January 9, 2012
MSK Initiative2nd Webinar
Low Back Pain
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Agenda
Webinar Housekeeping Project Update Tools Discussion Patient Self Management Evaluation Forms Feedback and Discussion
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Webinar Housekeeping
Audio and Visual Sound Chat Function Save
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Attendees
Doctors:
Herb, Jane, Mona, Helene, David
Facilitators:
Julia, Bruce, Brenda, Liza, Pam, Laura
Impact BC Host:
Christina, Lisa
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Project Update Discussion
Tool Kit– Explore the Tool Kit (Algorithm)– Test all tools as they fit your patient/practice– Provide Feedback on all tools– Send feedback form to PSP Central Weekly– Discuss project with coach support
www.gpscbc.ca/psp_msk
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Clinical Practice Tools – used at point of care and tools we want tested during trial period
Reference Tools – checklists and other materials that can be looked up in hard copy binder or in electronic format as physician interest and time permit
Patient Tools – to be completed by patient either jointly with GP, in the waiting room, or at home. These tools should be tested via GP pilot or with patient focus groups
Teaching Tools – optional for use in the learning / teaching sessions as aids
Inventory of MSK TOOLS & their classification
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Tuesday December 6, 2011 • Patient Questionnaire
• Red Flags
• Yellow Flags
• Assessment of Pain and Function
Patient History
Monday January 9, 2011•DN4
•Opioid Manager
•RACE
•Green Light
•Patient Self-Management Tools
•Personal Action Plan
•Low Back Patient Handout
Monitoring and Management
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Discussion Questions
1. Tell us how you implemented the tools into your practice ?
Patient Tools ? Clinical Tools ? Reference Tools? Teaching Tools ?
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Tools
Diagnostic Screening: DN4
Clinical Management: Opioid Manager RACE Green Light
Patient Self-Management: Personal Action Plan LBP Handout
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Low Back Pain
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DN4 Questionnaire
Utility:
To estimate the probability of Neuropathic Pain
Method: 4 Questions
Score: Yes=1, No= 0 /10 Points
If the patients score is equal to or greater than 4, the test is positive. (sensitivity: 82.9%; specificity: 89.9%)
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Opioid Manager
Assessment Patient Goals Opioid Risk Overdose Risk Initiation Checklist Selection Approach
Management Trial
Dosage Chart
Maintenance and Monitoring Chart
When and How to Stop
Drug related Behaviour
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RAPID ACCESS TO CONSULTATIVE EXPERTISE
Timely Telephone Advice Within 2 hours Assistance with care plan Continued Family Practice Management
Monday-Friday 8-5pm
604-696-2131 or 1-877-696-2131
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Giving Patients Green Light Advice
1. Stay Active -Usual Activities
2. Reassurance and Explanation
3. Pain Control
4. Return to Work
5. Ongoing management
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Follow-Up Visits:
Pain Worst Least Average Right Now
Function • Appreciate variation of pain intensity• Social/Physical/ Mood/ Work• Delve into various functional examples• Opportunity for educational intervention
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Patient Self Management
“The tasks that an individual must undertake to live well with one or more chronic conditions. These tasks include gaining confidence to deal with medical management, role management, and emotional management"
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Patient Self- Management Support
“ The systematic provision of education
and supportive interventions by health care staff to increase patients’ skills and confidence in managing their health problems, including regular assessment of progress and problems, goal setting, and problem-solving support.”
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Healthy
Communities and
Supportive Family, Friends, and
Caregivers
Honor
culture
Develop shared
understanding
Use Self-management Support Core Techniques:
Goal Setting, Action Planning,
Problem solving, Follow-up
Stepped Care for Self-management Support
Provide Advanced Approaches
(MI, Case Mgmt, PST, Group Interactions, etc.)
Offer Expert
Methods
Promote active
self-management
Based on the work of the Indian Health Service Improving Patient Care Self-management Support Workgroup and Division of Diabetes Treatment Program with input from the British
Columbia Ministry of Health Services Patients as Partners Committee and ImpactBC, 2011.
Brief Action Planning (B.A.P.)
“Is there anything you would like to do for your health
In the next week or two?”
“How confident (on a scale from 0 to 10) do you
feel about carrying out your plan?”
“When would you like to check in with me to
review how you are doing with your plan?”
Steven Cole, et. al.
SMART Behavioral Contracting Elicitation of Commitment Statement
If Confidence >7
Brief Action Planning (B.A.P.)
“Is there anything you would like to do for your health
In the next week or two?”
“How confident (on a scale from 0 to 10) do you
feel about carrying out your plan?”
“When would you like to check in with me to
review how you are doing with your plan?”
Steven Cole, et. al.
SMART Behavioral Contracting Elicitation of Commitment Statement
If Confidence <7, problem solve barriers
Behavioral
Menu
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Personal Action Plan
1.What is about your current health that worries you ?
2. How do you feel about this ?
3. What can you personally do about this issue ?
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National Resources: NGOs
Exercising with Arthritis
Managing pain
Eating healthy
Preventing fatigue
Protecting joints
Arthritis medications and working with your healthcare team
Dealing with stress and depression
Problem-solving
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Feedback Forms
Complete for each patient interaction, multiple tools per patient
Fax in every Friday Easy Evaluation Tick Sheet Open Boxes to add tools that are in the Tool
kit but not selected for testing Composite trends to be fed forward to
support group
Feedback Form
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Summary
1. Connect with your Support Physician
2. We need more data !
3. Keep the comments coming.
4. Your participation is appreciated.
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Next Webinar Date for Low Back Pain
Tuesday, March 6: 5 – 6:00 pm