Stepped Care Model for Pain Management Nabiha Gill, MD Staff Physician PM&R Chair, Indianapolis VA...
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Transcript of Stepped Care Model for Pain Management Nabiha Gill, MD Staff Physician PM&R Chair, Indianapolis VA...
Stepped Care Model for Stepped Care Model for Pain ManagementPain Management
Nabiha Gill, MDNabiha Gill, MDStaff Physician PM&RStaff Physician PM&R
Chair, Indianapolis VA Pain CommitteeChair, Indianapolis VA Pain CommitteeChair, VISN 11 Pain CommitteeChair, VISN 11 Pain Committee
Assistant Professor, PM&R, IUPUI, Indianapolis, INAssistant Professor, PM&R, IUPUI, Indianapolis, IN
ObjectivesObjectives
• Progress as facility pain committee
• Progress as VISN pain committee
• Successes
• Struggles
• Next steps
Indianapolis VA Pain Indianapolis VA Pain CommitteeCommittee
Indianapolis VA Pain CommitteeIndianapolis VA Pain Committee
• Updated pain committee member list• Added more pain disciplines rep• E-mail group for communication• More structured• More enthusiasm, motivation, energy among
members• Updated/reviewed committee objectives• Developed “Multidisciplinary Virtual Pain Team
Consultation”
““Multidisciplinary Virtual Pain Team Multidisciplinary Virtual Pain Team Consultation”Consultation”
• Developed “Multidisciplinary Virtual Pain Team Consultation”
• Subgroup of facility pain committee• Primary and secondary (back up) key people
from each discipline• Support from departmental chiefs and EMT• More than 10 disciplines on the team• Regular communication among team members• Pilot program done in primary care
““Multidisciplinary Virtual Pain Team Multidisciplinary Virtual Pain Team Consultation”Consultation”
• Key members from following disciplines;1. Physical Medicine & Rehab Physician2. Pain Psychologist3. Physical therapist4. Rec therapist5. Interventional pain specialist6. Ortho spine surgeon7. Neurosurgery8. Primary care physician9. Pharmacist10. Patient advocate11. Social worker
““Multidisciplinary Virtual Pain Team Multidisciplinary Virtual Pain Team Consultation”Consultation”
• Developed CPRS consult order, virtual/historical visit/note title/note/alerts
• Chart review by all disciplines prior to case discussion
• Primary care provider gets invited to meeting, short case presentation by PCP….then consultation from all disciplines
• Opportunity for provider education about services from different pain disciplines and pain management
• Support for PCP • Case example
Proposed “Stepped care Proposed “Stepped care model for pain management model for pain management
for Indianapolis VA”for Indianapolis VA”
TERTIARY LEVEL
SECONDARY LEVEL
PRIMARY LEVEL
Proposed Stepped care model for Proposed Stepped care model for pain for Indianapolis VA pain for Indianapolis VA
Provider education
Pain Medication Management
Pain Medication Management
Pain Policy
Pain School
Primary Care Clinics/Teams
Bupe Clinic/SATS
Secondary ConsultsInt Pain Clinic
Chronic Pain Rehab Program
Multi-dis pain
Tertiary
Sec
Primary
CBT
CBT
CRIPPCRIPPCComprehensive omprehensive RRehab ehab IIntegrative ntegrative PPain ain PProgramrogram
(Proposed)(Proposed)
CRIPPCRIPP (Comprehensive Rehab (Comprehensive Rehab Integrative Pain Program)Integrative Pain Program)
Chronic Pain Consult
Screening Clinic
Bupe clinic/SATS
Chronic Pain rehab program
PMMP
PMMP
Sec.consults/int/SATS/Biofeedba/PT/accupuncture
CBT
CBT
Pain School
Multi-dis Pain
PCP
Team meetings with OEF clinic, pain clinic, CRIPP staffing, PCP staffing (q6mon)
Tampa VA “Chronic Pain Rehab Tampa VA “Chronic Pain Rehab Program” trainingProgram” training
• Excellent training
VISN 11 Pain committee VISN 11 Pain committee progressprogress
VISN 11 Pain Committee progressVISN 11 Pain Committee progress
• V-Tel
• Communication
• Face to face meeting
• HSB
• Stepped care model/policy/education plans
• VISN Ambulatory care council
VISN Ambulatory care councilVISN Ambulatory care council
• “Too many clinical reminders”• “Not enough support for PCP’s decisions”• “Lack of access to comprehensive pain services”• “Lack of pain care standards and policies”• On-site workshops on chronic pain management for providers• Pain schools• ORC• CBT groups• Multidisciplinary virtual pain team consultations• Aquatic therapy• Interdisciplinary pain rehab programs• Opioid detox programs• CAM
Successes!!!Successes!!!
Struggles!!!Struggles!!!
Next Steps!!Next Steps!!
Questions!!Questions!!