Start and run a pain clinic

START AND RUN A PAIN CLINIC

A.M.TAKDIR MUSBA

PROGRAM FELLOWSHIP OF INTERVENTIONAL PAIN MANAGEMENT

KOLEGIUM ANESESIOLOGI DAN TERAPI INTENSIF

• Koord Pain Services di RS Wahidin

• Kerja di Pain Clinic

• Perwakilan KATI di KKI ttg IPM

• Pokja Nyeri di Kemkes

• Indonesia Pain Society

• Program FIPM Anestesi

• Komisi Fellowship di KATI

Blueprint of PM Development in Indonesia

Nurse School

Medical Faculty

Specialist Program

•Pain Subject in curriculum

•Pain education in every degree

•Role of professional health care provider

Primary Care Centre

•Pain as priority ( 5th vital sign )

•Pain training and competency

•Available of drug

•Guidelines and Clinical Pathway

•Pain Palliative Care

•Pain in medical system and referral system

•MoH Support

•Pain organization support

•Pain CME

Secondary and TertierCare Centre

•Pain Competency for Medical provider

•Acute Pain Services

•Guidelines and Clinical pathway

•Procedures standardize (SOP)

•Available of drug and equipment

•Interdisciplinary collaboration

•Hospital accreditation

•RESEARCH

GOOD PAIN MANAGEMENT IN COMMUNITY

Medical Education System Collegium Role in Competency

Medical Council (KKI ) regulationPain Society Organization ( IPS )Hospital Organization ( PERSI )

Ministry of Health Policy

OUTLINE

• A SHORT HISTORY

• THE NEED OF PAIN CLINIC

• TYPE OF PAIN CLINIC

• PREPARING PAIN CLINIC – HUMAN RESOURCES

– SYSTEM

– EQUIPMENT

– FINANCING

• IDEAL CONCEPT OF PAIN CLINIC

PAIN CLINIC HISTORY

• Pre- Bonica era – Pain Management concept

– Scholleser, 1903 : injecting specific nerve for analgesia

– Rovenstine, 1936 : first nerve block in pain clinic

– Pain practice and centres unorganized and a sngledisciplinary approach

• Bonica, Waldman and Raj ( 1947 till now ) in Seattle– Bonica, 1947 : First Multidiscplinary pain clinic

– Waldman, 1995 : Interventional pain management term

– Prithvi Raj, 1993 : World Institute of Pain ( WIP )

We need PAIN CLINIC

• PLACE FOR START IN PAIN PRACTICE

• PREREQUISITE FOR INVOLVE IN PAIN

• PATIENT KNOW WHERE THEY GO

• PLACE FOR CONSULTATION, DIAGNOSTIC,

FOLLOW-UP AND OTHERS

• SOME PROCEDURES CAN BE DONE

PAIN CLINIC ANESTESI (IPM)

TYPE OF PAIN CLINIC

• MODALITY ORIENTED PAIN CLINIC

• SINGLE-DISCIPLINARY PAIN CLINIC

• MULTI-DISCIPLINARY PAIN CLINIC

• MULTI-DISCIPLINARY PAIN CENTRES

• HOSPITAL-BASED PAIN CLINIC

• SOLO PAIN CLINICS

ADVANTAGES AND DIS-ADVANTAGESOF PAIN CLINIC TYPE

PREPARING PAIN CLINIC

1. HUMAN RESOURCES

2. SYSTEM

3. FACILITY

1. HUMAN RESOURCES

• DOCTORS

• NURSES

• RADIOGRAFERS

• REHABILITATION TEAM

• PSYCHOLOGIC TEAM

• NON-MEDICAL SUPPORTING TEAM

– Doctor’s holistic view on pain management ?

– Every Specialty have Specific Modality, but collaboration ?

– Willingness and preparedness to work in Pain ?

– Well trained interventionist ?

– Pain Specialist ?

– Nurse Pain ?

Some question in HUMAN RESOURCES

DOCTOR COMPETENCY IN PAIN

• IDEALLY– ASSSESSMENT TO TREATMENT– HOLISTIC POINT OF VIEW– PAIN SPECIALIST

• COMPETENCIES IN PAIN MANAGEMENT – MEDICAL DOCTOR in SKDI 2012– PROGRAMMES FOR SPECIALIST TRAINING AND CERTIFICATION

• ACGME “Subspecialty Certification in Pain Medicine”, 1992 • ACGME-accredited Pain Fellowship, 2005• Fellowship of Interventional Pain Practice,WIP, 2001• ASIPP ( American Society of Interventional Pain Physicians), 1998• EFIC ( European Federation IASP Chapter )

Indonesia conditions

• Legal fundament for IPM procedures ?

• Medical competencies for pain management ?

• Standard Procedures IPM technique ?

Clinical Privileges

• Collegium based

– Program kompetensi tambahan

• Komite medik credential

• Self-assessment

PENDIDIKAN KONSULTAN MANAJEMEN NYERI -KATI

Lulusan : 33 orang Dr.SpAn-KMN

PROGRAM FELLOWSHIP IPM

CLINICAL PRIVILAGE Dr.SpAn di RS berdasar Buku Kewenangan Klinis

•Pengajuan Kewenangan Klinis•Credential Komite Medik RS•Surat Penugasan Klinik dari Direktur RS

Muatan Nyeri di kurikulum PPDS, 2017

Kewenangan Klinis Manajemen Nyeribagi Spesialis Anestesi

2. SYSTEM

• HOSPITAL POLICY

• PPK, CLINICAL PATHWAY

• FINANCIAL COVERAGE

• REFERRAL AND INTERDISCIPLINARY COLLABORATION

• MONITORING AND EVALUATION

Pain Clinic plan UNI-DISCIPLINARY PAIN CLINIC MULTI-DISCIPLINARY PAIN CLINIC

Pain Clinic in Hospital IT System

Financial system

• Investment

• Insurance coverage

– ICD 10 diagnosis, ICD 9-CM procedures

• Fee and reward system

PPK, SPO, CP

Pain referral services

Multidisciplinary team

Pergolizzi J. TOWARDS A MULTIDISCIPLINARY TEAM APPROACH IN CHRONIC PAIN MANAGEMENT

3. FACILITIES • OPD

– Equipmet tools for pain measurement– Basic equipment at OPD

• PROCEDURES ROOM– Fluoroscope / C-arm machine– Radio-protective equipment– Surgical table c-arm compatible– Ultrasound machine– Radiofrequency generators– Equipment for CPR – Vital parameter monitoring– Medicine /Drugs – Advanced equipment

Some deficiencies of Pain Clinic

• Over-dependencies on interventional procedures

• Lack of evidence practice

• Lack of multidisciplinary model

• Lack of safer drug for long term used

• Failure to establish palliative care model for chronic pain

• Vague and restricted criteria for reimbursement

Ideal pain clinic

• Promoting multidisciplinary team approach

• Coordinating all specialist effort

• Measuring the outcome of treatment offered

• Promoting palliative model rather than curative models of pain treatments

• Identifying complications of IPM and promoting safe and base-evidence intervention

• Thank you very much for your kind attention