrative account of the Fond du Lac led partnership with the CTSA. • Identification of important themes that have characterized this partnership. • To highlight the key role of the CTSA in this partnership.

  5. The risks and perils of “celebrityhood.”

  6. Research Literature 2003 2007 2009

  7. Research Literature 2009 2007 2003

  8. FDL identification of a health care problem.

  9. FLD-led Action Plan • Summer 2007. • Members of the Health Services Division initiated a visit to PRC. • Two physicians and one PA.

  10. Invited Site Visit • Mid-2008. • Leaders of the HSD invited PRC clinical staff for a site visit. • They talked about their need to improve chronic pain care.

  11. Fond du Lac HSD • Integrated health deliver system. • Owned & administered by FDL. • Provide health services for approximately 7,000 American Indians. • Electronic medical record.

  12. On-site pharmacy services

  13. FDL led solution(s) that would provide direct and immediate benefits to the community.

  14. Chronic Pain Clinical Services Research Grants

  15. Delivery of On-Site Health Services • Scheduled by FDL providers. • FDL providers identified patients for participation. • Gained approval and support of Mayo including malpractice coverage.

  16. Cynthia O. Townsend, PhD Assistant Professor Department of Psychiatry and Psychology Director of Clinical Research Mayo Pain Rehabilitation Center

  17. Min-No-Aya-Win Clinic and Mayo Clinic Pain Rehabilitation Executive Program The Impact of Pain… and the Process of Regaining Control Over your Life Again

  18. Three Different Types of Pain • Acute • Chronic or Persistent • Terminal • Pain associated with dying process. • Care focuses on comfort and quality of life rather than treatment/cure. • Opioids/narcotics provide comfort during end of life.

  19. Elimination of Pain Behaviors Stress Management Relaxation Moderation No Analgesic Medications for Chronic Pain Distraction/Diversion Sleep Hygiene Exercise (Stretching, Strengthening, and Aerobic Activities) Awareness of Emotional Impact of Chronic Pain Wellness Concepts

  20. Cycle of Chronic Pain(Behaviors, Emotions, Family Response) Illness/Injury Fear & Concern Offer Support Decreased activity & pain Hope & Trust Increase attentiveness, Help with daily tasks. Withdrawal & Isolation Sadness & depression Ignore, Withdraw Pain is in Control Seek medical attention Loss of control Continue to Do More, Care-taking Loss of strength & endurance Guilty & withdrawn Do it All, Over-invest Increased activity & pain Anger, frustration Attempt to Re-establish Roles

  21. Goal : Break the Cycle of Pain • Learn adaptive ways to cope with pain • Strategies for applying wellness principles to pain management • Improve quality of life

  22. A way of life that you design, by making informed healthy choices to achieve your optimal health. What is Wellness?

  23. FDL led research that would build clinical capacity, provide education to tribal members and could be disseminated to other tribal communities

  24. Research Component • Fall 2008. • Healthier Minnesota Community Clinic Fund grant. • Not funded but… • Demonstrated feasibility. • Rough draft for a NARCH grant.

  25. NARCH • January 2009 • Meeting at the HSD included: • Mayo CTSA representatives • Great Lakes NARCH • FDL staff • U MN-Duluth Medical School

  26. FDL Visit to Mayo CTSA • February 2009. • Chuck Walt identified as NARCH PI. • Presented CTSA Grand Rounds. • Disussed basic role(s) of CTSA in the NARCH grant.

  27. Dr. Dorscher

  28. Take Home Points • FDL identification of a clinical problem. • Action plan developed by FDL. • FDL led partnership with the CTSA and the U MN-Duluth….

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