electronic Persistent Pain Outcomes Collaboration update 2015 Chris Hayes Hunter Integrated Pain Service NSW Agency for Clinical Innovation Faculty of Pain Medicine

ePPOC implementation so far …. Data submitting services: 21 adult: New South Wales (14) Victoria (6) Western Australia (1) 3 paediatric (New South Wales)

ePPOC implementation so far …. In progress: 14 adult: New South Wales (2) Victoria (9) Western Australia (1) Queensland (1) New Zealand (2) 3 paediatric Victoria (2) 41 services in total have ‘signed up’

National data – overview (adult data) Questionnaires All services Number of patients 6361 Number of questionnaires returned 6267 - Referral (baseline) 5159 - Pathway (treatment) start 410 - Pathway (treatment) end 170 - Post-episode follow-up 50 updated data since the abstract

National data – overview (paediatric) Questionnaires All services Number of patients 113 Number of questionnaires returned 104 (P) 100 (C) - Referral (baseline) 78 (P) 78 (C) - Pathway start 10 (P) 10 (C) - Pathway end 1 (P) 1(C) - Post-episode follow-up

Top 5 main pain sites

Number of pain sites

Pain duration

Medication use Patients using opioid medication >2 days per week 55.8% Average daily oral morphine equivalent 62.7 mg (max =1560 ) Average number of major drug groups (of six) 2.9

National clinical profile Measure Referral (n=5159) Interpretation BPI pain severity 6.4 Moderate (7= severe) BPI interference 7.1 DASS depression 20.3 Moderate (21=severe) DASS anxiety 14.2 Moderate (15=severe) DASS stress 21.0 Moderate Pain catastrophising 30.0 High (≥30 = high) Pain self efficacy 20.6 Moderate (<20 = severe)

NSW clinical profiles Measure Tier 2 Tier 3 Other BPI pain severity (i.e. not NSW) BPI pain severity 6.3 6.4 BPI interference 7.0 7.1 DASS depression 20.2 20.4 DASS anxiety 13.8 14.4 14.5 DASS stress 21.0 20.7 Pain catastrophising 29.1 30.6 30.3 Pain self-efficacy 21.2 20.3

Treatment pathway outcomes (n=126, 104 PMPs) Measure Pathway start Pathway end BPI average pain 6.2 5.6 BPI interference 7.0 5.7 DASS depression 19.2 15.3 DASS anxiety 13.5 11.7 DASS stress 20.2 18.3 Pain catastrophising 26.9 19.8 Pain self-efficacy 20.6 27.7

BPI average pain IMMPACT recommendations for assessing change - 5.1% made substantial change 13.7% moderate change 29.9% minimally important change 31.6% did not change, 19.7% deteriorated

DASS depression 40.2% made clinically significant change 46.2% did not change 13.7% deteriorated (Based on ≥5 pt change and move to different severity category)

Literacy and CALD (ePPOC)

Complexity (ePPOC)

Pathway type (ePPOC) Pathway HIPS All Services Number Percentage Group 466 81.9 866 35.8 Individual 64 11.2 1142 47.2 Concurrent 39 6.9 242 10.0 One-off 0.0 172 7.1 All pathways 569 100.0 2422

Wait time (ePPOC)

Average outcome scores (ePPOC)

Medication use (ePPOC)

2015 …. Continue implementation of ePPOC throughout Australia and New Zealand Investigate/identify sub-groups of patients getting better, worse, not improving Maximise follow-up data Start benchmarking process