Transcript HK - ANZCA

Pain Education in the Community
Dr Tim Semple
Royal Adelaide Hospital
Chronic Pain in South Australia – South Australian Health
Omnibus Survey 2006
Currow et al. Aust NZ J Public Health.2010;34(3)
• Whole of population, face-to-face, 2973 interviewed
• Prevalence of chronic pain 17.9%
• Severe pain interfering severely with activity 5%
Chronic Pain in South Australia – South Australian Health
Omnibus Survey 2006
Currow et al. Aust NZ J Public Health.2010;34(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 !
Unmet Burden of
Community Pain
Pain Clinic
Unmet Burden of
Community Pain
Pain
Clinic
When systems fail to meet demands.....
• Allow change and plasticity
• Partner informed consumers with responsive professionals
System plasticity...... : informed consumers guide clinical reorientation and
system reorganisation
Davies, Hayes and Quintner. Pain Med 2011; 12
STEPS - Preclinic group education sessions reduce waiting times
and costs.
Davies SJ et al. Pain Med 2011;12
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
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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
Preclinic group education sessions reduce waiting times and
costs.
Davies SJ et al. Pain Med 2011;12
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
Pain education in the community - improving capacity
• Health reform
• Mass Media
• Web-based information
• Pain self-management
• Support
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......
Health Reform - National Pain Strategy 2010
Goal 2: Knowledgeable empowered and supported consumers
“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
“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
Kaiser model of care for chronic conditions – 80/20
80% self-management:20% professional care
80%
20%
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
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
Getting the message out there – mass media
• Mass media can be an effective tool
Grilli R. Mass media interventions: effects on health services utilisation.
Cochrane Database 2002, Issue 1. .
• Current mass media campaigns in Australia
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Heart disease
Smoking
Osteoporosis
Obesity
etc etc etc
• Victorian WorkCover Authority back pain campaign 1997-99 highly
effective – most cited for pain education
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
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.......
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
Pharmaceuticals and Mass Media - early direct to
consumer advertising
ASPRO
“for treatment of pain AND
depression”.......
More early direct to consumer advertising
Entrenching pharmaceuticals into the
“national myth”
“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
im
Time Magazine
March 21 2011
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
Net-based pain education from a govt-funded site!
Pain education tools direct
from the consumer via the
net
Pete Moore EPP
HIPS community pain information
RCT of community-based psychoeducational program for selfmanagement 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
Calgary Pain Program
Integrating educational resources and community early access programs with
primary and specialist services
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
Who is providing support for consumers?
Consumers supporting consumers in Australia
APMA promoting self-management with UK expert patient champion to
primary care
Consumers supporting consumers in Australia
Consumers supporting consumers in Australia
Old thinking
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
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
New thinking