HAMILTON NIAGARA HALDIMAND BRANT LOCAL HEALTH … · There is currently a growing and aging population with a disproportionate number of smokers, obesity and co-morbidities. These

HAMILTON NIAGARA HALDIMAND BRANT LOCAL HEALTH INTEGRATION NETWORK

CLINICAL SERVICES PLANNING PROJECT

Chronic Pain

PLANNING ADVISORY GROUP MEETING GUIDE

May, 2009

HNHB LHIN Clinical Services Planning Project, Planning Advisory Group Meeting Guide

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1. Complete Template #1. Describe the strengths and challenges within the existing health care system in addressing population health care needs for the PAG’s patient/client population. Primers for discussion: ‘Summary of Community Values and Preferences’ (Appendix A), ‘Criteria for PAG Service Delivery Models’ (Appendix B) and ‘Guiding Principles for PAG Service Delivery Models’ (Appendix C).

Template #1: Strengths and Challenges within the Current System in Addressing Population Needs PAG Name

PAG Facilitator

Strengths Challenges There is an identified interest and passion for chronic pain. The

practitioners involved in caring for chronic pain patients have advocated to participate in the LHIN IV Clinical Planning process. The LHIN has supported this planning.

There is a long tradition since 1972 in Hamilton regarding pain management expertise

McMaster clinical faculties have lately emphasized pain awareness and the importance of pain relief, and our students upon graduation will be the clinicians of tomorrow in our region

Chronic pain patients are stereotyped to be of lower socioeconomic status, depressed, non-compliant, chemically dependent and/or drug seeking.

This is a patient population that is very challenging to work with and achieve positive outcomes for.

There is no political agenda advocating for this patient population. Their chronic pain condition often impacts their return to work and the economy. As a result, many of these patients have limited financial resources to purchase therapeutic services and/or treatment modalities.

There currently is no system/process in place to monitor the

magnitude of the demand for services for chronic pain patients (no provincial registry or wait time data regarding access to care), standardized triage system, nor clinical outcomes and/or indicators being evaluated on a provincial basis. There is no current Canadian data however guidelines have been suggested by NOUGG.

There is varying degrees of knowledge amongst all health care

practitioners of “chronic pain”. This may result in misinformation and/or under diagnosing patients. In addition, there are patients who


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There is currently a chronic pain center established within our LHIN at HHS and limited interventional procedures performed in other LHIN centers (Niagara Health and Joseph Brant)

There is currently one multidisciplinary pain rehabilitation program at HHS

There are self management programs established in the LHIN (Niagara)

There are several physicians who operate pain services in various

parts of the Hamilton medical community The McMaster University School of Medicine, Department of

Anesthesia has a pain management training fellowship which is offered to 3 candidates annually.

Within the School of Medicine's palliative care program there is

formal education for residents which is focussed on non-malignant pain.

do not have a family physician…collectively resulting in a limitation in determining the exact magnitude of this condition

The existing services are insufficient to meet patient demand. Each physician providing assessment/care for chronic pain has very long waiting lists. Many primary care physicians are not aware of those health care professionals providing expertise in chronic pain management.

There are insufficient resources to meet demand (including access to clinics, technology to support interventional procedures, dedicated procedure room) and there is a shortage of services for patients requiring multidisciplinary pain management. At present, the pain management center at Chedoke Rehab Center has been operating since 1972, and as a large multidisciplinary group since 1989. It is not permitted to treat patients who do not have third party funding. This means that many chronic pain patients are automatically excluded.

The sustainability of the hospital services providing care for chronic

pain patients is threatened by the current financial challenges at all hospitals across the LHIN

Within the hospitals, the current models are physician and nursing

only. There is the need for integration of a multidisciplinary team in both of the hospital and community setting.

There are no formal linkages between hospital services and

community resources for chronic pain (e.g. PT, psychology, psychiatry, CCAC, social work, pharmacy)

Community/non-hospital resources are often not covered under

current OHIP fee schedule. The majority of these patients are unable to pay for service.


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There are local practitioners with a higher level of knowledge and

expertise who have the capability to develop practical guidelines There is an academic interest in chronic pain associated with

McMaster University School of Medicine. There is national and international support for the treatment of

chronic pain and the development of clinical algorithms and practice guidelines.

There is ongoing monthly educational sessions offered by the

Department of Anesthesia There is a recognized correlation between the management of acute

pain and chronic pain. Within our acute care hospitals, there is the ability to identify chronic pain patients prior to surgical intervention to provide appropriate post-operative care (acute on chronic)

There are some local patient advocacy associations within the LHIN

(local chapter of RSDS, MS Society) There is great staff satisfaction from participating in the

care/management for chronic pain patients. There are positive patient outcomes from patients who receive care

in the Chronic Pain Clinics and/or interventional procedures

From a primary care perspective, patients may have challenges accessing a primary care physician to initially assess, diagnosis and treat their co-existing medical problems, which adds to the complexity of the chronic pain condition

There is a need to improve communication and collaboration with

WSIB for occupational related injuries to provide a more patient centered and seamless utilization of resources.

There is a need to have more practitioners with the knowledge, skill and judgment related to chronic pain (anesthesia, family/primary care physicians, APN’s, psychiatry, psychology, social work, pharmacy, nursing, PT/OT) and ongoing formal mentor ship and collaboration with experts in pain management

There is no formal curriculum within the School of Medicine, Nursing, PT/OT related to chronic pain.

There are no established practical guidelines in place for the care and treatment of chronic pain. The NOUGG is a national consortium of regulatory bodies in Canada that is well on the way to producing evidence-based guidelines for pain management and harm reduction, and will be disseminating these guidelines within this year.

There is misinformation regarding the pharmacological management of chronic pain and concern from the primary care practitioners regarding the dosing of narcotics

Many primary care physicians are unwilling to prescribe opioids for

pain relief – a Canadian epidemiological survey revealed recently that one third of Canadian physicians would not prescribe opioid for pain even as a third-line drug option.

Many family physicians require education to manage the patients’

ongoing issues following assessment and/or intervention by the “chronic pain practitioner”


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There is the need for an electronic health record and/or access to a provincial data base for an up to date list of all patients medications (this data is available for ED physicians for a limited group of patients).


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2. Complete Template #2: Describe the leading factors that are most likely to increase or decrease the demand for health care by the PAG’s patient/client population by 2013. For each of these factors, indicate whether it will have a modest or significant impact on the future demand for health care. And, list factors that may influence the demand for care beyond 2013

Template #2: Factors Most Likely to Increase or Decrease the Future Demand for Health Care: PAG Name:

Describe the Factor that will increase or decrease the demand for health care by 2013: Will this

factor have a modest or significant impact on future demand for health care?

Health promotion/disease prevention strategies that will reduce the prevalence of preventable health conditions will decrease the demand for health care in the future.

The current economic climate is contributing to increased unemployment resulting in an increased sedentary lifestyle, poor

nutrition and a decline in overall health of individuals both physically and mentally. These factors will contribute to an increased amount of disability and demand for services.

Strategies to improve timely access for the treatment of acute conditions will decrease the likelihood of chronic conditions

and chronic pain (specifically access to total joint surgeries).

The delay in the treatment of acute care needs of patients will cause health status to deteriorate over time as wait times continue to increase. Those under serviced areas will continue to experience poor health status thus increasing the demand for services.

Improved access to diagnostic tests (CT and MRI) will improve the primary care practitioners’ and specialists access to diagnostic results. This improved access will have a positive impact on timely diagnosis of conditions impacting chronic pain.

Significant To be determined Significant Modest Significant Modest


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PAG Name:

Describe the Factor that will increase or decrease the demand for health care by 2013: Will this factor have a modest or significant impact on future demand for health care?

There is currently 15% of the LHIN population who experience pain resulting in a decreased activity level. This pain if left untreated will develop into chronic pain coupled with the increased likelihood of comorbidities leading to an increased demand for services.

Advances in information/communication technology and the availability of health information, empowers people to assume

greater responsibility for their own health. An increased awareness of the services available and increased advocacy will increase the demand for services.

Technological advances, such as the increased use of ultrasound, may decrease the need for more costly diagnostics such as fluoroscopy resulting is a decreased financial demands on the health care system.

The implementation of best practice guidelines with improved and standardized treatment modalities will result in improved

management of chronic pain These will enable primary care practitioners to support shared care and resume total care of patients resulting in better patient outcomes and less long term use of secondary and tertiary care centers.

The limited availability of human resources and the changes in the scope of practice of health professionals in this area

increase the need for recruitment and retention of anesthesiologists to manage this complex, challenging and chronic patient population. A remuneration schedule that supports the care provided will also support recruitment and retention of these specialized practitioners. This will enable more specialized service delivery with better clinical outcomes and a decreased demand for health care.

The increased public awareness of chronic pain and advocacy for this will heighten political awareness creating an

increased demand for services.

There is currently and will continue to be a population that demands timely access to standardized care with expected positive outcomes. This will increase the demand the health care.

Significant Significant Modest Modest Significant Modest


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PAG Name:


Prevalence of chronic pain now is 7% of those under 20, increasing with age to 40% of those who are elderly, and overall

prevalence in adults of 15%. Expertise needs to be developed at the primary care level to identify and manage chronic pain and to decrease the dependence on specialists with increase waiting lists.

There is currently a growing and aging population with a disproportionate number of smokers, obesity and co-morbidities.

These require services that address each of their chronic health care needs with a multidisciplinary approach.

Modest Significant

What factors are expected to influence the demand for health care beyond 2013?

A lack of human resources particularly family physicians with less time to devote to chronic pain and an increased need to seek assistance from other sources will continue to influence the demand for health care.

A continued growing aging population with comorbidities and a sedentary lifestyle will continue to influence the demand for health care.

The implementation of best practice guidelines with improved and standardized treatment modalities will result in improved management of

chronic pain.

The limited availability of human resources and the changes in the scope of practice of health professionals in this area increase the need for recruitment and retention of anesthesiologists to manage this complex, challenging and chronic patient population. A remuneration schedule that supports the care provided will also support recruitment and retention of these specialized practitioners. These limited resources will continue to influence the demand for health care. There are at least three arenas of pain management that address different aspects of this problem. For interventional pain, anesthetists traditionally were the only practitioners, but now there is a significant presence of primary care MDs who have changed scope of practice, and a few dentists. For pain management there are a few psychiatrists, many


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PAG Name:


psychologists including those involved in no-fault accident benefit funded treatment and a few multidisciplinary or rehab clinics. For pharmacological management there are increasingly primary care doctors and representatives of other specialties with special expertise. The focus needs to be on all three types of pain management strategy and practitioners to provide the care. Likely in the near future there will be a development of credentialing of non-specialists in pain management to address the manpower gap.


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3. Complete Template #3. Describe the key components of an ideal service delivery model for the PAG’s target population.

Template #3: Components of an Ideal Service Delivery Model Preamble: Prevalence of chronic pain now is 7% of those under 20, increasing with age to 40% of those who are elderly, and overall prevalence in adults of 15% if one includes chronic intermittent pain (eg trigeminal neuralgia, chronic migraine) plus chronic continuous pain. Epidemiological studies show that three months is the point after which signs of chronicity and deteriorating prognosis begins to set in, and efficacy studies show universally that multidisciplinary and rehabilitation procedures can be shown to be effective up to the subacute stage (up to three months) and not later. There is consensus among many agencies (College of Family Practice, OMA Pain Physicians Section, Canadian Academy of Pain Management, Nova Scotia Ministry of Health, Royal College of Physicians and Surgeons Task Force on Pain Specialization) that expertise needs to be developed at the primary care level to identify and manage chronic pain. Treatment at that point is essentially rehabilitation, work reentry strategies, treatment of coexisting psychological distress, and analgesic if indicated. The efficacy of that early intervention approach has been documented in prospective trial by the group of Loisel et al in Sherbrooke. It is not at all feasible to base acute or subacute pain care on staffing of specialty clinics, psychologist run clinics, opioid/drug prescribing clinics, since there will never be enough specialists, the wait times will be too long, the location will not be near primary care, and the procedures will tend to be specialty specific rather than based on the need to prevent onset of chronic pain and disability at the primary care level. There is no study or meta analysis that proves the efficacy of specific pain procedures in improving function or return to work in the chronic population (6 months or more) or with procedure oriented treatment (interventional injection therapies, multidisciplinary behavioral treatment outside the work setting, or pain drugs).


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PAG Name PAG Facilitator

Component of service delivery model

Services associated with this component of the model

Clinical and non-clinical interdependencies (e.g., DI, lab, other programs/services, other PAGs)

Linkages to community services

Health Promotion/Disease Prevention

Public education regarding healthy lifestyle (obesity, need for activity, backpacks, management of other chronic health conditions, body mechanics, minimizing risk of repetitive strain injuries) Available access to support groups and physicians to enable patients to be better informed about chronic pain Easy access to local resources Physician and health care professional education, training and mentor ship

Provincial Medication registry CPSO Pharmacy Patient registry for Chronic Pain and wait times

WSIB Occupational Health and Safety School Boards - fitness and healthy lifestyle education Public Health (Health Promotion strategies, management of chronic illness)

Primary Care

Easy access to a network of regional pain centers. Practical guidance for physicians and primary care health practitioners in the emergency departments and walk-in clinics specific to management of chronic pain patients. Family physicians will have access to a local mentor who is available for consultation to enable standardization of care. A centralized referral system, that is based on criteria, and will enable primary care practitioners to appropriately access tertiary care, pain management specialists and multidisciplinary care (psychology, psychiatry, rehab, anesthesia , etc)

CT/MRI wait times Medication registry Provincial electronic health record Fundamental knowledge and skills regarding chronic pain management taught in medical, nursing, OT/PT programs, pharmacy and social work Establishment of a LHIN/provincial registry for Chronic Pain to monitor Wait Times

CCAC Public Health


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Readily accessible health professionals with the expertise in chronic pain to provide ongoing consultation. The ability to monitor wait times from the family physician to the time the patient is assessed and provided treatment at the secondary and tertiary levels. College endorsed guidelines regarding the safe and effective use of opioids for chronic pain patients which have been translated into practice A provincial monitoring system for prescribing opioids. A fee code for assessing and treating CNCP (Chronic noncancer pain) which recognizes the increased time required to assess, monitor and counsel CNCP. CME courses specific to managing chronic pain patients. The recognition by the MOHLTC of chronic pain as a chronic condition A mentorship program of pain experts attending all LHIN primary care clinics from time to time would provide the best education and support in the most timely way with the greatest impact. This could also be aimed at the early identification of


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work absence and strategies for occupational rehabilitation before disability becomes permanent.

Acute Pain Management for acute hospitalization post operatively

A well established acute pain service with a multidisciplinary model, established collaborative practice model with practitioners and/or services with expertise in chronic pain. Service specific clinical pathways for the management of acute pain. Pain Specialist designated by a Royal College Fellowship A designated Pain Nurse to liaise with the physician and the patient/ the patient and their family/ and the hospital who updates the chronic pain condition and vice versa from the acute pain service to the chronic pain clinic. Identification, by primary care practitioner and/or specialist, of patients who are not responding well to the plan of care for acute pain. A standardized triage process for referral to tertiary and quaternary care.

Decision support with user friendly database Infusion technology for PCA and Epidural with smart technology. Access and collaboration with pharmacy, vendors, WSIB and third party insurance Timely access to surgical/interventional services (e.g. Neurosurgery, orthopaedic surgery) Linkages with appropriate PAGs (neurosurgery, MSK, chronic illness)

Canadian Neuromodulation Society CCAC Clinic follow up CP society March of Dimes


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Secondary Level (provider of chronic pain services with specialized expertise)

A standardized triage process to enable the referral to the tertiary pain center. The referral will include an adequate assessment of the pain mechanism, a functional assessment and existing comorbidities. The majority of chronic pain patients cannot be managed by anesthesiological procedures or neurostimulation. Rehabilitation and management of work and traffic injuries are examples that require behavioral, rehab, psychological, and pharmacological expertise. This exists in several places in the community and academic network, however patient volume is in excess of resources. Since chronicity starts at about 3 months, these resources are needed in the secondary more than in the tertiary centers

Decision support with user friendly database Infusion technology for PCA and Epidural with smart technology. Access and collaboration with pharmacy, vendors, WSIB and third party insurance Timely access to surgical/interventional services (e.g. Neurosurgery, orthopaedic surgery) and rehabilitation teams. Linkages with appropriate PAGs (neurosurgery, MSK, chronic illness)

CCAC Specialized multidisciplinary outpatient chronic pain and rehabilitation clinics. Primary Care Physicians


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Tertiary Care Center

A standardized triage process for referral to a tertiary care center from the primary care practitioner and/or specialist (secondary care). By definition the tertiary center will offer minimally two of the following: a pain management specialist with one allied health practitioner or psychology or psychiatry or nursing. Services to be provided here to include stellates, lumbar and caudal injections, facet blocks and cervical epidurals. There needs to be established thresholds on procedures to maintain competency These services would be regional and beyond the primary level to include Hamilton, Niagara, Brantford and Burlington A designated Pain Nurse to liaise with the doctor and the patient; the patient and their family; and the hospital providers to formally communicate with the chronic pain clinic and/or pain specialists.


CCAC Specialized multidisciplinary outpatient chronic pain clinics Community agencies (NM; MS Society) Primary Care Physicians


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Quaternary Care Center

This center would manage those patients who are complex with multi faceted issues and present challenges for the tertiary care center. This center would have a lead academic and research role in the LHIN with all aspects of chronic pain management. There is an accountability for a standardized triage process and dissemination of evidence based practice across the LHIN. Services here would include all services provided at the tertiary care center as well as neuro stimulators and intrathecal modes of pain relief delivery. There needs to be established thresholds on procedures to maintain competency. Neuromodulation program and advanced interventional treatment such as spinal cord stimulators


CCAC Specialized multidisciplinary outpatient chronic pain clinics Community agencies (NM; MS Society) Primary Care Physicians


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Chronic Pain Clinic

A multidisciplinary outpatient clinic which provides a full range of services for the patient with chronic pain, including psychology; psychiatry, PT/OT, nursing, pharmacology, social work. These outpatient clinics would be located throughout the LHIN. Referral to a Chronic Pain Clinic would be from primary, secondary, tertiary or quaternary care levels. Well established linkages with community and acute care resources including WSIB, rehabilitation clinics, etc, as well as expertise in all health professions for the management of chronic pain.

WSIB Linkages with appropriate PAGs (neurosurgery, MSK, chronic illness and rehabilitation)

Primary, Secondary, Tertiary and Quaternary Care Providers CCAC


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Diagram of Ideal Service Delivery Model:


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Template #4. Assess and Describe the PAG service delivery model using the HNHB LHIN Criteria PAG Name

Domain Criteria Assessment Description Strategic Fit Alignment with LHIN

priorities for health improvement

The model is aligned with the priority of Chronic disease prevention management with the management of chronic pain as a major priority. This model, while focusing on the education and mentorship of primary care practitioners, will promote diversion from emergency department visits and appropriate use of specialty care.

Alignment with trends in health care needs and system transformation

The model will enable chronic disease prevention management

Health status (clinical outcomes & QOL)

Persistent pain is associated with increased with unemployment, depression and psychological issues and other comorbidities thus creating a vicious cycle. This model will improve the quality of life for patients resulting in less dependency on the health care system. There will be more efficiency and an ability to respond quicker to patient needs in a more cost effective manner. We will also have the ability for early identification of patients requiring a higher level of care to promote appropriate access to care.

Prevalence Prevalence of chronic pain now is 7% of those under 20, increasing with age to 40% of those who are elderly, and overall prevalence in adults of 15% if one includes chronic intermittent pain (eg trigeminal neuralgia, chronic migraine) plus chronic continuous pain. Epidemiological studies show that three months is the point after which signs of chronicity and deteriorating prognosis begins to set in, and efficacy studies show universally that multidisciplinary and rehabilitation procedures can be shown to be effective up to the subacute stage (up to three months) and not later.

Health promotion & disease prevention

This model promotes early access to pain management to improve prognosis and promote and maintain good health combined with public education related to good body mechanics. In order to continue to promote good health and address illness the model is also designed to treat patients at the acute level, prior to 3 months, to prevent the deterioration to a chronic state.

System Values Client-focus The client is defined as the patient, the health care provider, industry, academia and WSIB. This model is not only patient and family but also industry (return to work) focused enabling the right care


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PAG Name

Domain Criteria Assessment Description at the right place at the right time.

Partnerships Partnerships will well be established with patients, industry, other health care providers, WSIB and educational institutions. Thus streamlining and coordinating access with the broader health system.

Community Engagement There is strong engagement of primary care practitioners which will clearly reflect community needs and preferences. 90% of the patients will be cared for by primary care physicians who are located in the community. The development of centers of excellence in tertiary care centers with open communication back to primacy care practitioners will enable the return of patients to the community. Community engagement will also be established with respective hospitals, including St. Joseph's hospital, the department of family medicine and the LHIN 4 Perioperative Directors.

Innovation This model is highly organized with clear connections and the prevention of silos. Through the use of clinical practice guidelines, advanced information technology and the funding of mentorships this model will prove to be innovative and sustainable. The tertiary and quaternary centers will focus their resources on the most complex clients and foster leadership through research and the establishment of best practice guidelines while supporting the primacy care practitioner in delivering 90% of the care.

Equity Currently we are caring for 90% of the patients at the primary care level however, this is not done in a coordinated and efficient manner. The current state prevents patients from being cared for properly and in a timely manner. This model will improve acces to efficient care at the primary care level through mentorship, a clear triage process and wait time monitoring from the tertiary and quaternary centers.

Efficiency (operational) This model will avoid inappropriate referrals to tertiary centers through a well defined triage process and wait time monitoring. There will be the appropriate care by the appropriate care provider, patients will have a clear plan of care to be followed by the primary care practitioner and only referred on when necessary.

System Performance Access Access to the most appropriate care in a timely manner will be achieved. Mentorships will be established


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PAG Name

Domain Criteria Assessment Description to improve the knowledge, skill and judgment of primary and secondary care providers.

Quality Best practice guidelines will be utilized at all levels of the model to ensure quality health care delivery. Ongoing clinical trials are an expectation of the quaternary academic center. Mentorships will be established to advance the knowledge, skill and judgment of primary and secondary care providers to improve care delivery.

Sustainability

Infrastructure is needed to ensure sustainability as well as clear organization, patient registry and wait list registry. Linkages and mentor ship between centers already exists however formalization of this will ensure it's sustainability.

Integration

This model will ensure the continuity of care across various care settings and health care professionals


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Complete Template #5. Describe the pre-requisites, enablers and challenges to implementation of the ideal service model.

Template #5: Description of Pre-requisites, Enablers and Challenges to Implementation: Category Pre-requisites Enablers Challenges Policy/legislation Acknowledgment of chronic pain

as a chronic disease. Legislative acknowledgment of primary care practitioners with credentialing and expertise for referral.

Fee codes for complex chronic pain management. Medication registry. Credentialing of Pain Management Specialists. Wait list registry. Electronic Health Record

The current lack of a certification process to identify pain specialists. Credentialing. Well established mentorships and remuneration for these.

Resources (e.g., human, fiscal, capital, etc.)

Multidisciplinary resources which are publically funded (coverage for Physiotherapy).

Wait time data for chronic pain. Allocation of funding for neuromodulation in LHIN IV.

Currently there is no funding for the Neuromodulation Program in LHIN IV. Critical components of the multidisciplinary team are not funded (OT/PT, psychology). The need to establish infrastructure to enable appropriate triage. Objective wait time data. Well established mentorships with financial remuneration.

Community readiness

There needs to be an infrastructure to support mentorships and referrals. Access to primary care practitioners (MD, NP's)

There are many primary care physicians who are supportive. Patients and providers (including WSIB) are requesting a system that is timely and seamless. There is community readiness for better quality of life.


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Services

There needs to be adequately trained and knowledgeable staff. Adequate human resources that will enable an increase in the number of secondary level providers. There needs to be dedicated procedure room time with imaging, knowledgeable staff and adequate funding at the tertiary and quaternary care levels. There needs to be an established Acute Pain Services at all acute care hospitals.

Adequate funding and human resources. Strong partnerships and linkages with all disciplines.

There is currently a lack of an organizational acknowledgment of chronic pain as a priority. Adequate funding to support the operating supplies and equipment. Adequately trained and knowledgeable staff.

Partnerships/linkages

Partnerships need to be well established with patients, health care providers, industry and academic centers. A clear referral process. The engagement of key stake holders

The engagement of key stake holders. Political readiness, the Canadian Pain Society and Canadian Pain Coalition is ready to address this problem. Community readiness Academic readiness, universities need to be interested, specifically the Department of Anesthesia to provide education and linkages and the development of pain curriculum for all health disciplines.

The engagement of WSIB


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Appendix D: Meeting #1: PAG Meeting Summary Form: PAG Meeting Summary Form Meeting #1

PAG Name: Chronic Pain

PAG Facilitator: Dr. Norm Buckley & Leslie Gauthier

Summary of PAG progress: 1.0 Reviewed mandate of PAG working group 2.0 Reviewed membership of chronic pain PAG and the perspective each member was representing 3.0 Completed Template 1 and 2 4.0 Initiated Template 3 5.0 Plan: electronically circulate Templates 1 – 3 for feedback and revisions. Outstanding questions or Issues for follow-up 1.0 Revision of Template 3 to reflect the components of a service delivery model specific to chronic pain (the current template is not applicable to

the service model) Information and questions to be communicated to other PAG(s) 2.0 need to follow-up if other PAG’s are considering the role of an Acute Pain Service during the acute hospitalization for specific patient

populations (orthopaedic, neurosurgery, GI,) Other comments


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Appendix E: Meeting #2 PAG Meeting Summary Form: PAG Meeting Summary Form Meeting #2

PAG Name: Chronic Pain Facilitator: Dr. Norm Buckley and Leslie Gauthier

Summary of PAG progress 1. Completion of templates 4 and 5 2. Refinement of the model and diagram Outstanding questions or Issues for follow-up Information and questions to be communicated to other PAG(s) Identification of the importance of a strong linkage for all acute surgical/trauma services (at all sites) to have a well established acute pain service. Other comments


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Appendix F: Meeting #3 PAG Meeting Summary Form: PAG Meeting Summary Form Meeting #3

PAG Name: Chronic Pain Facilitator: Dr. Norm Buckley and Leslie Gauthier

Summary of PAG progress: 1. Reviewed/revised Templates 1-5 2. Reviewed/clarified the model and diagram 3. Identification of stake holders for discussion Outstanding questions or Issues for follow-up: What are the linkages with other PAGs, specifically mental health and addiction, rehabilitation, pediatrics, geriatrics, ED trauma, oncology, ENT, orthopedics. Information and questions to be communicated to other PAG(s) – Indicate if a joint meeting with another PAG is desired. Other comments

Documents

HAMILTON NIAGARA HALDIMAND BRANT LOCAL HEALTH … · There is currently a growing and aging population with a disproportionate number of smokers, obesity and co-morbidities. These