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Organisation of Chronic Pain Therapy in Slovenia

Organisation of Chronic Pain Therapy in Slovenia. Prim. mag. Marija Cesar-Komar dr.med. President of the Slovenian Association for Therapy of Pain (SZZB) General Hospital of Slovenj Gradec. Historical Re view.

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Organisation of Chronic Pain Therapy in Slovenia

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  1. Organisation of Chronic Pain Therapy in Slovenia Prim. mag. Marija Cesar-Komar dr.med. President of the Slovenian Association for Therapy of Pain (SZZB) General Hospital of Slovenj Gradec 1 st Congress of Pain,BLed 9.-10.oct.2009

  2. Historical Review 1977 - Outpatient clinic for Th of pain in UCC of Ljubljana – department for anaesthesiology and intensive care medicine (prim Jasna Muller,dr.med.) 1978 - Yugoslav-Chinese Symposium of Traditional Chinese Medicine (Slovenj Gradec, prim Drago Plešivčnik,dr.med. 1979 - Yugoslav-Chinese Course for Acupuncture in Zagreb (4 participants from Slovenia) 1979 - Outpatient clinic for Th of pain in General Hospital of Slovenj Gradec- Depatment for anaesthesiology and intensive care therapy 1 st Congress of Pain,BLed 9.-10.oct.2009

  3. Units for pain therapy in Slovenia: 16 13 working 1 st Congress of Pain,BLed 9.-10.oct.2009

  4. Medical Association for Pain Therapy Slovenian Association for Pain Therapy -Slovensko združenje za zdravljenje bolečine(SZZB) 11th Nov. 1996 30founding members 140current members IASP-1998-1999 Wiena EFIC-1997 1 st Congress of Pain,BLed 9.-10.oct.2009

  5. Pain Therapy Clinics- PTC Departments of anaesthesiology in general hospitals Departments of anaesthesiology of both Clinical Centres(Ljubljana, Maribor) Department of anaesthesiology of Oncologycal Institute Ljubljana Two private clinics for out-patients . 1 st Congress of Pain,BLed 9.-10.oct.2009

  6. In what way is the organisated the pain therapy in Slovenia ?-Questionnaire Sent to all the heads of PTC in Slovenia (16) 10 questions Time - January 2009 Returned 13 from 16, (81 % ) 1 st Congress of Pain,BLed 9.-10.oct.2009

  7. Aims of the questionnaire - 1 How many times and hours per week-PTC? How many different doctors and their rotation? How many patients per day in the PTC? How many factors were done in the year 2008? How many first visits (new patients ) occured in the year 2008? 1 st Congress of Pain,BLed 9.-10.oct.2009

  8. Which therapeutic methods were used, and how many in % ? The cooperation with family physicians, and other specialists. Is there a need for expansion of the clinic? Where are the limitations? What are thefuture plans-wishes ? Aims of the questionnaire - 2 1 st Congress of Pain,BLed 9.-10.oct.2009

  9. Table1: Working hours per week 1 st Congress of Pain,BLed 9.-10.oct.2009

  10. Table 2: Number of doctors 1 st Congress of Pain,BLed 9.-10.oct.2009

  11. Table 3: Rotation of doctors 1 st Congress of Pain,BLed 9.-10.oct.2009

  12. Table 4: Cooperation 1 st Congress of Pain,BLed 9.-10.oct.2009

  13. Table 5:Needs for extension - PTC 1 st Congress of Pain,BLed 9.-10.oct.2009

  14. Table 6: Limitations in PTC 1 st Congress of Pain,BLed 9.-10.oct.2009

  15. Table7-a:Therapeutic methods in PTC 1 st Congress of Pain,BLed 9.-10.oct.2009

  16. Tabela 7-b: Therapeutic methods in PTC 1 st Congress of Pain,BLed 9.-10.oct.2009

  17. Tabela 7-c : Therapeutic methods in PTC 1 st Congress of Pain,BLed 9.-10.oct.2009

  18. Table 8:Future plans - wishes 1 st Congress of Pain,BLed 9.-10.oct.2009

  19. Table 9: Number of new patients (first visits) ,in the year 2008 1 st Congress of Pain,BLed 9.-10.oct.2009

  20. Table 10: Number of done factors in the year 2008 (324377) 1 st Congress of Pain,BLed 9.-10.oct.2009

  21. All work performed in PTCs in Slovenia in the year 2008 324.093 – factors 9241 new patients 13PTC-working 33different doctors 376 hours per week 1 st Congress of Pain,BLed 9.-10.oct.2009

  22. Therapeutic methods used in PTAs Acupuncture10 -90% not in UCC Mb and GH NG Medicament. Therapy 7-100% Pharmacological blocks 5-60% Catheters 1-30% Pumps 1-50% not in Reh UCC Mb,GH B,GH J,PPTC V Electrodes (EPI) for central stimulation only in UKC Mb 1 st Congress of Pain,BLed 9.-10.oct.2009

  23. Working time in PTCs in Slovenia - 1 Full time -40 hours /week in 6 of 14 PTCs. UCC Ljubljana UCC Maribor OI Ljubljana GH Jesenice GH Novo Mesto PPTC Vrabl 1 st Congress of Pain,BLed 9.-10.oct.2009

  24. Working time in PTCs in Slovenia - 2 More than half- GH Murska Sobota 32 GH Slovenj Gradec 28 Others - Less than half GH Izola,GH Ptuj, GH Celje16 GH Brežice, Rehab.UCCMaribor10 GH Nova Gorica 8 Nevrol. Kl UCC Lj, PTC BEM no data 1 st Congress of Pain,BLed 9.-10.oct.2009

  25. Number of doctors More than 3 -OI Ljubljana 3-UCC LJ; UCC Mb;GH Murska Sobota 2-GH Slovenj Gradec,Reh.UCC Mb,GH Izola,GH Ptuj, GH Nova Gorica,GH Novo Mesto 1-GH Brežice,Celje, Jesenice,PPTC Vrabl No data-PTC Bem, Nevr kl UKC Lj 1 st Congress of Pain,BLed 9.-10.oct.2009

  26. Rotation of doctors in PTCs Every day - UCC Mb Every other day-GH MS,GH I,GH P,GH NM, Every week -Reh UCC Mb Every month –GH NG,GH SL G,OI Lj None -GH Br,GH C,GH J,PPTC V, Depends on the needs -UCC LJ 1 st Congress of Pain,BLed 9.-10.oct.2009

  27. Cooperation-multidisciplinary work Family medicine doctors good Other specialists good Psychiatrists, psychologists bad (3X) 1 st Congress of Pain,BLed 9.-10.oct.2009

  28. Needs for extension All - yes 1 st Congress of Pain,BLed 9.-10.oct.2009

  29. Limitations in PTCs in Slovenia Personel - (Doctors) 9 Places - 7 ZZZS - (Insurance) 6 1 st Congress of Pain,BLed 9.-10.oct.2009

  30. Whishes of doctors in PTCs in Slovenia Places 9/13 Equipment10/13 More invasive methods 9/13 Better cooperation 7/13 1 st Congress of Pain,BLed 9.-10.oct.2009

  31. Performed factors in PTCs in the year 2008 324.903 all in Slovenia No data for 3 PTC 87564-UCC LJ, GH MS,UCC Mb, GHNM, GH SG, GH I, Others under 25000 1 st Congress of Pain,BLed 9.-10.oct.2009

  32. Summary QUESTIONNAIRE- basic status of pain therapy in Slovenia In three decades the situation advanced in a great measure. Great merits for that lie on the work ofSZZB. In the future we have to continue our activities for the recognition and the proper payment for the already performed and not paid services . Activities for the recognition as well as the programme of the special knowledge on the field of pain therapy. 1 st Congress of Pain,BLed 9.-10.oct.2009

  33. General Prevalence = 19%srednje močna 13% močna6% 30% 27% 26% 23% 23% 21% 19% 18% 18% Norveška (n=2,018) 17% 17% 16% 16% 15% 13% 13% 11% Nemčija (n=3,832) Poljska (n=3,812) Izrael (n=2,244) Italija (n=3,849) Danska (n=2,169) Slovenija (n=1,009) Švica (n=2,083) Belgija (n=2,451) Francija (n=3,846) Avstrija (n=2,004) Irska (n=2,722) Finland (n=2,004) Švedska (n=2,563) VB (n=3,800) Nizozemska (n=3,197) Španija (n=3,801) 1 st Congress of Pain,BLed 9.-10.oct.2009 SOURCE: Pain In Europe Survey 2003

  34. About 180.000 of Slovenians suffer strong chronical pains (according to VAS 7 or even more). 1 st Congress of Pain,BLed 9.-10.oct.2009

  35. Izvor bolečine N=386 Mostly the pains are of nononcological origin (98%) . onkološka bolečina 2% neonkološka bolečina 98% 1 st Congress of Pain,BLed 9.-10.oct.2009

  36. The average duration of the chronical pain in Slovenia (4,8 years ) is somewhat shorter than in Evrope (7,0 years) . Trajanje kronične bolečine (lahko tudi z vmesnimi prekinitvami) N=231 kumulativni odstotki Slovenija Evropa 100% 100% Povprečje Slovenija = 4,8 let 90% Povprečje Evropa = 7,0 let 80% 66% 70% 60% 50% 50% 50% 40% 27% 30% 23% 22% 19% 20% 8% 8% 10% 4% 0% 1 st Congress of Pain,BLed 9.-10.oct.2009 6 mesecev do < 1 leto 1 leto do <2 leti 2 leti do <5 let 5 let in več

  37. SUMMARY We need more place for pain therapy We need more doctors for pain therapy We take activities for better payment of analgetics preceedures from insurance company We are preparing clinical guidelines for the use of opioids for chronic noncancer pain 1 st Congress of Pain,BLed 9.-10.oct.2009

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