Stepped Care Model for Pain Management

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Stepped Care Model for Pain Management

• Nabiha Gill, MD
• Staff Physician PMR
• Chair, Indianapolis VA Pain Committee
• Chair, VISN 11 Pain Committee
• Assistant Professor, PMR, IUPUI, Indianapolis, IN

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Objectives

• Progress as facility pain committee
• Progress as VISN pain committee
• Successes
• Struggles
• Next steps

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Indianapolis VA Pain Committee
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Indianapolis VA Pain Committee

• Updated pain committee member list
• Added more pain disciplines rep
• E-mail group for communication
• More structured
• More enthusiasm, motivation, energy among members
• Updated/reviewed committee objectives
• Developed Multidisciplinary Virtual Pain Team
  Consultation

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Multidisciplinary Virtual Pain Team
Consultation

• Developed Multidisciplinary Virtual Pain Team
  Consultation
• Subgroup of facility pain committee
• Primary and secondary (back up) key people from
  each discipline
• Support from departmental chiefs and EMT
• More than 10 disciplines on the team
• Regular communication among team members
• Pilot program done in primary care

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Multidisciplinary Virtual Pain Team
Consultation

• Key members from following disciplines
• Physical Medicine Rehab Physician
• Pain Psychologist
• Physical therapist
• Rec therapist
• Interventional pain specialist
• Ortho spine surgeon
• Neurosurgery
• Primary care physician
• Pharmacist
• Patient advocate
• Social worker

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Multidisciplinary Virtual Pain Team
Consultation

• Developed CPRS consult order, virtual/historical
  visit/note title/note/alerts
• Chart review by all disciplines prior to case
  discussion
• Primary care provider gets invited to meeting,
  short case presentation by PCP.then consultation
  from all disciplines
• Opportunity for provider education about services
  from different pain disciplines and pain
  management
• Support for PCP
• Case example

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Proposed Stepped care model for pain management
for Indianapolis VA
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Proposed Stepped care model for pain for
Indianapolis VA
Multi-dis pain
Tertiary
Chronic Pain Rehab Program
Bupe Clinic/SATS
Int Pain Clinic
Sec
Secondary Consults
Pain Medication Management
Pain Policy
Primary
Provider education
CBT
Pain School
CBT
Pain Medication Management
Primary Care Clinics/Teams
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CRIPPComprehensive Rehab Integrative Pain
Program

• (Proposed)

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CRIPP (Comprehensive Rehab Integrative Pain
Program)
Team meetings with OEF clinic, pain clinic, CRIPP
staffing, PCP staffing (q6mon)
Bupe clinic/SATS
Multi-dis Pain
PCP
Chronic Pain rehab program
Screening Clinic
Chronic Pain Consult
CBT
PMMP
CBT
PMMP
Pain School
Sec.consults/int/SATS/Biofeedba/PT/accupuncture
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Tampa VA Chronic Pain Rehab Program training

• Excellent training

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VISN 11 Pain committee progress
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VISN 11 Pain Committee progress

• V-Tel
• Communication
• Face to face meeting
• HSB
• Stepped care model/policy/education plans
• VISN Ambulatory care council

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VISN Ambulatory care council

• Too many clinical reminders
• Not enough support for PCPs decisions
• Lack of access to comprehensive pain services
• Lack of pain care standards and policies
• On-site workshops on chronic pain management for
  providers
• Pain schools
• ORC
• CBT groups
• Multidisciplinary virtual pain team consultations
• Aquatic therapy
• Interdisciplinary pain rehab programs
• Opioid detox programs
• CAM

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Successes!!!
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Struggles!!!
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Next Steps!!
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Questions!!