Building capacity for chronic pain management in a regional centre: Are we getting bang for our buck?

Background and Context: Chronic pain affects 1 in 5 Australians in their lifetime, and is associated with lengthy waits for specialist services. Prevalence appears higher in regional areas, yet access to care is limited, given the lack of regional specialist services and GPs with professional pain management training. The National Action Plan for Pain Management recommends improving access in regional areas, by not only bringing services to patients (e.g., regular regional clinics/telehealth), but also by capacity-building among local professionals, and adapting models of care where possible to better support regional patients’ needs. Our pain unit has trialled regional outreach in Murray Bridge, a town 75km South-East of Adelaide.

Process: Our regional model of care focused on group pain education and combined interdisciplinary assessments, where patients see multiple pain specialists (consultant, psychologist, physiotherapist) in one appointment. This resulted in greater access through less travel (distance and occasions), swifter case discussion and GP correspondence, and opportunity for review. A novel addition was access to 6-8 telephone-led low-intensity cognitive behavioural therapy sessions for interested patients. This model was designed to generate timely specialist recommendations to support GPs and patients in implementing a biopsychosocial pain management approach locally. We have completed 12 months of the regional trial (September 2018 to August 2019), including multidisciplinary assessments for 52 patients. We critically evaluated this model by surveying GPs and patients.

Analysis: The 5 responding GPs (18% response rate) were quite satisfied with the service, providing ‘average’ to ‘very good’ ratings on all questions. All GPs spontaneously requested easy phone contact with the outreach team. The 20 responding patients’ (38% response rate) mean scores indicated at least 'average' satisfaction ratings, including satisfaction with the location, information provided, and usefulness of recommendations. However, individual responses often spanned the entire 1-5 scale. Only 15% said their situation had improved due to the assessment. Qualitative feedback centred on improving follow-up (e.g., automatic/more regular/quicker) and responding to their subjective pain experience (providing more self-management strategies, better understanding their experience). Seven patients spontaneously made positive comments regarding the service.

Outcomes: While we may be better supporting regional GPs in managing chronic pain, some patients may not understand or share this goal. Moreover, little changes regarding patient outcomes. This relates to the scarcity of local allied health services, resulting in few referring options. We have learnt that to invest pain services in regional centres, we must conduct greater capacity-building and engagement (e.g., community liaison, train-the- trainer); equally, buy-in from local champions (including telehealth facilitators) is required for pain self-management to be owned by the local community. Our activity targets may hinder this engagement phase. Ultimately, a visiting team treating a limited number of patients in isolation will not produce the most desirable return on investment.