Stepped Care Model for Pain Management

1. Stepped Care Model for Pain Management Nabiha Gill, MD Staff Physician PM&R Chair, Indianapolis VA Pain Committee Chair, VISN 11 Pain Committee Assistant Professor, PM&R, IUPUI, Indianapolis, IN

2. Objectives • Progress as facility pain committee • Progress as VISN pain committee • Successes • Struggles • Next steps

4. Indianapolis VA Pain Committee

5. Indianapolis 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”

6. “Multidisciplinary Virtual Pain Team 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

7. “Multidisciplinary Virtual Pain Team Consultation” • Key members from following disciplines; • Physical Medicine & Rehab Physician • Pain Psychologist • Physical therapist • Rec therapist • Interventional pain specialist • Ortho spine surgeon • Neurosurgery • Primary care physician • Pharmacist • Patient advocate • Social worker

8. “Multidisciplinary Virtual Pain Team 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

10. Proposed “Stepped care model for pain management for Indianapolis VA”

12. Proposed Stepped care model for pain for Indianapolis VA Multi-dis pain Tertiary Chronic Pain Rehab Program BupeClinic/SATS Int Pain Clinic Sec Secondary Consults Primary Pain Medication Management Pain Policy Provider education CBT Pain School CBT Pain Medication Management Primary Care Clinics/Teams

13. CRIPPComprehensive Rehab Integrative Pain Program (Proposed)

14. CRIPP(Comprehensive Rehab Integrative Pain Program) Team meetings with OEF clinic, pain clinic, CRIPP staffing, PCP staffing (q6mon) Bupe clinic/SATS Multi-dis Pain PCP Chronic Pain rehab program Screening Clinic Chronic Pain Consult CBT PMMP CBT Pain School PMMP Sec.consults/int/SATS/Biofeedba/PT/accupuncture

15. Tampa VA “Chronic Pain Rehab Program” training • Excellent training

16. VISN 11 Pain committee progress

17. VISN 11 Pain Committee progress • V-Tel • Communication • Face to face meeting • HSB • Stepped care model/policy/education plans • VISN Ambulatory care council

18. VISN 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

19. Successes!!!

20. Struggles!!!

21. Next Steps!!

22. Questions!!