A Sustainable Hospitalcommunity. Programme for Orthopaedic Patients with Chronic Pain Syndrome

Transcription

1 A Sustainable Hospitalcommunity Partnership Programme for Orthopaedic Patients with Chronic Pain Syndrome

2 Cheung KK 1 Chan PH 1 Chow YY 1 Hung ATF 2 Ho JPS 2 Tse A 1 Chan I 1 Ip A 1 Wong C 1 Fung C 1 Kwok LC 1 Ng CH 1 Chan PKY 2 1 Tuen Mun Hospital, Hong Kong Hospital Authority 2 Tai Hing Centre, Community Rehabilitation Network, The Hong Kong Society for Rehabilitation, Hong Hong

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4 Diagnosis of 946 patients at first consultation in an Orthopaedic Out-patient Clinic

5 Orthopaedic surgeons Trained to do surgery chronic pain problems Analgesics and passive therapy modalities ineffective

6 Underlying psycho-social issues may perpetuate the chronic pain syndrome Mind / Mood Pain Stress Financial burden Family issue Depression

7 If the underlying hidden perpetuators of the chronic pain syndrome are not tackled Pain will not get better Patients will become more depressed and dependent Keep coming back to SOPD Orthopaedic surgeons skill and knowledge are not maximally applied Dissatisfaction among this group of patients multiplies

8 A loss-loss situation!

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10 Problems Passive and negative groups of patients Misconceptions Media Resources

11 3S programme

12 Mission To provide one stop service to clients that have musculoskeletal pain syndrome while there is no active significant organic pathology Introduce the concept of pain syndrome self management to clients by active participation Cognitive therapy Social activities Exercise programmes

13 Who are the stakeholders Orthopaedic Surgeon Orthopaedic nursing specialist Clinical psychologist Community Services Centre [CSC](social worker) Physiotherapist Community Rehabilitation Network [CRN](social worker)

14 Clients with Chronic Pain Syndrome Hospital Assessed by Orthopaedic Specialist Organic causes No Organic causes/ psychosocial factor High risk Treat accordingly 1. Depression 2. Strong fear avoidance element 3. Poor functioning Questionnaire 1. Lack of exercise 2. Lack of social resources Low risk Hospital Intervention Clinical psychologist and Physiotherapist Community Social worker for social resources Joint service: Education programme on self-management of Chronic Pain Syndrome Community Rehabilitation Network Pain Self-Management Programme (PSMP) Reintegrate

15 屯門醫院及香港復康會社區復康網絡合辦 # 痛症自我管理課程緊接推出, 日期及時間稍後通知! 對象 : 於屯門醫院骨科覆診病人 ( 須由醫生轉介及會進行心身健康問卷評估 ) 費用 : 全免報名及查詢 : 屯門醫院社區服務中心 香港復康會社區復康網絡 ( 大興中心 ) 更新日期 :2011 年 4 月 -> 醫咗咁耐都繼續痛, 係咪無得醫? -> 點解我食咗咁耐止痛藥都仲係痛? -> 做物理治療會唔會令我痛上加痛? -> 除咗係醫院, 社區裡仲有冇其他服務可以幫到我? 若你都有以上疑問, 以下活動能幫你找到答案! 簡介會 ( 上篇 ) 日期 :13/5 8/7 9/9 11/11/2011( 星期五 ) 時間 : 下午 2:30 至 4:00 地點 : 屯門醫院一樓社區服務中心活動室講員 : 骨科護士 物理治療師 社工及社區復康單位同工 簡介會 ( 下篇 ) 日期 :27/5 22/7 23/9 25/11/2011( 星期五 ) 時間 : 下午 2:30 至 4:00 地點 : 屯門大興邨興昌樓 號地下香港復康會社區復康網絡大興中心講員 : 骨科護士 物理治療師及社工講題 : 物理治療概念及藥理知識

16 The actual workflow Referred from SOPD Appointment booked in CSC Introductory class in CSC

17 Introductory Class in CSC: passivity discouraged Orebro Musculoskeletal Pain Questionnaire (OMPQ) as screening tool for at risk group Orthopaedic nurse specialist Introduction to pain pathology Physiotherapist Current concept in chronic pain syndrome selfmanagement CSC Introduction to various community resources CRN Introduction of services to be provided Meet the successor and sharing

18 Nursing specialist

19 Physiotherapist

20 CRN introduction

21 The actual workflow Referred from SOPD Appointment booked in CSC Introductory class in CSC Intermediate class in CRN

22 Intermediate class in CRN: gesture of continuation of hospital care into the community Orthopaedic nursing specialist Introduction to analgesic Physiotherapist Recent concepts in management of chronic neck and back pain Self care and exercise class afterwards in Tuen Mun Hospital (optional) CRN Concepts in self-management of chronic pain Pain Self Management Programme (PSMP)

23 In the community

24 The actual workflow Referred from SOPD Appointment booked in CSC Introductory class in CSC Intermediate class in CRN PSMP in CRN

25 身心力行課程 Pain Self Management Programme (PSMP)

26 PSMP Objectives: Adopt systematic problem-solving process Manage pain & emotions Master self-management behavior

27 PSMP Qualified facilitators Leader s Manual Key topics: Action planning, Problem-solving & symptom cycle Tool-Box concept Self-management behaviors

28 PSMP

29 PSMP

30 The actual workflow Referred from SOPD Appointment booked in CSC Introductory class in CSC Intermediate class in CRN PSMP in CRN Reintegration

31 Evaluation Client satisfactory questionnaire OMPQ score before and after PSMP Pain Depressive mood Fear avoidance Function SOPD attendance before and after completion of programme Pain medication prescription

32 Results Feb 2009 to Dec 2011

33 27 sessions 391 attendees 364 questionnaires returned 93.1% return rate

34 Age Range Mean 50.8 Median 51 Sex Male 13.3% Female 86.7%

35 十分有幫助 Very useful 有幫助 useful 普通 neutral 沒有幫助 Not useful 非常沒有幫 useless 痛症之病理知識 Pain pathology 42 (11.6%) 242 (66.9%) 75 (20.7%) 3 (0.8%) 0 長期 ( 慢性 ) 痛症的現代醫療概念 Concept in pain self-management 32 (9%) 224 (63.5%) 91 (25.8%) 6 (1.7%) 0 社區資源 / 熱線服務介紹 Introduction to community resources 48 (13.9%) 228 (65.9%) 66 (19.1%) 3 (0.9%) 1 (0.1%) 復康單位服務介紹 ( 社區復康網絡 ) Introduction to community rehabilitation (CRN) 51 (14.8%) 222 (64.5%) 66 (19.2%) 5 (1.5%) 0

36 身心力行課程 Pain Self Management Programme (PSMP) 12 sessions No. of participants completed the whole programme: 86 Percentage of clients completed the whole programme: 22% (86 / 391)

37 Pre-Post Orebro Questionnaire and Socioeconomic stress measurement Comparison: N=86 Significant improvement Functioning Pain Intensity Anxiety Mood Improvement Socio-economic stress Fear Avoidance approach Depressed mood Total score

38 Pre-Post Orebro Questionnaire and Socioeconomic stress measurement Comparison: Pre Post Significance (paired sample t-test) Orebro Total score Pain intensity * Depressed mood Fear avoidance approach Functioning * Socioeconomic stress SF12 PCS MCS HADS Anxiety Score * Depression Score

39 Pain support group: Christmas gathering 2010

40 Pain support group: Voluntary work

41 Pain support group: Outing

42 SOPD consultation and pain medication prescription 117 control 86 PSMP graduates

43 Matched Age Sex Chief complaints Psychosocial problems Gainful employment Litigation issue No. of consultations before 3S referral

44 Outcome after SOPD consultation Doctor s action No follow-up appointment given Follow-up expected Client s response Comes back as instructed Not come again as instructed Comes back / defaulted despite being told the opposite

45 Outcome after SOPD consultation Attended (%) Not seen again (%) No follow-up appointment given Control PSMP Follow-up expected Control PSMP

46 Outcome after SOPD consultation Attended (%) Not seen again (%) No follow-up appointment given Control PSMP Follow-up expected Control PSMP

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48 Drug score Paracetamol 1 Non-steroidal anti-inflammatory drugs (NSAID) 2 Weak opioids 3

49 Drug score PSMP Control Average drug score before referred to 3S Average drug score at end of survey Percentage reduction in drug score (%)

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51 Our 3S Programme has demonstrated its effectiveness for pain patients increased patients well-being including self-management knowledge and skills, sense of self-efficacy, social network, emotion, involvement in community, etc

52 Our 3S Programme has Helped to reduce the health care utilization Established flow between hospital and community (synergy, collaboration) Facilitated multi-disciplinary collaboration

53 Can our 3S programme model apply to other specialties that treat patients with chronic complaints associating with dominant psychosocial needs?