December 6, 2011

1. MSK InitiativeOrientation WebinarLow Back Pain December 6, 2011

2. Agenda • Webinar Housekeeping • Participant Introductions • Polling Questions • Overview of the Pilot Project • Role of Participants • Overview Algorithms • Case Application of Key Tools • Questions • Summary

3. Webinar Opportunities • Audio and Visual • Sound • Polling Questions • Chat Function • Save

4. GPs to participate in testing / trial of clinical practice tools

5. Polling Questions 2, 4,5, 6, 7,

6. Purpose of MSK Initiative • To design and pilot an evidence-based, best practice system of MSK care: • For four conditions (RA, JIA, OA, LBP) • Reflecting the needs of urban, rural and remote areas of British Columbia • Engaging the diverse network of service providers • Suggesting tools and strategies for improvement in clinical practice and access to MSK services/supports

7. Recap – Areas of MSK Focus • Screening tools for early identification of inflammatory arthritis • Red flags and criteria for expedited referral • Supports for dealing with complex and chronic pain • Practical, simple point of care tools / checklists • Timely access to specialists for quick advice • Criteria for appropriate referrals • Tools for responding to psychosocial patient needs • Patient educational resources and community supports for patient self-management • Building network of relationships at local / community level

8. 8 Support Roles for GP Trial

9. Your Role • Test the tools in your practice • Explore the Tool Kit (Algorithm) • Test all tools as they fit your patient/practice • Feedback on all tools • Webinars will focus on selected tools • Send feedback form to PSP Central Weekly • Participate in the webinars and use supports

10. Background Information Low Back Guidelines Summary Rationale Seeded Guidelines Http://www.topalbertadoctors.org www.gpscbc.ca/psp_msk

11. Inventory of MSK TOOLS & their classification • Clinical Practice Tools – used at point of care and tools we want tested during trial period • Reference Tools – checklists and other materials that can be looked up in hard copy binder or in electronic format as physician interest and time permit • Patient Tools – to be completed by patient either jointly with GP, in the waiting room, or at home. These tools should be tested via GP pilot or with patient focus groups • Teaching Tools – optional for use in the learning / teaching sessions as aids

12. LBP Tool Selections

13. Toolkit Implemenation Patient to complete Medical Office Assistant Mailed out prior to appt. Interactive with Assessment

16. Feedback Forms Complete for each patient interaction, multiple tools per patient Fax in every Friday Easy Evaluation Tick Sheet Open Boxes to add tools that are in the Tool kit but not selected for testing Composite trends to be feed forward to support group

17. The Patient in our Project

19. Mr. Donald Dorn is a 45 year old accountant who has come to see you on Tuesday morning in your family practice for new onset low back pain. He was cycling over the weekend and began to feel some mild stiffness when he completed his 1 hour ride. The following morning, he awoke and had difficulty getting out of bed with morning stiffness lasting 30 minutes located in his right and left low back area. He describes his pain as intermittent but frequent episodes of moderate intensity aching with sharp shooting back pain more pronounced on his left side with occasional radiation to his buttock and upper posterior thigh.

20. Donald Dorn His symptoms are exacerbated with sitting longer than 15 minutes and somewhat eased when he walks up and down his hallway. He has called in sick to work today as he feels that his symptoms are worsening overall. This has occurred twice before in the last year and he has used over the counter medications for relief .

21. What other Questions would you like to ask Donald ?

22. Patient Questionnaire Are any of your joint swollen ?No How would you rate the intensity of your pain ? 6-9/10 Do your symptoms interfere with your general daily activity, mood or relationships ? Yes, not working, feeling irritable What is currently giving you relief ? Medications not working, tried ice for 10 min/heat 10 Are you getting treatment for any other health problems ? No

23. How do you approach the Red Flags ?

25. Mr. Dorn becomes inpatient with your line of questioning and says, he told you that he was otherwise healthy and beside you know his history, he asks you, "are you going to give me anything for the pain? ". He tells you that he has an insurance plan and needs a prescription for massage also. He is very concerned that his "workaholic boss" will not tolerate any more sick time from him since he has already taken 5 days this year for a previous episode of back pain and a flu bug . He had been looking at a self employed job opportunity before this happened but is afraid to let his health benefits go.

28. Follow-Up Visits: Pain Worst Least Average Right Now Function Appreciate variation of pain intensity Social/Physical/ Mood/ Work Delve into various functional examples Opportunity for educational intervention

29. Summary 1. We appreciate your participation 2. You have Support ! 3. You have patients with Low Back Pain. 4. Try the Tools 5. Feedback Tracking Sheets

30. End of Session- 2 Polling Questions

31. 31 NextWebinar Dates for Low Back Pain Monday, January 9: 5 – 6:30 pm Tuesday, March 6: 5 – 6:30 pm