WA Primary Health Alliance - Persistent Pain Program

In 2016-17 WA Primary Health Alliance (WAPHA), operator of Western Australia’s three Primary Health Networks (PHNs), undertook a review of community based chronic pain programs available in Australia. An Advisory Group made up of local pain physicians, public hospital staff, general practitioners (GPs), and allied health professionals, together with advice from existing contracted service providers and other PHNs, and a literature review, identified that a best practice model would comprise care coordination, group education and multidisciplinary care provided by allied health and GPs. Alternatives for capturing clinical outcomes were also explored.

Identification of a program to support people with chronic pain in the primary care settings that met all the above elements, lead to a program designed by Joyce McSwan of Painwise. A Clinical Pharmacist specialising in treatment of pain, Joyce developed and trialled a program called Turning Pain Into Gain, funded by Gold Coast Medicare Local / PHN and evaluated by Griffith University. Turning Pain Into Gain is a twelve-month community pain program which reduces self-reported hospitalisations and medication use and improves quality of life and functioning through a series of six group education sessions. These group sessions are supported by individual sessions with a care coordinator and allied health practitioner and cover such topics as nutrition, exercise physiology, psychology, occupation therapy and physiotherapy. Group education sessions and group exercise programs, such as hydrotherapy, have both a physical and psychological benefit, as many clients are isolated by their condition. Education events for GPs and primary health professionals, also builds local workforce capacity to manage chronic pain and the importance of interdisciplinary care.

Analysis of potentially preventable hospitalisation data from WA Health, assisted in determining the locations where the program would be delivered in each of the four Perth metropolitan regions; two in Perth North PHN and two in Perth South PHN. WAPHA purchases an annual license to use the Turning Pain Into Gain program in the four locations, and a licence to use clinical software (epiCentre) developed and managed by the University of Wollongong, which is overseen by the Electronic Persistent Pain Outcomes Collaboration (ePPOC). ePPOC collects and interprets clinical data from over 90 participating sites in Australia and New Zealand, benchmarking care and treatment of adult and paediatric pain services. ePPOC questionnaires collect data on medication use, comorbidity, healthcare, work, pain intensity and interference, and include several validated tools such as DASS21, PSEQ and PCS.

A GP referral is required to be eligible to join the Persistent Pain Program. On receipt of the referral, WAPHA’s contracted service providers telephone the individual to outline the benefits of the program and the requirement to attend six group sessions. If the person consents to participate, the first of three ePPOC questionnaires is emailed to them along with dates for their first appointment and six group sessions. The first appointment with the Clinical Facilitator, a qualified nurse or allied health professional, is to review the initial ePPOC questionnaire, understand the client’s situation and establish goals. This is supported by a workbook with resources added after each of the group sessions, which are held one month apart. The Clinical Facilitator also assists the client to navigate appropriate allied health services, in conjunction with their GP, and provides support for up to twelve months. Distribution of a hardcopy newsletter between group sessions, information shared through a closed group Facebook page, SMS messaging and a refresher course delivered around six months after completion of the program, all help to create a network of peers and reinforce knowledge and skills to manage chronic pain.

The Persistent Pain Program in WA receives over 100 referrals a year in each location. Between July 2018 and December 2020, the four services achieved the outputs tabled below.

Clinical outcomes data for WAPHA’s commissioned services are published in ePPOC reports. The treatment pathway for the Persistent Pain Program is up to twelve months and the program was only fully implemented in mid-2018. These factors along with difficulty obtaining discharge questionnaires, has meant that clinical improvements are not yet represented in these reports. Hopefully in another year, data will demonstrate significant outcomes. It is important to note that ePPOC benchmarks are designed for tertiary and/or private pain clinics, which make up the majority of the participating members. At present very few ePPOC services run a concurrent model of care combining groups, allied health appointments and individual care coordination. If more services were to use a concurrent model, then it is possible separate benchmarking could occur in the future.

Above shows the profile of Persistent Pain Program clients across the four Perth locations, from July 2019 to June 2020 (ePPOC, October 2020).

Physical distancing restrictions related to COVID-19 meant that many group sessions were cancelled in March 2020 for at least three months. A range of strategies were initiated by service providers to ensure their clients continued to be supported and receive education. The six Turning Pain Into Gain group education sessions were recorded by Joyce McSwan and an allied health practitioner, as a digital substitute for face-to-face groups. Links to the web-based videos were shared with Persistent Pain Program clients for viewing at the scheduled day and time of the group sessions. Increased support was provided by telephone, closed Facebook groups and SMS messaging. Some service providers opted to proceed with virtual groups using Zoom and Facebook Live. The effectiveness of these methods was dependent on many factors, including the client and presenters’ ability to negotiate the required technology.

Acknowledgement is made to 360 Health + Community, Arche Health and Black Swan Health who deliver the Persistent Pain Program in Perth South PHN and Perth North PHN. For more information visit HealthPathwaysWA or email Regional Coordinator, Debra Royle debra.royle@wapha.org.au.