nsag poster - Welsh Pain Society

Audit of Chronic Pain Services in Wales
NATIONAL SPECIALIST ADVISORY GROUP FOR WALES, ROYAL COLLEGE OF ANAESTHETISTS, PAIN SUB GROUP
Dr. Christian Egeler, Dr. Lyn (Carolyn) Middleton, Mr. Gareth Parsons
Location and Provision of Chronic Pain Services
Background
Chronic Non-Malignant Pain (CNMP) is a significant problem affecting
one in five people according to the Pain in Europe study (Breivik et. al.
2006). This type of pain not only affects people physically but also
psychologically and socially, having a significant impact on an
individual’s quality of life.
Pain Management Programme
Of 11 independently run clinics, not all provide specific TENS or
acupuncture service, only one uses dedicated CP physiotherapy. 5
of 9 services use theatre space for interventions, 7 DSU facilities, 1
a flouroscopy room.
Pain Management Programmes are provided in 9 locations
(C&V via Velindre HB). All use PT, 75 % have Psychology
support., only 45% OTs. Most PMPs run 8 sessions and 10
patients. ABM and Powys will increase capacity next year.
HCSW
CPN
OT
PT
Psychologist
Staff grade
GP
Consultant
The Welsh Government (WG)in their Designed for People with
Chronic Conditions, CNMP Document (2008) is committed to ensuring
evidence-based multi-disciplinary service provision, underpinned by
national and professional standards, which they believe are required
in order to address the needs of the 21st Century.
WG recognizes that the current position in Wales is one of
considerable variation in both the organization and delivery of CNMP
services. The publication of the Designed for Pain document aimed to
redress this variability ensuring that service provision across Wales is
consistent, patient centered and addresses the balance of service
provision across primary, community and secondary care.
Treatments/services offered to patients
PMP in 9 locations
9
7
Team members
5
2
0
Psychologist
Team members and sessions per month. Most services are fully
multidisciplinary, though only 3 have GPs, only 1 has a Consultant with other
than anaesthetic background, OTs only in 3, Psychologist in 6 HBs.
OT
CNS
Medicine
200
team members
theatre
flouroscopy
DSU
12
9
150
sessions
Patients per year
100
team members
6
PT
50
3
0
Anaesthetist
GP
Nurse
OT
0
HCSW Osteopath
ABMU BCU central BCU east Cwm Taf
H D west Powys resid
Discussion
sessions
new patients
repeats
other
GP
Day Centre
Com Hosp
Acute Hosp
Ref:
1. Welsh Assembly Government(2008)Designed for People with Chronic
Conditions, chronic non-malignant pain. Cardiff: WG.
2. Breivik, H., et. Al. (2006) Survey of chronic pain in Europe:
Prevalence impact on daily life and treatment. European Journal of
Pain. 10 287-333.
Clinic locations and monthly sessions: Most services remain
secondary care based, 3 utilise day centres, 2 GP practices.
NATIONAL SPECIALIST ADVISORY GROUP FOR WALES
The Welsh National Specialist Advisory Group (NSAG) set up
a pain subgroup, which commissioned an audit of chronic
pain services across the seven Health Boards Abertawe Bro
Morgannwg University HB, Aneurin Bevan University HB,
Betsi Cadwaladr University HB, Cardiff and Vale University
HB, Cwm Taff HB, Hywel Dda HB and Powys Teaching HB
and Velindre NHS Trust.
The audit aimed to capture data on the location of pain
services, staffing, the breath of provision of treatments
offered, availability of Pain Management Programmes along
with information on the recent National Orthopaedic funding
of pain service projects in Wales.
TEMPLATE DESIGN © 2007
www.PosterPresentations.com
Sessional provision varies considerably for interventions, also the
number of patient throughput. However the latter may simply reflect
the complexity of interventions performed.
Orthopaedic Board funding
Clinics and Patient numbers
70
53
OPD sessions
MDT sessions
35
18
Non-recurring funding from the Welsh Government’s National
Orthopaedic Board was intended for projects which support the
achievement of RTT targets and the ongoing delivery of access
times, a key element of the sustainable service model for
orthopaedic demand management.
0
ABMU
BCU central
BCU east
Cwm Taf
H D west
Velindre
Whilst most services are multidisciplinary, only 3 utilise both OPD and MDT
clinics, 6 exclusively OPD clinics. However no clear definition was used what
constitutes a MDT clinic. The number of new patients is similar, though F/Us seen
varies considerably.
14
11
OPD new
OPD F/U
MDT new
7
4
0
ABMU
BCU central
BCU east
Cwm Taf
H D west
Velindre
Successful bids were made by 4 HBs: ABMU, ABHB, Cwm Taf and
Powys. The funding was used as follows:
• ABMU – money withheld by HB.
• ABHB – Community Low Back Pain Service established to
implement a pathway allocation system to divert patients who
do not need orthopaedic review into appropriate services.
• Cwm Taf –Pilot of osteopath and chiropractor services and the
development of a mirror chronic pain service across the HB.
• Powys - Physiotherapy led orthopaedic triage.
➢This audit has been complex and relies on accurate and detailed
description by each service. As each locality has developed
complex pathways which are impossible to capture completely, the
figures given may not be fully accurate.
➢All HBs now provide a CPS and there has been a considerable
move towards multimodal and multidisciplinary services, though not
all have developed this fully yet. Considerable variability still exists
based on local factors, i.e. lack of investment by some HBs. In
particular improving psychology and OT support into all services is
desirable. Equally, consideration should be given how to provide
interventional treatment facilities to patients in all HBs.
➢PMPs are now offered in most HBs, although this will need
further investment in some areas.
➢Some HBs, due to a large geographical area and traditional set
up, have more than one service. Service provision remains largely
in the secondary care domain, though some utilise both primary
and secondary care.
➢Interventional treatment varies considerably, and utilisation of
theatre space may not be the most cost effective way to provide
this.
➢Further projects will need to look at logistical aspects of service
provision and limitations as regards to further movement of CP
services into primary care.