Transcript Management of Pain

Variation in Pain
Care in the South of
England region
Dr Cathy Price
Travel
Relationships
and sex life
Dealing with the
financial impact
Making
adjustments to
everyday
activities
Childcare
and
parenting
Impact on
friends
Communicating
with health care
professionals
Managing
work and
study
Need for
aids and
equipment
Coming to terms
with pain
Finding new
work
Social Life
www.healthtalkonline.org
Impact
on the
family
Coping with the
emotional
impact
Sleep and
Fatigue
Variation
•
•
•
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What should we look for?
Where should we look?
What evidence is there of the quality of care?
Is this matched to need?
Where we have looked potential Indicators
• Prescribing Data – PCT level
• National Pain audit – Organisational Data Provider level
• HES activity data –outpatient and inpatient activity and costs –
PCT level
• CQUIN project - unscheduled care in UHS
• Quality of Provision of specialist pain care – National Pain
Audit
1- Prescribing
• Is best practice being followed?
• What might be an indicator of problems?
Issues (Troup studies in USA)
“When the necessary resources of time,
personnel, and multidisciplinary rehabilitation
are not available, physicians tend to bypass the
principles outlined in the guidelines and comply
with patients' demands for increased opioid
doses, even when the treatment goals are not
achieved.”
”prolonged, high-dose opioid therapy may be
neither safe nor effective”
Use of pain medicines prior to
referral
3 NeP
medicines
6%
2 NeP
medicines
19%
1 NeP
medicine
41%
4 NeP
medicines
1%
Average time from
diagnosis to pain
medicine: 2 months
0 NeP
medicines
33%
Average time from
pain medicine to
referral: 2 years
33% of NeP patients
received <1 medicine
recommended by BPS
guidance
THIN analysis of patients referred to a pain consultant (over 1 year) with a preceding NeP diagnosis within last 5 years
NIC/1000 (£) on pain
medicines
£1,400
£1,200
South East
South Central
£1,126
£1,000
£800
£731
£600
£350
£400
£200
£120
£0
PGB/GBP
NSAIDs
Opioids
Others
Estimated from Qtr to Dec 2011: http://www.nhsbsa.nhs.uk/PrescriptionServices/2585.aspx
* Other Includes: Co-Codamol, Co-Proxamol, Paracetamol Co-Dydramol & Others in this category
2 -planned specialist pain
services in SoE
• Access
• Content
• Quality – patient experience, clinical effectiveness
18 week waits (clinic estimate)
Is this time to
first
appointment
rather than
when a patient
needed it?
What about
time to
treatment?
What is
important to
patients?
Pain Outpatient Appointments
South of England
600
500
400
503
397
300
253
195
200
106
100
144
81
120
0
Total South of
England
South East
Apt/ 1000 Head
South Central
Att/ 1000 Head
Dr Foster Data on Pain Outpatient Appointments Jan – Dec 2011
South West
Access to multidisciplinary
care per head of population
The Shires in the
SoE have mainly
very low coverage
East Sussex
and IOW
have high
coverage
% of patients reporting that their pain service had provided advice on
managing pain
120%
100%
80%
60%
40%
20%
0%
0
5
10
15
20
25
30
35
Change in pain related disability (Brief Pain Inventory) (less than 0
represents improvement)
2.00
1.50
1.00
0.50
0.00
0
-0.50
-1.00
-1.50
10
20
30
40
50
60
70
80
90
Source National Pain Audit Dec 2012
3-Unscheduled care visits
• Unscheduled care visits for people with LTC’s are a barometer
for the system
Those at high risk of admission Southampton using the adjusted
clinical groups tool (RUB 3-5)
MSK disorders have significant co-morbidities – CVS/depression most
common; require careful meds management and multiple needs
% of enduring frequent attenders in
UHS
(c 300 p.a. /800 FA’s p.a.)
Many people in this group
have unresolved medical
.surgical issues
Many people in this
group have alcohol
related pain
Many people in this group
present with non specific
pain issues & have h/o
personality disorder
Many of this group were transient
frequent attenders – all have
clear care pathways in place
Top 10 pain-related inpatient
admissions over 1 year
50000
45000
South East
44024
South Central
South West
Total South England
40000
35000
33027
30000
25000
20000
15000
24018
19932
19412
14828
14776
11674
8531
10000
6440
5000
0
Chest pain, Other and
Pain
Other chest Low back Pain in joint
Pain
Precordial Pain in Dorsalgia,
unspecified unspecified localized to
pain
pain
localized to
pain
Limb
unspecified
abdominal other parts
upper
Unspecified
pain
of lower
abdomen
abdomen
Dr Foster Data on Pain-related Inpatient Admissions (September 2011 to August 2012)
Total pain-related inpatient
admissions and associated tariff
over 1 year
Episode
Spells
Superspells
Total Tariff
(spend)
South
East
77,724
68,486
68,358
£64,561,507
South
Central
49,811
43,925
43,828
£43,562,986
South
West
99,247
80,376
80,277
£78,688,671
Total
226,782
192,787
192,463
£186,813,164
Dr Foster Data on Pain-related Inpatient Admissions (September 2011 to August 2012)
Tackling variation
• “The decisions made by individual doctors,
population factors, and the settings in which
care is provided have a substantial impact
on costs and activity.”
• ”variations in standards of healthcare could be
reduced by giving specialist clinicians greater
responsibility for the design and planning of their
own services.”
Nigel Edwards