Chronic pain management resource development and evaluation

Dr Katy Knott, Consultant Clinical Psychologist

Grevin Jones, Clinical Specialist Physiotherapist

Ruth Burgess, Clinical Nurse Specialist


Chronic Pain Service East


Betsi Cadwaladr University Health Board

Background


Individuals accessing BCUHB Chronic Pain Service East have often received little guidance, support or practical measures relating to managing pain prior to accessing the service. The service currently has lengthy waiting times for assessment and intervention.

Evidence suggests a worsening in wellbeing, mood, physical presentation and increased reliance on medication are associated with increased waiting times. The service therefore identified that improving access to self-management resources during the waiting time was fundamental. To address this we undertook a pilot project integrating the Education for Patients Programme for chronic pain (EPP) into our secondary pain service referral pathway.

Project Aims

Our aim for the project was to:

  • Increase accessibility to high quality pain self-management resources for those experiencing persistent pain

  • Reduce the likelihood of pain becoming further established in its chronicity or health and wellbeing further deteriorating by providing access to self-management resources whilst an individual is waiting to be seen by a specialist pain service

  • Improve patient outcomes and experience

  • Reduce service demand due to decreased need for direct clinical contact

  • Reducing demand for face to face contact with clinicians, of particular importance during the current pandemic

  • Move towards a stepped model of care, with individuals who are more engaged in a self-management approach able to work through resources independently and those with more complex needs being seen in a more timely manner, in line with principles of Prudent Healthcare

  • Embrace new ways of working by providing access to a remote self-management programme

  • Improve co-ordination between services and therefore reduce duplication of work

  • Identify barriers to engagement with self-management resources

Challenges


Our project evolved during the course of the Exemplar Programme. Our initial aim was to develop a range of high quality, bilingual resources to meet the needs of the local population.

During the course of the project we identified EPP as a key resource and therefore our project focus moved towards integrating EPP into our referral pathway. This Bevan Exemplar was an accelerated programme, which left very little time to plan, undertake the pilot project, in particular recruitment and evaluating outcomes.

Key Outcomes


Key outcomes include:

  • 77% of those who attended EPP found it to be beneficial

  • Of the 71 individuals offered EPP 57 opted in

  • Standardised outcome measures evaluating patient outcomes, comparing measures of mood and pain experience at point of referral and post completion of the EPP, demonstrated an improvement across all domains, with mood demonstrating a significant improvement

  • Of those who did not engage in the EPP 96% cited lifestyle reasons, with only 4% stating that they did not believe the programme to be relevant

  • A trend is emerging that individuals who complete the EPP require less input from the service

In the longer-term we predict:

  • An anticipated reduction in the number of clinical contacts within and external to the pain service

  • Improved patient outcomes and engagement with the self-management approach adopted by the service

  • A reduction in complaints and risk reporting relating to avoidable or preventable deterioration of patient wellbeing associated with long waiting times for assessment and interventions

  • If the EPP was integrated as a pre-referral stage in our referral pathway we predict an anticipated reduction in number of referrals; reduced waiting times for initial assessment; and waiting time for interventions

Patient Feedback

“It enabled me to set goals and realise that tasks don't have to be completed in one go but can be broken into manageable steps”
“It gives more options”
“It definitely helps in identifying problems and finding solutions to deal with it”
“It helped me remember to do my exercises”
“I now practice relaxation most days”
“It kept me focused”
“Some of it I found useful”
“There was nothing I didn’t know already”

Next Steps

  • A larger scale and/or multi-site evaluation of the integration of EPP into referral pathways

  • Identify predictors of engagement and further evaluate outcomes associated with attendance of EPP, which will better inform selection criteria for pathways

  • Evaluate the impact of EPP on the referral pathway to include evaluating the difference in number of clinician hours required and patient outcomes for those who attended EPP vs do not attend EPP

  • Review the process by which EPP is offered and accompanying information

  • Continue to integrate with other services

  • Working with other pain services to encourage adopt and spread

Our Exemplar Experience

"Satisfying"
"Challenging"
"Time-constrained"
"A learning process"
"Opened doors to supportive networks"

Contact

Katy.knott@wales.nhs.uk

Grevin.jones@wales.nhs.uk

Ruth.burgess@wales.nhs.uk

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