PAIN makes a difference

Transcription

1 PAIN makes a difference 1

2 yester day. large problem small solutions 2

3 not just compassion. 3

4 opioid consumption 2006!0.35 National healthcare service per capita disbursement 4

5 opioid consumption 2007!0.67 National healthcare service per capita disbursement 5

6 painless hospital committees 6

7 the patient Pain patients had few warranties and little information. They can choose where to have what kind of surgery, but choice is limited when it comes to treating pain. No guarantees of quality care professionals No minimum requirements of care for pain pts. Few, if any recognition for excellent care. Pain was not a condition as any. the healthcare system Little coordination/ information on own services Costs are paid without adequate information. Paid costs for care without having adequate information on results society Pays for chronic pain Pays to treat chronic pain Could not insure access to adequate therapy for chronic pain 7

8 Problems in palliative care 8

9 Inappropriate care death due to cancer in acute care hospitals inpatient days 346 million euros spent Data from Source: Min. for Labor, Healthcare and Social Policy 9

10 Law 39/ million euros for 188 centers 2025 beds 10

11 Bed availability in hospices <0.2 beds <0.3 beds <0.4 beds <0.5 beds!0.5 beds >0.6 beds Benchmark value (per residents) 11

12 <0.2 beds <0.3 beds <0.4 beds <0.5 beds!0.5 beds >0.6 beds % of funds spent 79 Min. Labor, Healthcare and Social Policy

13 Total L. 39/99 Funds Fondi erogati 21% 79% Claimed Available 13

14 In-hospice care expense Region Fondi erogati Amount Piemonte!258 PA Bolzano!410 PA Trento!109/120 Veneto!230/250 (!500/d pediatric pts) Liguria!191/ Emilia-Romagna!237 Toscana!200 Lazio!170 + drugs/devices Campania!238/!350 (hospice) Basilicata!180 + drugs Puglia!196,22 Calabria!260 ( Via delle Stelle hospice only) Sicilia!201,40 Sardegna!138 + staff supplement 14

15 Home care expense Region Fondi erogati Piemonte Lombardia Amount!70/d Initial fee!150!60/d Marche! according to contract Lazio Campania Puglia Calabria Sicilia Sardegna!170/die + drugs/devices!90/die + drugs/devices!1200 (flat fee)!65/d!72.30/d!23 + staff supplement 15

16 Minimum requirements for palliative care in 2008 Cancer-related deaths in palliative care / all cancer-related deaths "65% Hospice beds 11 DPCM 20/1/00 + regional requirements 100% Days of home palliative care " Waiting times "72 h for home care access (% of total home care pts) Waiting times "72 h for hospice access (% of total hospice pts) Admissions "7 d / total hospice admissions Admissions #30 d / total hospice admissions "80% "40% #20% #25% DM 43/2007 in compliance with art. 1, comma 169, L. 311/

17 Where to? Taking advantage of available resources Bed occupation evaluation: too few places? Too many? Implementation of minimum requirements 17

18 moving over 18

19 19

20 Selecting a winning team. 20

21 Primary Care Oncologists Government Commission Hospitals (anesth & other hospitalists) Hospices (palliative care specialists) NGOs Who are the players in chronic pain? 21

22 Primary Care Oncologists Hospitals (anesth & other hospitalists) Hospices (palliative care specialists) NGOs Real people behind organizations 22

23 Not just the frontmen 23

24 Specialist in the topic 24

25 Connected 25

26 Thinking big 26

27 Privileged spokespersons to lead the way 27

28 Privileged spokespersons to lead the way 28

29 Listening. 29

30 Moving out from walled gardens 30

31 to an outreaching program 31

32 Primary care From separate services Clinics To integrated systems Pain med centers 32

33 1. Textbook with procedural algorithm PAIN 1. Pathophysiology 2. Algorithms 3. Education 33

34 2. TtT Train the Trainer Education 34

35 3. Online Education Education 35

36 Primary care trusts Primary care 36

37 37

38 GP Specialist From home 38

39 Inappropriate Admissions Cost Increase No treatment planning to acute care hospitals 39

40 The concept Primary Care Trusts Pain Medicine Clinics Pain Medicine Centers 40

41 The concept Local presence Widespread treatment Specialty centers Presidi Ambulatoriali Territoriali Pain Medicine Clinics Pain Medicine Centers 41

42 Pain Medicine Clinics Existing centers meeting requirements in terms of procedure range, minimum volume and device availability Specialist, ambulatory procedures Interactions with palliative care specialists/centers 42

43 Pain Medicine Centers In-hospital care, with potential 1-day admission, multiple specialties, advanced diagnostics & procedures Invasive procedures for which admission is indicated Patient recruitment, treatment start and hand-off to local care 43

44 Palliative care/rehab constantly present PCT PMCl PMCe 44

45 education45

46 2009 Educational project in pilot regions Education 46

47 2009 Emilia-Romagna coordinating region Experimental project 47

48 Education based on territorial distribution of (human) resources 48

49 Education project Budget Goals Delivery! Improve general practitioners approach to pain Distance learning, live events, reference texts 49

50 Training the trainers 50

51 TtT Train the Trainer Education 51

52 Local GP trusts 52

53 Trainer & trainees 1:50 relationship between trainer GP and trainees GPs 53

54 in every region courses trainers operators Cost effectiveness 54

55 Simplification of enteral opioid prescriptions 55

56 56

57 In Senate: 334 Promoters 630 Total members unanimous approval 57

58 58

59 ! A new law Policies to guarantee access to palliative care and pain medicine impact & perspectives? Guido Fanelli gfanelli@parmanesthesia.com

60 60! Art. 1 This law grants citizens the legal right to have access to palliative care and pain medicine.

61 Palliative care Interventions for patients and families in the presence of progressive disease with negative prognosis, not amenable to specific treatment. " Art. 2 Definitions Pain medicine Diagnostics and therapeutics aimed at suppressing or controlling pain of any etiology Patient Person who suffers from chronic, evolving illness and/or chronic pain.

62 Art. 3: responsibilities National health service Palliative care and pain medicine are priority objectives; implementation is required for access to complementary funding by the government. " Ministry of health Defines guidelines for publicity, development and coordination of regional policies State-Regions Committee Verifies:! Status of implementation of the law! Appropriateness of interventions! Adequacy of available resources with respect to performance Photo by hidden side - Colby Cosh -

63 Information & Education " Art. 4 " for information campaigns Art. 6 Pain-free Territory " for practical education of personnel Photo c 2009 Marco Baciarello. Some rights reserved. ib yn ld

64 ! Art. 5 State-Regions Committee! Institutions Accreditation Criteria! Staff Accreditation Criteria! System coordination! Reimbursement control! Care homogeneity

65 65 Art. 7! Pain as vital sign: Regular assessment in patients medical records

66 Pain management is the patient s right, and the caring physician s duty Art. 7 66! Law requirements Written records of treatments and outcomes

67 Art. 8 Educational Activities! Medical school masters and postgraduate masters (by the Ministry of Education and Research)! CME for physicians and other staff! Compulsory internships/ rotations (where applicable)! Special education for volunteers and charities/ NGOs " Photo 2008 Marilyn Nieves. Used with permission.

68 Art. 9 & 11 Photo c 2007 Flickr user hidden sites. bna Process Control National commission monitors and reports to Parliament about:! Network development! Performance & Efficiency! Education! Public information! Research! Budget! Technical reports by experts "

69 69 Art. 10! Simplification of prescription rules No more special logs for oral or transdermal opioid formulations Easier access to analgesics for acute and chronic outpatients. Egging on Europe s most reluctant opioid prescribers

70 Art. 12 " Budget for services: Ministry and State- Regions Permanent Conference: "!100 million/year taken from National Health Fund

71 ! Pain Medicine & Assistance We can make a difference

72 ! Pain Medicine & Assistance Guido Fanelli