Variation in Pain Care in the South of England region

1. Variation in Pain Care in the South of England region Dr Cathy Price

2. Travel Dealing with the financial impact Impact on friends Relationships and sex life Making adjustments to everyday activities Communicating with health care professionals Childcare and parenting Need for aids and equipment Managing work and study Coming to terms with pain Impact on the family Finding new work Coping with the emotional impact Social Life Sleep and Fatigue www.healthtalkonline.org

3. Variation • What should we look for? • Where should we look? • What evidence is there of the quality of care? • Is this matched to need?

4. Where we have looked - potential Indicators • Prescribing Data – PCT level • National Pain audit – Organisational Data Provider level • HES activity data –outpatient and inpatient activity and costs – PCT level • CQUIN project - unscheduled care in UHS • Quality of Provision of specialist pain care – National Pain Audit

5. 1- Prescribing • Is best practice being followed? • What might be an indicator of problems?

6. Issues (Troup studies in USA) “When the necessary resources of time, personnel, and multidisciplinary rehabilitation are not available, physicians tend to bypass the principles outlined in the guidelines and comply with patients' demands for increased opioid doses, even when the treatment goals are not achieved.”  ”prolonged, high-dose opioid therapy may be neither safe nor effective”

7. Use of pain medicines prior to referral Average time from diagnosis to pain medicine: 2 months Average time from pain medicine to referral: 2 years 33% of NeP patients received <1 medicine recommended by BPS guidance THIN analysis of patients referred to a pain consultant (over 1 year) with a preceding NeP diagnosis within last 5 years

8. NIC/1000 (£) on pain medicines Estimated from Qtr to Dec 2011: http://www.nhsbsa.nhs.uk/PrescriptionServices/2585.aspx * Other Includes: Co-Codamol, Co-Proxamol, Paracetamol Co-Dydramol & Others in this category

9. 2 -planned specialist pain services in SoE • Access • Content • Quality – patient experience, clinical effectiveness

10. 18 week waits (clinic estimate) Is this time to first appointment rather than when a patient needed it? What about time to treatment? What is important to patients?

11. Pain Outpatient AppointmentsSouth of England Dr Foster Data on Pain Outpatient Appointments Jan – Dec 2011

12. Access to multidisciplinary care per head of population East Sussex and IOW have high coverage The Shires in the SoE have mainly very low coverage

15. Source National Pain Audit Dec 2012

16. 3-Unscheduled care visits • Unscheduled care visits for people with LTC’s are a barometer for the system

17. Those at high risk of admission Southampton using the adjusted clinical groups tool (RUB 3-5) MSK disorders have significant co-morbidities – CVS/depression most common; require careful meds management and multiple needs

18. % of enduring frequent attenders in UHS (c 300 p.a. /800 FA’s p.a.) Many people in this group have unresolved medical .surgical issues Many people in this group have alcohol related pain Many people in this group present with non specific pain issues & have h/o personality disorder Many of this group were transient frequent attenders – all have clear care pathways in place

19. Top 10 pain-related inpatient admissions over 1 year Dr Foster Data on Pain-related Inpatient Admissions (September 2011 to August 2012)

20. Total pain-related inpatient admissions and associated tariff over 1 year Dr Foster Data on Pain-related Inpatient Admissions (September 2011 to August 2012)

21. Tackling variation • “The decisions made by individual doctors, population factors, and the settings in which care is provided have a substantial impact on costs and activity.” •  ”variations in standards of healthcare could be reduced by giving specialist clinicians greater responsibility for the design and planning of their own services.” Nigel Edwards