Do Pain Management Programs Keep Working for Compensable Patients Anne_Daly ACHRF 2014

7/17/2019 Do Pain Management Programs Keep Working for Compensable Patients Anne_Daly ACHRF 2014

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16/11/2014

Do pain management programs

keep working for compensable

patients? Three year follow up.

Anne Daly Pain Management &

Physiotherapy Advisor



16/11/2014 2

Introduction

Australian Pain Society

–‘Gold’ standard for pain management

–Goals

–Key points

Network Pain Management

–Background –Evaluation



16/11/2014 3

Australian Pain Society Position Statement

on Pain Management Programs

– Multidisciplinary / Interdisciplinary

– Based on a biopsychosocial understandingof persistent pain

– Cognitive behavioural paradigm



16/11/2014 4



Goals

– Improve understanding of persistent pain

– Improve function despite ongoing pain – Modify perceptions of pain and suffering

– Provide coping skills and strategies

– Promote self management

– Reinstate activities of daily living

– Reduce or modify future use

of health care services



16/11/2014 5



SUCCESS DOES NOT = PAIN REDUCTION

Pain reduction is a goal but pain elimination is not the

expected (or a reasonable) end point

OPEN COMMUNICATION IS KEY Alignment of goals between all stakeholders

TIME IS REQUIREDDesired behaviours need time to be normalised

Passive therapies work against this



16/11/2014 6

Network PMPs

– Meet the APS position statement criteria – Geographic distribution across Melbourne

– Standardised clinical outcome measures

– Education on compensation system – Agreement to focus on – Fast service

– Return to work (RTW) & communication

– Medication use and Mental health

– Future services and treatment



16/11/2014 7

Evaluation of Network Pain

– Medication utilisation

– Changes in health care utilisation

– Clinical outcome measurement

– Occupational outcomes



16/11/2014 8

Medication utilisation

Prior: 60% were prescribed medication

After: 35% were prescribed medication

Opioids and Sedatives

Neuropathics

Sustained or improved 3 years

after program completion



16/11/2014 9

Health care utilisation‘difference in costs 12 months after PM cf 12 mths before PM’

Overall -38%

GP -36%

Physiotherapy -81%

Other allied health -70%

Psychiatry 153%

Psychology 41%

Pharmacy 52%*

* Due to neuropathic medications being

unavailable on the PBS at the time



16/11/2014 10

Clinical outcome measurement:

Brief Pain Inventory: Pain Intensity

– Pain intensity drops slightly

– Not statistically significant, smaller than MDC

BUT function improves and medication

reduces without an increase in pain



16/11/2014 11


Brief Pain Inventory: Pain Interference

– 71% reported improvement

– 12% didn’t change

– Statistically significant, larger than MDC

– Enjoyment, sleep, activity, mood



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Fear Avoidance Beliefs QuestionnairePhysical:

– 74% improved

– 13% didn’t change – Statistically significant, larger than MDC

Work:

– 61% improved

– 12% didn’t change

– Statistically significant



16/11/2014 13

Occupational outcomes

Certified as unfit at assessment: – 41% were reclassified as fit for…..

Certified as fit for some duties at assessment: – 50% had increased hours and/or capacity

These changes occurred by discharge andcontinued to improve at follow up visits



16/11/2014 14

Global Impression of Change

92.5 % reported improvement

0

5

10

15

20

25

30

35

40

45

much

worse

w orse a l ittl e

worse

no

change

a littl e

better

better mu ch

better

change

%



16/11/2014 15

Client satisfaction94% were satisfied

0

10

20

30

40

50

60

70

very

unsatisfied

u n satis fied u nd ec id ed s atis fied v er y

satisfied

satisfaction

%



16/11/2014 16

Service timelines

64% were assessed within 20 businessdays of approval by agent

64% had commenced a program within15 business days of assessment

95% completed their programs



16/11/2014

Do pain managementprograms keep working

for compensable clients?



16/11/2014 18

Evaluation of Network Pain

Medication utilisation

Changes in health care utilisation

Clinical outcome measurement

Occupational outcomes

= EVIDENCE BASED PRACTICE

Documents

Do Pain Management Programs Keep Working for Compensable Patients Anne_Daly ACHRF 2014