Chronic Pain Programs at Hospitals

Name of Hospital has been removed. Please excuse the mess.

 

Improving Care for Patients with Chronic Pain at _______ Hospital and Clinics

Process Improvement Paper

The purpose of this process improvement paper it to develop a program intended to better meet the needs of patients with chronic pain at _____ Hospital and their network of clinics. I propose the formation of a chronic pain program consisting of an interdisciplinary team that has been trained to provide collaborative pain management interventions to patients with chronic pain.

Introduction:

Musculoskeletal pain affects between 13.5-47% of the general population, with chronic pain affecting between 11.4-24%1.  Over a million Americans have some form of persistent pain.2 Americans, who only make up of 5% of the world’s population, consumes 80% of the global opioid supply and 99% of the global hydrocone supply.3 With recent breakthroughs in pain management strategies and recent national exposure of the opioid epidemic, the stage is set to implement change.

A shift needs to take place from the tissue/biomedical model to a biopsychosocial approach in education and treatment of chronic pain conditions.  Explanations of chronic pain using the biomedical model is falling short when trying to explain someone’s pain to them.4 Shifting patient education to address the biopsychosocial factors that impact their pain state, may help them overcome their symptoms.  A recent study found that education strategies aimed at addressing neurophysiology and neurobiology of pain can have a positive effect on pain, disability, catastrophizing and physical performance in patients with chronic pain5.  Not one discipline has the answer to chronic pain.  But by working together, the patient may be able to receive care that overcomes the shortcomings of each specialty. By having healthcare providers prepared to work together to help those in chronic pain, will help meet the needs of the 11-24% of people with chronic pain.

Background

_______ Hospital is located in rural California and has a two clinics nearby.  They offer orthopedic, family medicine, pediatrics and women’s health services, and are the primary healthcare provider for local city.   The hospital network consists of many different sub-specialties and works in partnerships with providers in nearby cities for advanced care. They also operate an outpatient orthopedic clinic and a family medicine clinic in close by towns.  Having smaller clinics in nearby towns has allowed for a better continuum of care to their patients along this rural region.

The current process involves patients first consulting with either their primary care provider or an orthopedic specialist for medication, imaging and/or surgery, and is often referred to physical therapy for 6-8 weeks. Although this approach is sufficient for a majority of patients with musculoskeletal pain, those with chronic pain are often not treated successful. They are forced to seek care from multiple healthcare providers and some live their lives dependent on opioids.

Plan

The development of an interdisciplinary chronic pain program will help to address the needs of patients with chronic pain.  This program will be able to filter out patients who require services beyond the standard care. When these patients are identified by their healthcare provider, they will be referred to the program and their care will be taken over by a team of specialists. Their initial evaluation will be done interdisciplinary, which may consist of 2-3 practitioners in the fields of medicine, psychology and physical therapy.  Following the initial evaluation, a plan of care will be established, which will include the appropriate services, such as mental health, physical health, nutrition and social services.  These team members will then carry out the plan of care, drawing on the resources of the community whenever necessary.

 Implementation

A planning committee must be formed in order to make the arrangements necessary for implementation of the program.  The planning committee will identify those best qualified to serve in the program and assist in finding the training required. The program will consist of existing practitioners and of local partners that specialize in mental health, nutrition and social services. It is essential that all members of the program are locally based in order to guarantee accessibility by the patients. In order for the program to be a success, patients must be able to receive care as often and for as long as they need.

As with any new program, it will face obstacles. Some foreseeable obstacles include: low attendance and referrals, lack of specialized training for practitioners, compliance, and stigma of receiving psychiatric care. Although low attendance might happen, the pitfalls of low rates can be avoided by using existing hospital practitioners so that they will be ready, but not be dependent on this program. The practitioners chosen for the program will be required to complete extra training to best prepare them for collaborative treatment, chronic pain and working with those with psychological issues.  All clinical staff will need to be trained on using the correct terminology when enrolling a patient into the program. By using a collaborative team approach, psychosocial services are provided but in a way that is seen as part of the program and not as a “psych eval”.

 In order to determine the success or set-backs of the program, a review committee must be formed and goals must be set.  This committee may consist of the same members of the planning committee, but must also include the practitioners who are participating in the program. For the first year of implementation, quarterly meetings will be required to track the progress of the program.  Objective measures will be reviewed, such as the number of patients seen, their diagnoses and objective findings resulting in their care through the program. Case studies will be presented to highlight successes and failures of the programs. After a year of implementation, the practitioners are expected to design and publish case studies in a national publication. Essential elements for this program to be successful is dedicated practitioners, continual mutual input and feedback from everyone involved, leadership and a long term commitment.

 Conclusion

As with many other rural areas in the country, the opioid epidemic seems to be right outside the door.  Without the tools necessary to help those susceptible, the system will continue to fail them.  By forming teams of multi-disciplinary healthcare providers, they will help to address the complex nature of those suffering from chronic pain and susceptible to substance abuse.  _____ Hospital is in prime position to start and implement a program of this kind. Since they are a small organization with a wide outreach in the region. Implementing this program will help _____ Hospital provide a higher level of care to those who need it the most and set an example of quality care for patients with chronic pain.

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