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Transformation of a Community Pain Management Clinic to an entirely Digital and Telephone service

by Tom Shelton | 5 months ago | in Pain Management

Inhealth Pain Management provides NHS Clinics across England. Prior to the official government lockdown we recognised the concerns of the people using our service around the safety in attending physical appointments due to the viral outbreak. We promptly instigated changes to support staff to be able to work from home and continue to support patients. We ensured that all staff had hardware and software enabling them to continue their work, utilising technical solutions. Examples of this include providing access to diary management, VOIP software and use of digital collaboration platforms like Microsoft Teams. Equally important was supportive management practises; frequent contact through video calls, group messaging apps and empowering staff to adapt their diaries to accommodate working from home and any caring roles that they may also have to fulfil. The psychologist working in our service also provided self-care advice and resources to our staff.

We also developed resources to help us support patients using our service in the novel situation that COVID-19 presented. Clinic appointments were converted overnight to telephone clinics ensuring that our patients experienced no delay in their service. Clinicians worked hard to provide the same advice and information making use of online resources or postal resources as required.

Our Pain Management Programme (an 18-hour program running over 6 weeks) was converted to run over a digital video conferencing platform on the 20th of March, 3 days before the UK lockdown. We piloted three different applications in the South Yorkshire area across multiple groups, before making a decision based on patient and staff feedback. We were then quickly able to introduce the video Pain Management Programme to other parts of the country where we operate.

We were able to distribute printed copies of our Pain Management Handbook (text supporting our Programme) and share digital versions. To assist individuals with communication needs we have also produced audio recordings of our  written Pain Management material. This has helped us support who struggle to read, have visual impairments or are neurodiverse.

We have worked with our associated MSK clinic to develop video appointments for patients who require this.

For patients, nearly all were able to keep their scheduled appointments in the new digital or telephone format. We only had to cancel appointments where it was unavoidable, for instance when they were awaiting a physical intervention like injection or acupuncture. Alternatively, if they had a clinical need that could not be met through telephone digital appointments.

Patients have been able to use these appointments more easily. We have seen the number of cancellations reduce as patients value the convenience and that it is responsive to their difficult conditions. We have particularly seen attendance improve in our pain management programme now seeing 80 or 90% of people attend all sessions. Patients have fed back that this is because they find it easier to attend the appointments in a digital format or that they find there are less distractions or difficulties associated with busy group venues. Patients have also told us that they found the video group more appealing because they were able to mute their microphone and turn off their camera and interact with people in a way that they would not otherwise feel comfortable.

Service user feedback has been very important in developing new ways of working. We have surveyed individuals using the video pain management groups using anonymous online survey applications. All the completed surveys across 4 groups have said that they would either be extremely likely or likely to recommend the service to their GP (in a friends and family format). Comments included the following:

 

“This course has been the best thing I've ever been referred to. It has helped me talk about and share my positive experiences while learning other peoples perspectives and coping methods.”

“ It's a fantastic way of having these meetings as people who have chronic pain may not be able to get to the meetings in person. This is a much better way to hold meetings and much more comfortable. “

“Very informative, friendly and very easy to talk to. Makes people feel at ease to talk about our problems and share thoughts”.

“We've also been given feedback about different ways to use the video conferencing platform and it's been very useful to involve our patients in developing how we deliver these groups.”

 

All of these changes have been supported and welcomed by our patients and we are fortunate to be able to use their feedback to develop our services. We continue to explore and develop new digital resources that we are hoping to be able to offer people using our service and look forward to exploring the opportunity of working differently. 

What is needed to sustain the change?

We need to continue to work with our patients, our clinicians and our other stakeholders to develop our resources. We've been very grateful for the collaborative way in which they've assisted us and have only been able to make these changes with their involvement. We also hope to see commissioners recognise the value of providing pain clinics in more diverse ways. We also need to continue to consider the needs and challenges of those that use our service to help us continue to expand what we can offer to more and more people.

It has been interesting to learn from colleagues and others in the pain management community. Working together helps us to develop a range of resources to support those living with chronic pain. Events like the NHS Challenge support idea sharing like this.

Now that some of the new practices of working had been established we need to build on existing service evaluations and draw on the developing published evidence base to further develop our digital resources.

As a return to face to face clinics grows nearer we need to work with government advice, commissioner's and our communities to ensure that we offer clinics safely and in the appropriate places and times whilst also investing in our new working practises.

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