Auckland New Zealand

Transcription

1 Auckland New Zealand

2 There were 4 Doctors working at the hospice at the time. Generally found it easy to use Did change our practice not usual to ask when clerking in re addiction status/alcohol use. Has not been used on an ongoing basis but has made us identify type of pain early. Ongoing monitoring of pain intensity for inpatients was liked stopped us being woolly and getting side-tracked.

3 Since project have become a full time doctor working in a General Practice Continue to cover South Auckland Hospice on the on call Rota approx 60hrs a month. What can I offer this group now? What do I need to help my palliative patients as a GP using the ECS-CP.

4 Short consultation time UK = 7mins, NZ=15 mins per patient. Seeing average of patients a day. Significant time pressures Significant paperwork Computer based

5 Diagram to illustrate how patients are referred through to Palliative care services. General Practice Oncology Palliative Care Specialists Hospital Teams

6 Palliative Care Registrar Dr Jo Chambers team Collated from Hospital notes retrospectively. 121 cases looked at. 81% of patients Referred within 4 weeks of death mths 19% 1 day 25% 1-4 weeks 34% 1-7 days 22%

7 The general theme in NZ as well is an increasing number of referrals through to our palliative care services but often LATE in the journey. Classically referred with a Crisis physical, psychological or practical. Could we use the ECS-CP to improve this and how?

8 THE DAILY NEWS THE WORLD S FAVOURITE NEWSPAPER - Since 1879 IN-PAIN Tool life changing EARLY PAIN ASSESSMENT TOOL WILL ENHANCE QUALITY OF LIFE FOR CANCER PATIENTS tool will identify those with difficult pain A new tool available for our hard working family and hospital doctors means that Pain Specialist expertise will be targeted to those that need it most. The tool IN PAIN is: MEMORABLE With a catchy Pneumonic Medics seem to love these! QUICK TO USE SIMPLE COMPUTER based A TICK BOX System Can be practice driven ie used by nursing members of the team and others GP s are delighted with the 5 point tool that will be web based to allow access anywhere.

9 Have you ever felt you should cut down on your drinking? Have people annoyed you by criticising your drinking? Have you ever felt bad or guilty about your drinking? Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (eye-opener)? Two or more positive answers are correlated with alcohol dependence in 90% of cases.

10 During the past two weeks, have you ever been bothered by: 1. Little interest or pleasure in doing things? 2. Feeling down, depressed or hopeless? Results The two screening questions showed a sensitivity and specificity of 97% (95% confidence interval, 83% to 99%) and 67% (62% to 72%), respectively. Conclusion Two verbally asked questions for screening for depression would detect most cases of depression in general practice. The questions have the advantage of brevity. As treatment is more likely when doctors make the diagnosis, these questions may have even greater utility. Bruce Arroll BMJ 2003; 327 : 1144

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12 INtensity of Pain Psychological distress is present History of Addiction Incident pain Neuropathic element to pain If patient scores positive for 3/5 consider early referral to your local palliative care team.

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