The Medicines Management team have worked closely with local GPs and the Health Board's Persistent Pain Service (PPS) to facilitate strengthened collaboration with the aim of improving the care of patients experiencing persistent pain in the Swansea Bay University Health Board (SBUHB) area. This led to the development of a quality improvement initiative made up of three discrete pilot projects:
1. To provide introductory patient education sessions within the local community setting for patients currently on the waiting list for the PPS The overall aim is to improve the pain management experience of patients in SBUHB by increasing patient engagement with the PPS and therefore demonstrate a subsequent decrease in Did Not Attends (DNAs) for self-management strategies. To date it has been rolled out across two clusters in the SBUHB area.
Patient education sessions providing an introduction to what the service can offer, as well as an introduction to self-management have been offered to patients on existing waiting lists. Patients are invited to attend two sessions delivered locally in a face to face group setting by the team's specialist nurse, physiotherapist, pharmacist and psychologist. The first session is considers the biopsychosocial model and living with persistent pain. The second session discusses exercise and well being. Following the group sessions patients are given the opportunity to opt into a range of services provided by the PPS e.g. pain management programmes, physiotherapy, medication review etc. or to opt out of the service completely.
The project is in its infancy with collection of outcome data ongoing, however an initial reduction in the waiting list time for first appointments with the PPS has been seen. The service has also collected some positive patient qualitative data.
1. To improve the current referral mechanism for GPs wishing to access the PPS, including investigating routes of dynamic communication. This pilot has involved collaborative working between a small cohort of GPs, the Medicines Management team and the PPS. The aim is to support effective and timely communication between clinicians involved in the care of the patient.
The group has focused on discussing the current referral template for the PPS and working to ensure it meets the needs of GPs, whilst also including the necessary information required for PPS to assess the referral. The group have also investigated routes of electronic dynamic communication to support GPs and specialists during both the referral process and ongoing management of pain patients under the care of the service.
Data collection is ongoing however, pilot outcomes include the number of referrals which the PPS are able to accept and GP/PPS satisfaction scores following use of the strengthened referral/ communication mechanisms
1. To explore the use of an informal multidisciplinary team (MDT) to support GPs in their management of complex patients with both persistent pain and substance misuseComplex patients with both persistent pain and substance misuse can pose difficulties for GPs who are trying to manage their pain in Primary Care. The aim of this pilot is to support GPs in the management of this cohort of patients, who often fall between specialities and as a result may benefit from an MDT approach.
The aim of this pilot is to support GPs to manage the care of complex patients who experience persistent pain with a history of substance misuse. To date, the Medicines Mangement Team have facilitated two informal MDTs which have included specialist representation from the PPS, Community Drug and Alcohol Team (CDAT) and psychology. These MDTs have provided a forum for a small number of GPs to present complex patient cases in order to receive advice and support regarding their ongoing management.
Data collection is ongoing, however, pilot outcome measures include GP satisfaction and patient outcomes.
