Transcript Slides I1
Session # I1 Chronic Pain: How Can WE Stop the Suffering? Meghan Fondow, PhD Ashley Grosshans, LCSW Elizabeth Zeidler Schreiter, PsyD Chantelle Thomas, PhD Kevin Fehr, MD CFHA 18th Annual Conference October 13-15, 2016 Charlotte, NC U.S.A. Faculty Disclosure The presenters of this session have NOT had any relevant financial relationships during the past 12 months. Learning Objectives At the conclusion of this session, the participant will be able to: • Describe key steps in implementing a clinic wide shift in chronic pain management initiates • Discuss consistency in EHR documentation, deriving opiate pain management registry, systematization of UDS, and opiate medication refill management protocol • Explore how multi-disciplinary team meetings have been instrumental in shifting provider attitudes, treatment planning, and prescribing patterns while facilitating reciprocal cross discipline education through a collaborative, supportive work group Bibliography / Reference Sherman, Richard (2011), PAIN: Assessment & Intervention From A Psychological Perspective, Second Edition Dowell, D., Haegerich, T. M., & Chou, R. (2016). CDC guideline for prescribing opioids for chronic pain—United States, 2016. JAMA, 315(15), 1624-1645. Salvetti, M. D. G., Cobelo, A., Vernalha, P. D. M., Vianna, C. I. D. A., Canarezi, L. C. C. C. C., & Calegare, R. G. L. (2012). Effects of a psychoeducational program for chronic pain management. Revista latino-americana de enfermagem, 20(5), 896-902. http://www.iasppain.org/files/Content/NavigationMenu/EducationalResources/IASP_ Wait_ Times.pdf Jones, T., Lookatch, S., & Moore, T. (2013). Effects of a Single Session Group Intervention for Pain Management in Chronic Pain Patients: A Pilot Study. Pain and therapy, 2(1), 57-64. Chronic Pain Overview Pain is considered chronic when it is continuous or recurrent and lasts more than three months. Chronic pain has a negative impact on an individual’s quality of life, affecting sleep, diet, relationships, ability to work and functionality, among other aspects of daily life (Salvetti et al 2012) Chronic Pain Overview Major public health problem US prevalence: 11.2% (Dowell et al 2016) ◦ Opioids have serious risks: from 1999 to 2014 more than 165,000 overdose deaths from pain medications ◦ PCPs report concerns about misuse, stress managing chronic pain populations, not enough training Access Community Health Centers Federally Qualified Health Center (FQHC) in which patients receive a wide array of services in one clinic location (medical, dental, behavioral health, pharmacy, community resources) More than 26,000 people call Access their health care home 3 primary care clinic locations in Madison, WI all certified as Patient Centered Medical Homes Over 5800 BHC visits in 2015 1 in 5 patients met with BHC in 2015 Access and Chronic Pain Started in 2009 ◦ Consisted of BHC Champion and Medical Provider Champion ◦ Series of provider meetings exploring their needs surrounding chronic pain management (1 year) ◦ Identified systemic issues ◦ Identified issues with provider comfort Recognized need for cultural shift in what it means to “treat” chronic pain What didn’t work Providers compelling BHC involvement ◦ Tasked with teaching “coping” to unwilling patients ◦ Narcotics contingent on meeting with BHC BHC handoffs ◦ How BHC introduced to patient for chronic pain ◦ “You think it is all in my head” ◦ How BHC involved in conversations regarding narcotics ◦ BHC as messenger that narcotics not prescribed Provider Education Series of videos were created to: ⦿ provide language for challenging discussions ⦿ gave framework for appropriate referrals ⦿ education regarding non-medication treatment options What didn’t work: Provider Education Placed demands on providers outside of normal work schedule Facilitated an isolated learning experience Do not allow for collegial sharing of the burden What did work Monthly chronic pain team peer review meetings ◦ Forum for discussing challenging patient presentations ◦ Open to all staff including nurses and support staff ◦ Team review of prescription regimen and brainstorming for treatment options ◦ Provided another forum for clarifying best practices surrounding various pain conditions ◦ Protected time to ensure that all aspects of patient care related to pain are being prioritized What did work Strong leadership from CMO and BHC Increased systems change Consistent documentation Routine urine drug screens Ongoing discussions with providers on “compassionate no” Exposing shared struggle amongst providers (decreased shame/guilt) ◦ Monitoring patients at higher doses ◦ Increased exploration of alternate treatment methods and diagnostic testing ◦ ◦ ◦ ◦ Other BHC Impacts Support and collaboration with PCP colleagues for debriefing before/after challenging patient interactions Support in developing language to communicate plan of care when including the “compassionate no” in regards to opioid prescribing Supporting providers in developing curiosity in patient understanding of their pain diagnosis, impacts on daily functioning, and safety concerns Chronic Pain Groups Pilot Summer 2016 Collaboration between medical provider and BHC Group medical visit Goal: non-medical options for managing chronic pain Topics include understanding pain, sleep, stress, nutrition, communication Outcomes Consistency in documentation processes by providers ◦ > 85% patients with chronic pain dx ◦ > 66% patients on registry with standardized documentation Urine Drug Screens ◦ 65% in past 6 months (increase from 20% in 2014) Rates of narcotics prescribing similar, but doses declined Future Directions Plans to expand services to include universal substance abuse and depression screening SBIRT Consideration of on-site fully integrated physical therapy Questions? Session Evaluation Please complete and return the evaluation form before leaving this session. Thank you!