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Pain Education in the Community

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Pain Education in the Community Dr Tim Semple Royal Adelaide Hospital – PowerPoint PPT presentation

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Date added: 28 November 2019
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Title: Pain Education in the Community


1
Pain Education in the Community
  • Dr Tim Semple
  • Royal Adelaide Hospital

2
Chronic Pain in South Australia South
Australian Health Omnibus Survey 2006 Currow et
al. Aust NZ J Public Health.201034(3)
  • Whole of population, face-to-face, 2973
    interviewed
  • Prevalence of chronic pain 17.9
  • Severe pain interfering severely with activity 5


3
Chronic Pain in South Australia South
Australian Health Omnibus Survey 2006 Currow et
al. Aust NZ J Public Health.201034(3)
  • 240,000 adults with mild-moderate pain
  • 65,000 adults with severe pain
  • Pain Clinic Service capacity - 2400 adults
    assessed annually
  • 1 of the CNCP population !


4
Unmet Burden of Community Pain
Pain Clinic
5
Unmet Burden of Community Pain
Pain Clinic
6
System plasticity...... informed consumers
guide clinical reorientation and system
reorganisation
Davies, Hayes and Quintner. Pain
Med 2011 12
  • When systems fail to meet demands.....
  • Allow change and plasticity
  • Partner informed consumers with responsive
    professionals

7
STEPS - Preclinic group education sessions reduce
waiting times and costs.

Davies SJ et al. Pain Med 201112
  • Systematic redesign of traditional model of care
    of tertiary pain medicine unit initial group
    rather than individual appointments
  • Small group, 8 hours over 2 days - clinical
    psychology, occupational therapy, physiotherapy
    and pain medicine
  • Outcomes
  • Waiting lists down to 16 weeks from 105 weeks
  • Costs per new patient appointed reduced from
    1805 to 541
  • Positive patient satisfaction
  • Improved Global Perceived Impression of Change
  • Increased utilisation of active pain management
    strategies

8
Preclinic group education sessions reduce waiting
times and costs.
Davies SJ et al. Pain
Med 201112
  • Interesting point
  • Mean duration of pain prior to intervention 9.2
    years !
  • Delivered by highly-specialised practitioners
  • STEPS - one option but just part of the bigger
    picture

9
Pain education in the community - improving
capacity
  • Health reform
  • Mass Media
  • Web-based information
  • Pain self-management
  • Support

10
National Health and Hospitals Reform Agenda
Final Report June 2009
  • Recommendations for a healthier future for all
    Australians....
  • 10. We support strategies that help people take
    greater personal responsibility for improving
    their health through policies that make healthy
    choices easy choices.
  • 11. We recommend that health literacy is included
    as a core element of the National Curriculum and
    that it is incorporated in national skills
    assessment. This should apply across primary and
    secondary schools.
  • 12. We urge all relevant groups to provide access
    to evidence-based, consumer-friendly information
    that supports people in making healthy choices
    and in better understanding and making decisions
    about their use of health services......

11
Health Reform - National Pain Strategy 2010
Goal 2 Knowledgeable empowered and supported
consumers
12
Health literacy what is it ?
  • The ability of a patient to navigate a
    healthcare system in a positive way
  • To able to work in an equal partnership with care
    team
  • To be a fully activated patient undertaking
    necessary lifestyle changes to achieve optimum
    outcomes from treatment and disease management

13
Health literacy just more jargon ?
  • Latest systematic review
  • Associated with lower health literacy are
  • Increased hospitalisation
  • Greater use of emergency care
  • Poorer ability to take medications as directed
  • Berkman ND et al. Health Literacy Interventions
    and Outcomes An Updated Systematic Review, .
    AHRQ Publication Number 11-E006-1, March 2011.
    Agency for Healthcare Research and Quality
    http//www.ahrq.gov/clinic/epcsums/litupsum.htm

14
Kaiser model of care for chronic conditions
80/20 80 self-management20 professional care
15
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16
80
20
17
NHS focus on self-management for chronic
conditions
  • Wanless Report 2002 Only one viable longterm
    option for NHS citizens as partners in care and
    responsible for maintenance of physical and
    mental well-being
  • EPP trialled 2001-2004, mainstreamed 2004-2007
  • Follow-up on 1000 patients involved in
    self-management

18
Expert Patient Program outcomes for chronic
conditions
  • Annual savings per individual 4000
  • Greatest benefits in individuals with low
    impairment but high disability
  • Improving health literacy achieved significant
    benefit
  • Clinicians needed training in self-management as
    much as patients

19
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20
Getting the message out there mass media
  • Mass media can be an effective tool
  • Current mass media campaigns in Australia
  • Heart disease
  • Smoking
  • Osteoporosis
  • Obesity
  • etc etc etc
  • Victorian WorkCover Authority back pain campaign
    1997-99 highly effective most cited for pain
    education

Grilli R. Mass media interventions effects on
health services utilisation. Cochrane Database
2002, Issue 1. .
21
Victorian WorkCover Back Pain campaign 1997-99
  • Goal altering population attitudes and beliefs
    concerning back pain
  • Delivered positive messages about back pain
  • Stay active
  • Normal daily activities
  • Avoid medicalisation and unnecessary diagnostic
    tests
  • Overcome fear-avoidance by gradually tackling
    difficult tasks
  • Be aware of red flags
  • September 1997 - intense 3 month TV commercial
    campaign followed by 9 month of low key
    maintenance
  • September 1999 further 3 month intense TV
    campaign

22
Victorian WorkCover Back Pain campaign
  • Outcome
  • Improved community attitudes and beliefs
    concerning LBP
  • Improved general practitioner attitudes and
    beliefs
  • Reduced claims and medical payments for LBP
  • Sustained changes for at least 4.5 years.......

23
Getting the message out there mass media
  • Components of success
  • Full range of approaches TV, radio, billboard,
    bus, Web, Facebook
  • Short sharp message delivered by creditable
    personalities
  • Not too long, not too short 3 months to 12
    months duration
  • Lots of money close to 2 million


24
Pharmaceuticals and Mass Media - early direct to
consumer advertising
  • ASPRO
  • for treatment of pain AND depression.......

25
More early direct to consumer advertising
  • Entrenching pharmaceuticals into the national
    myth

26
Direct to Consumer Advertising of medicines
USA-style
  • Significant impact in USA the wonder drug for
    the pharmaceutical industry
  • 2.5 billion advertising spending in 2000
  • 15 disease awareness
  • 85 in brand-specific
  • targets new high-cost drugs for long-term
    conditions
  • New drug samples of 8 billion value provided
    to prescribers to meet consumer enquiries
  • DTCAreport,
    PHARM Committee, Australian Government DHA
    April 2004

27
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28
im
29
What is TIME telling consumers ?
  • 76 millions US citizens with chronic pain 80
    undertreated
  • Doctors We do it badly
  • Pain is a disease not a symptom

30
Net-based pain education from a govt-funded site!
31
Pain education tools direct from the consumer via
the net
  • Pete Moore EPP

32
HIPS community pain information
33
RCT of community-based psychoeducational program
for self-management of chronic pain
  • Chronic pain adaption of arthritis
    self-management program (Kate
    Lorig, Stanford Patient Education Research
    Centre)
  • Low-cost community-based 12 hour nurse-led
    program
  • 110 individuals, mixed pain diagnoses, mean pain
    duration 6 yrs
  • Significant improvements in pain, self-efficacy,
    vitality, life satisfaction

  • Sandra LeFort et al. Pain
    74 (1998) 297-306

34
Calgary Pain Program
  • Integrating educational resources and community
    early access programs with primary and
    specialist services

35
  • Consumer organisation
  • Peer-led program for pain self-management
  • Based on Stanford model
  • Integrated with NHS Scotland with strong tertiary
    and primary links
  • Funding support from NHS

36
Who is providing support for consumers? Consumers
supporting consumers in Australia
37
APMA promoting self-management with UK expert
patient champion to primary care
38
Consumers supporting consumers in Australia
39
Consumers supporting consumers in Australia
40
Old thinking
41
New thinking !
  • Combining
  • E-newsletter
  • Consumer organisation
  • GP network
  • Tertiary pain service
  • Applying
  • Scottish consumer-led self management programme
  • Derived from Stanford Chronic Condition programme

42
Pain and (Education in) the Community Sector
  • Health reform is coming first to community sector
    pain medicine needs to be there too
  • Mass media pain campaign when ?
  • Early access self-management programs are
    effective... but which is best model ?
  • Consumer pain organisations are leading change in
    the community sector
  • Government responds to consumer messages foremost

43
New thinking
44
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