Health and service needs, priorities and initiatives of primary health networks related to chronic pain
Simone De Morgan A B * , Pippy Walker![https://orcid.org/0000-0002-3043-1069](/media/client/orcid_16x16.png)
![https://orcid.org/0000-0001-8037-9812](/media/client/orcid_16x16.png)
A Menzies Centre for Health Policy and Economics, School of Public Health, Faculty of Medicine and Health, University of Sydney, Charles Perkins Centre D17, Camperdown, NSW 2006, Australia.
B The Australian Prevention Partnership Centre based at the Sax Institute, Level 3, 30C Wentworth Street, Glebe, NSW 2037, Australia.
C School of Public Health, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building A27, Camperdown, NSW 2006, Australia.
D Pain Management Research Institute, The University of Sydney, Ground Floor, Douglas Building, Royal North Shore Hospital, St Leonards, Sydney, NSW 2065, Australia.
Australian Journal of Primary Health 28(5) 417-427 https://doi.org/10.1071/PY21209
Submitted: 24 August 2021 Accepted: 25 April 2022 Published: 24 June 2022
© 2022 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of La Trobe University. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)
Abstract
Background: Chronic pain is a major and growing public health issue. Multidisciplinary tertiary pain services cannot meet patient demand and greater involvement of primary care is needed. The aims of this study were to understand the needs and priorities of Australian primary health networks (PHNs) related to the management and secondary prevention of chronic pain; map current PHN chronic pain initiatives and identify gaps; highlight key enablers to implementation; and highlight solutions identified by PHNs to increase capacity to commission initiatives.
Methods: Mixed methods were used, including: a review of PHN needs assessments; and consultation with PHN executive-level staff and program managers from 27 out of the 28 PHNs, and the WA Primary Health Alliance (WAPHA – a state alliance between three Western Australian PHNs) via telephone interviews, online surveys, a workshop, a deliberative dialogue and email consultation.
Results: Chronic pain was identified as a health and/or service need by approximately half of PHNs. Barriers for PHNs to identifying chronic pain as a need or priority are highlighted. Gaps identified by the mapping included: initiatives related to the secondary prevention of chronic pain (post-surgery or post-injury), digitally enabled consumer and health professional chronic pain initiatives, and chronic pain initiatives for specific populations groups such as Aboriginal and Torres Strait Islander people. Among existing PHN practice, two exemplar evidence-based initiatives suitable for scale-up across PHNs in Australia were identified: multidisciplinary community-based pain programs, and an online health professional capacity-building initiative, Project ECHO (chronic pain). Solutions identified by PHNs to increase capacity to commission initiatives included: co-funding initiatives across different PHN funding streams, collaborative initiatives between PHNs, and co-commissioning with government and non-government partners.
Conclusions: Chronic pain has been classified as a disease in itself through the World Health Organization. PHNs recognising chronic pain as a distinct condition in PHN needs analysis and data collection would lead to more dedicated funding. PHNs could do more to improve the secondary prevention and management of chronic pain. A self-identified need for greater collaboration across PHNs and co-commissioning with local and state governments and non-government partners would help to build PHN capacity.
Keywords: chronic disease, chronic pain, delivery of health care: integrated, health services: accessibility, health services: needs and demands, implementation, primary health care, secondary prevention.
References
Allen ML, Leslie K, Parker AV, Kim CC, Brooks SL, Braat S, Schug SA, Story DA (2019) Post-surgical opioid stewardship programs across Australia and New Zealand: Current situation and future directions. Anaesthesia and Intensive Care 47, 548–552.| Post-surgical opioid stewardship programs across Australia and New Zealand: Current situation and future directions.Crossref | GoogleScholarGoogle Scholar | 31766854PubMed |
Allen ML, Kim CC, Braat S, Jones K, Winter N, Hucker TR, Chia A, Lang C, Brooks SL, Williams DL (2020) Post-discharge opioid use and handling in surgical patients: a multicentre prospective cohort study. Anaesthesia and Intensive Care 48, 36–42.
| Post-discharge opioid use and handling in surgical patients: a multicentre prospective cohort study.Crossref | GoogleScholarGoogle Scholar | 32050781PubMed |
Australian Government (2018) PHN program performance and quality framework. Australian Government, Canberra, Australia.
Blyth FM, Briggs AM, Schneider CH, Hoy DG, March LM (2019) The global burden of musculoskeletal pain—where to from here? American Journal of Public Health 109, 35–40.
| The global burden of musculoskeletal pain—where to from here?Crossref | GoogleScholarGoogle Scholar | 30495997PubMed |
Darnall BD, Juurlink D, Kerns RD, et al. (2019) International stakeholder community of pain experts and leaders call for an urgent action on forced opioid tapering. Pain Medicine 20, 429–433.
| International stakeholder community of pain experts and leaders call for an urgent action on forced opioid tapering.Crossref | GoogleScholarGoogle Scholar | 30496540PubMed |
De Allegri M, Brenner S, Kambala C, Mazalale J, Muula AS, Chinkhumba J, Wilhelm D, Lohmann J (2020) Exploiting the emergent nature of mixed methods designs: insights from a mixed methods impact evaluation in Malawi. Health Policy and Planning 35, 102–106.
| Exploiting the emergent nature of mixed methods designs: insights from a mixed methods impact evaluation in Malawi.Crossref | GoogleScholarGoogle Scholar | 31625554PubMed |
Freeman T, Baum F, Javanparast S, Ziersch A, Mackean T, Windle A (2021) Challenges facing primary health care in federated government systems: implementation of primary health networks in Australian states and territories. Health Policy 125, 495–503.
| Challenges facing primary health care in federated government systems: implementation of primary health networks in Australian states and territories.Crossref | GoogleScholarGoogle Scholar | 33602531PubMed |
Glare P, Aubrey KR, Myles PS (2019) Transition from acute to chronic pain after surgery. The Lancet 393, 1537–1546.
| Transition from acute to chronic pain after surgery.Crossref | GoogleScholarGoogle Scholar |
Gray JS, Swan JR, Lynch MA, Tay TM, Mackenzie MJ, Wiggers JH, Harrison KA, McDonald RC, O’Dea IP, Harrigan LM, Fitzgerald SM (2018) Hunter and New England HealthPathways: a 4-year journey of integrated care. Australian Health Review 42, 66–71.
| Hunter and New England HealthPathways: a 4-year journey of integrated care.Crossref | GoogleScholarGoogle Scholar | 28214475PubMed |
Hassan S, Carlin L, Zhao J, Taenzer P, Furlan AD (2021) Promoting an interprofessional approach to chronic pain management in primary care using Project ECHO. Journal of Interprofessional Care 35, 464–467.
| Promoting an interprofessional approach to chronic pain management in primary care using Project ECHO.Crossref | GoogleScholarGoogle Scholar | 32148115PubMed |
Hogg MN, Kavanagh A, Farrell MJ, Burke ALJ (2021) Waiting in pain II: an updated review of the provision of persistent pain services in Australia. Pain Medicine 22, 1367–1375.
| Waiting in pain II: an updated review of the provision of persistent pain services in Australia.Crossref | GoogleScholarGoogle Scholar | 33106875PubMed |
Javanparast S, Freeman T, Baum F, Labonté R, Ziersch A, Mackean T, Reed R, Sanders D (2018) How institutional forces, ideas and actors shaped population health planning in Australian regional primary health care organisations. BMC Public Health 18, 383
| How institutional forces, ideas and actors shaped population health planning in Australian regional primary health care organisations.Crossref | GoogleScholarGoogle Scholar | 29558903PubMed |
Katz J, Weinrib A, Fashler SR, Katznelzon R, Shah BR, Ladak SS, Jiang J, Li Q, McMillan K, Santa Mina D, Wentlandt K, McRae K, Tamir D, Lyn S, de Perrot M, Rao V, Grant D, Roche-Nagle G, Cleary SP, Hofer SO, Gilbert R, Wijeysundera D, Ritvo P, Janmohamed T, O’Leary G, Clarke H (2015) The Toronto general hospital transitional pain service: development and implementation of a multidisciplinary program to prevent chronic postsurgical pain. Journal of Pain Research 8, 695
| The Toronto general hospital transitional pain service: development and implementation of a multidisciplinary program to prevent chronic postsurgical pain.Crossref | GoogleScholarGoogle Scholar | 26508886PubMed |
Koff E, Pearce S, Peiris DP (2021) Collaborative Commissioning: regional funding models to support value-based care in New South Wales. The Medical Journal of Australia 215, 297–301.e1.
| Collaborative Commissioning: regional funding models to support value-based care in New South Wales.Crossref | GoogleScholarGoogle Scholar | 34514609PubMed |
Lavis JN, Boyko JA, Oxman AD, Lewin S, Fretheim A (2009) SUPPORT tools for evidence-informed health Policymaking (STP) 14: organising and using policy dialogues to support evidence-informed policymaking. Health Research Policy and Systems 7, S14
| SUPPORT tools for evidence-informed health Policymaking (STP) 14: organising and using policy dialogues to support evidence-informed policymaking.Crossref | GoogleScholarGoogle Scholar | 20018104PubMed |
Lin I, Green C, Bessarab D (2016) ‘Yarn with me’: applying clinical yarning to improve clinician–patient communication in Aboriginal health care. Australian Journal of Primary Health 22, 377–382.
| ‘Yarn with me’: applying clinical yarning to improve clinician–patient communication in Aboriginal health care.Crossref | GoogleScholarGoogle Scholar | 28442021PubMed |
Lin I, Green C, Bessarab D (2019) Improving musculoskeletal pain care for Australia’s first peoples: better communication as a first step. Journal of Physiotherapy 65, 183
| Improving musculoskeletal pain care for Australia’s first peoples: better communication as a first step.Crossref | GoogleScholarGoogle Scholar | 31521547PubMed |
Miles MB, Michael Huberman A, Saldana J (2014) ‘Qualitative data analysis: a methods sourcebook.’ (Sage Publications, Inc.)
Nicholas MK, Blyth FM (2016) Are self-management strategies effective in chronic pain treatment? Pain Management 6, 75–88.
| Are self-management strategies effective in chronic pain treatment?Crossref | GoogleScholarGoogle Scholar | 26678703PubMed |
Nicholas MK, Linton SJ, Watson PJ, Main CJ (2011) Early identification and management of psychological risk factors (“yellow flags”) in patients with low back pain: a reappraisal. Physical Therapy 91, 737–753.
| Early identification and management of psychological risk factors (“yellow flags”) in patients with low back pain: a reappraisal.Crossref | GoogleScholarGoogle Scholar | 21451099PubMed |
Painaustralia (2010) National Pain Strategy: Pain management for all Australians. The National Pain Summit Initiative Canberra, Australia.
Russell L, Dawda P (2019) The role of Primary Health Networks in the delivery of primary care reforms. University of Sydney and University of Canberra.
Shah S, Diwan S, Kohan L, Rosenblum D, Gharibo C, Soin A, Sulindro A, Nguyen Q, Provenzano DA (2020) The technological impact of COVID-19 on the future of education and health care delivery. Pain Physician 23, S367–S380.
The Society of Hospital Pharmacists of Australia (SHPA) (2018) Reducing opioid-related harm: a hospital pharmacy landscape paper. SHPA, Australia. Available at https://www.shpa.org.au/sites/default/files/uploaded-content/website-content/shpa_-_reducing_opioid_related_harm.pdf.Please%20check%20the%20edit%20made%20to%20Ref.%20(SHPA%202018).correct
Sowden G, Hill JC, Konstantinou K, Khanna M, Main CJ, Salmon P, Somerville S, Wathall S, Foster NE (2011) Targeted treatment in primary care for low back pain: the treatment system and clinical training programmes used in the IMPaCT Back study (ISRCTN 55174281). Family Practice 29, 50–62.
| Targeted treatment in primary care for low back pain: the treatment system and clinical training programmes used in the IMPaCT Back study (ISRCTN 55174281).Crossref | GoogleScholarGoogle Scholar | 21708984PubMed |
Swerissen H, Duckett S, Moran G (2018) ‘Mapping primary care in Australia.’ (Grattan Institute: Victoria, Australia)
Treede R-D, Rief W, Barke A, Aziz Q, Bennett MI, Benoliel R, Cohen M, Evers S, Finnerup NB, First MB, Giamberardino MA, Kaasa S, Korwisi B, Kosek E, Lavand’homme P, Nicholas M, Perrot S, Scholz J, Schug S, Smith BH, Svensson P, Vlaeyen JWS, Wang SJ (2019) Chronic pain as a symptom or a disease: the IASP classification of chronic pain for the International Classification of Diseases (ICD-11). Pain 160, 19–27.
| Chronic pain as a symptom or a disease: the IASP classification of chronic pain for the International Classification of Diseases (ICD-11).Crossref | GoogleScholarGoogle Scholar | 30586067PubMed |
Walker P, Cornell S, De Morgan S, Bonner C, Blyth FM (2021) Chronic pain and cardiovascular disease prevention in primary care: a review of Australian primary health network needs assessments. Australian Health Review 46, 70–77.
| Chronic pain and cardiovascular disease prevention in primary care: a review of Australian primary health network needs assessments.Crossref | GoogleScholarGoogle Scholar |