Stepped Care Model for Pain Management Nabiha Gill, MD Staff

Stepped Care Model for Pain Management Nabiha Gill, MD Staff Physician PM&R Chair, Indianapolis VA Pain Committee Chair, VISN 11 Pain Committee Assistant Professor, PM&R, IUPUI, Indianapolis, IN

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

Indianapolis VA Pain Committee

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”

“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

“Multidisciplinary Virtual Pain Team Consultation” 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 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

“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

Proposed “Stepped care model for pain management for Indianapolis VA”

TERTIARY LEVEL SECONDARY LEVEL PRIMARY LEVEL

Proposed Stepped care model for pain for Indianapolis VA Multi-dis pain T e r t i a r y Sec Primary Chronic Pain Rehab Program Bupe Clinic/ SATS Secondary Consults Provider education CBT CBT Pain Medication Management Pain Medication Management Primary Care Clinics/Teams Int Pain Clinic Pain Policy Pain School

CRIPP Comprehensive Rehab Integrative Pain Program (Proposed)

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

Tampa VA “Chronic Pain Rehab Program” training Excellent training

VISN 11 Pain committee progress

VISN 11 Pain Committee progress V-Tel Communication Face to face meeting HSB Stepped care model/policy/education plans VISN Ambulatory care council

VISN Ambulatory care council “Too many clinical reminders” “Not enough support for PCP’s 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

Successes!!!

Struggles!!!

Next Steps!!

Questions!!