Fife Integrated Pain Management Service - 1 year on The ‘RIVERS’ Experience

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Fife Integrated Pain Management Service- 1 year
onThe RIVERS Experience

• Deborah Paton Lead Pharmacist, Fife Integrated
  Pain management Service (FIPMS)

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Fife Pain Services pre 2010

• Secondary Care Pain Service delivered from QMH,
  Dunfermline
• Primary Care based pain programme (RIVERS)
  delivered in West Fife locality only

• INEQUITY
• LONG DISTANCES

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Fife Model pre bid
Pain Service- all services provided at QMH
Complex co-morbidity 3 5
RIVERS programme- West Fife locality only
Level 2
Poorly controlled single condition 15 20
Level 1 Self Management 70-80
Informal links to PAS
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Bid to Capacity Sustainability

• Key elements
• Integrated service across primary and secondary
  care
• Achieve equity across Fife- develop RIVERS in
  Dunfermline locality, KL and GNEF CHPs
• Shifting the Balance of Care- deliver more
  complex interventions locally (40 target)

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Fifes Pain Service 2010 onwards
Patient requiring Pain Management -Referred by
GP/ Physio/ Other
Questionnaire/ Referral letter triaged to
intervention depending on complexity
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(No Transcript)
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Whats RIVERS?

• Primary Care based programme
• Exercise
• Education
• Medication review
• Developed 2004 in West Fife locality
• Now covers 60 GP practices, based in 5 sites in
  Fife
• Leisure Community centres
• Physio/ Pharmacy led
• Physio assistants/Expert Patient
• Redesign of PAIN services
• Meets Balance of Care and Long Term Conditions
  agenda

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Whats it all about?

• Holistic way to manage pain
• Recognising how it affects patients quality of
  life
• Equipping patients with skills to manage their
  pain
• Increasing their physical activity
• Making the most of their medication
• Emphasis on Fun!

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RIVERS Programme

• Education/information session before programme (
  2hr session)
• Cover Pain Mechanisms, programme content basic
  medication key messages
• Patient signs up to programme
• Pre-assessed by Physio
• 6 week RIVERS programme (2-2.5hrs
  sessions)
• Groups 6-12 patients

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RIVERS content

• Medication
• Non- pharmacological self-management
• Relaxation/ distraction
• Managing Flare ups
• Addressing negative thoughts
• Good sleep hygiene
• Progressing activities

• Concepts of pain
• Home exercise programme
• Weekly exercise class
• Addressing Fear avoidance of activity
• Pacing, Planning, Prioritisation
• Posture
• Drainers Feeders

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Post RIVERS

• Established a weekly exercise maintenance class
  in 3 Leisure Centres in Fife- Keeping Afloat
• Run by Expert Patient Leisure attendant
• Collaboration with Fife Sports Leisure trust
• Formal referral to Pain Association Scotland-
  skill maintenance

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Fife Model post bid

• Pain Service- Main centre QMH
• KPMP delivered on 2 sites
• Psychology OT delivered across Fife
• Other services planned

Complex co-morbidity 3 5

• RIVERS programme-
• 5 sites across Fife
• Further sites planned

Level 2
Poorly controlled single condition 15 20
Level 1 Self Management 70-80

• Formal links to PAS, Pain Concern voluntary
  sector
• Book Prescription
• Website

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Shifting the balance of care- of patients
referred to pain service triaged to primary care
target 40
57
48
50
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Benefits to Service

• Patients seen more locally
• Consultant wait time down to 6 weeks
• Physio wait time decreased
• More KPMP and wait decreased
• Developing Pharmacy input

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Pharmacy Team

• 4 pharmacists
• 1 WTE
• 0.4 WTE
• 0.3 WTE
• 0.1 WTE
• Independent prescribers
• Due to CD Regs work as Supplementary Prescribers

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Pharmacy input currently

• Information sessions and med reviews during
  RIVERS programme
• Information sessions for Kingdom Pain Management
  programme
• Medication Review pilot
• Prescribing Work-stream

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Pharmacy input over next year

• Roll-out of pilot medication reviews across Fife
• Collaborate on appropriate formulary section
  reviews
• Deliver Protected learning across Fife
• Deliver NES evening on Chronic Pain and develop a
  programme for Community Pharmacists HCA
• Expand RIVERS?
• Conquer the world.

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Any questions?dpaton_at_nhs.net