I was fascinated to learn this week that one in three children being referred to pain clinics are identified as the ‘least disadvantaged’ while one in eight referrals were from areas identified as the most disadvantaged.
We know that adult patients were equally likely to be referred to a pain management service regardless of whether they lived in an area of high compared to low disadvantage as outlined in the ePPOCC data.
Another interesting insight is that we actually know that pain management works – and that’s more than most health services can demonstrate. A significant proportion of people presenting to our multidisciplinary pain clinics are reporting clinically meaningful improvement in their depression (57%) and anxiety (41%).
Almost half of all patients were able to reduce their opioid dose by 50% or more and there was a 35% reduction in healthcare utilisation (including emergency department presentations, hospital admissions and GP/specialist/allied health visits). Those are quite compelling statistics.
This week, Painaustralia participated in the Clinical and Management Advisory Committee meeting for the electronic Persistent Pain Outcomes Collaboration (ePPOC).
ePPOC is a program which aims to help improve services and outcomes for patients experiencing chronic pain through benchmarking of care and treatment. Managed by the Australian Health Services Research Institute at the University of Wollongong, ePPOC is an initiative of the Faculty of Pain Medicine ANZCA and has been further developed in recent years by the Faculty and the wider pain sector. ePPOC’s governance is managed by key stakeholders within the pain management sectors, including the Faculty of Pain Medicine, consumer groups, the Australian Pain Society and Painaustralia.
ePPOC involves the collection of a standard set of data items and assessment tools by specialist pain services throughout Australia and New Zealand to measure outcomes for their patients as a result of multidisciplinary pain management and treatment. Participation in ePPOC is voluntary, despite its support across the pain sector with over 80 services currently participating.
The results are startling and present a more detailed picture of who is accessing services to support them in managing their chronic pain condition.
ePPOC data collected over the past 12 months shows that in Australia prior to receiving pain management services:
patients had been visiting a health care clinician every week (on average) for their pain
over 75% of people were of working age
26% were employed
Those who were employed missed over 25% of their usual hours due to their pain.
A large proportion of people accessing pain services also reported depression (37%) and anxiety (25%)
63% are using opioid medications.
While ePPOC facilitates the routine collection of pain management data to drive quality improvement through reporting and benchmarking, one of its most important functions is providing a way for clinicians to systematically assess individual patient experience. Important benchmarks that ePPOC measures to ensure clinically significant improvements include progress against pain interference, depression, anxiety and stress, as well as pain self-efficacy.
ePPOCC is one of the most valuable tools we have at our disposal to ensure that multidisciplinary pain management continues to deliver outcomes for people living with chronic pain. Unfortunately, despite its broad uptake, not all services participate, and to date support for publicly-funded pain services to participate has generally been short-term, and variable across jurisdictions.
It is perhaps an indictment on our approach to health policy and funding that we continue to support many interventions and programs with limited evidence of efficacy while ignoring those that demonstrate high value and are cost-effective.
That is why securing the future funding of the ePPOC is an important goal under the National Strategic Action Plan for Pain Management. This includes developing a model for outcomes measurement developed at the primary care level and ensuring all public pain services can be funded to participate.
We know that multidisciplinary pain management is the gold standard of treatment for chronic pain, but it is also vital that we keep measuring and improving patient centred outcomes. Ongoing monitoring and benchmarking is critical to ensuring that we can keep delivering the best care to some of the most vulnerable people in our society.
ePPOCC is certainly demonstrating its worth and that of the services that support some of the most difficult to treat and complex patients living with chronic pain. Surely this is an opportunity to walk to the talk by measuring and improving our health services. Its time that our health system aimed to measure (and ideally pay for) quality outcomes.