1. January 9, 2012 MSK Initiative 2 nd Webinar Low Back Pain

2. 2 Agenda  Webinar Housekeeping  Project Update  Tools Discussion  Patient Self Management  Evaluation Forms  Feedback and Discussion

3. 3 Webinar Housekeeping  Audio and Visual  Sound  Chat Function  Save

4. 4 Attendees Doctors: Herb, Jane, Mona, Helene, David Facilitators: Julia, Bruce, Brenda, Liza, Pam, Laura Impact BC Host: Christina, Lisa

5. 5 Project Update Discussion Tool Kit – Explore the Tool Kit (Algorithm) – Test all tools as they fit your patient/practice – Provide Feedback on all tools – Send feedback form to PSP Central Weekly – Discuss project with coach support www.gpscbc.ca/psp_msk

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7. 7  Clinical Practice Tools – used at point of care and tools we want tested during trial period  Reference Tools – checklists and other materials that can be looked up in hard copy binder or in electronic format as physician interest and time permit  Patient Tools – to be completed by patient either jointly with GP, in the waiting room, or at home. These tools should be tested via GP pilot or with patient focus groups  Teaching Tools – optional for use in the learning / teaching sessions as aids Inventory of MSK TOOLS & their classification

8. 8 Tuesday December 6, 2011Patient Questionnaire Red Flags Yellow Flags Assessment of Pain and Function Patient History Monday January 9, 2011 DN4 Opioid Manager RACE Green Light Patient Self-Management Tools Personal Action Plan Low Back Patient Handout Monitoring and Management

9. 9 Discussion Questions 1. Tell us how you implemented the tools into your practice ?  Patient Tools ?  Clinical Tools ?  Reference Tools?  Teaching Tools ?

10. 10 Tools Diagnostic Screening:  DN4 Clinical Management:  Opioid Manager  RACE  Green Light Patient Self-Management:  Personal Action Plan  LBP Handout

11. 11 Low Back Pain

12. 12 DN4 Questionnaire Utility: To estimate the probability of Neuropathic Pain Method: 4 Questions Score: Yes=1, No= 0 /10 Points If the patients score is equal to or greater than 4, the test is positive. (sensitivity: 82.9%; specificity: 89.9%)

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14. 14 Opioid Manager Assessment Patient Goals Opioid Risk Overdose Risk Initiation Checklist Selection Approach Management Trial Dosage Chart Maintenance and Monitoring Chart When and How to Stop Drug related Behaviour

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17. 17 RAPID ACCESS TO CONSULTATIVE EXPERTISE  Timely Telephone Advice  Within 2 hours  Assistance with care plan  Continued Family Practice Management Monday-Friday 8-5pm 604-696-2131 or 1-877-696-2131

18. 18 Giving Patients Green Light Advice 1. Stay Active -Usual Activities 2. Reassurance and Explanation 3. Pain Control 4. Return to Work 5. Ongoing management

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20. 20 Follow-Up Visits:  Pain  Worst  Least  Average  Right Now  Function Appreciate variation of pain intensity Social/Physical/ Mood/ Work Delve into various functional examples Opportunity for educational intervention

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22. 22 Patient Self Management “The tasks that an individual must undertake to live well with one or more chronic conditions. These tasks include gaining confidence to deal with medical management, role management, and emotional management"

23. 23 Patient Self- Management Support “ The systematic provision of education and supportive interventions by health care staff to increase patients’ skills and confidence in managing their health problems, including regular assessment of progress and problems, goal setting, and problem-solving support.”

24. 24 Healthy Communities and Supportive Family, Friends, and Caregivers Honor culture Develop shared understanding Use Self-management Support Core Techniques: Goal Setting, Action Planning, Problem solving, Follow-up Stepped Care for Self-management Support Provide Advanced Approaches (MI, Case Mgmt, PST, Group Interactions, etc.) Offer Expert Methods Promote active self-management Based on the work of the Indian Health Service Improving Patient Care Self-management Support Workgroup and Division of Diabetes Treatment Program with input from the British Columbia Ministry of Health Services Patients as Partners Committee and ImpactBC, 2011.

25. Brief Action Planning (B.A.P.) “Is there anything you would like to do for your health In the next week or two?” “How confident (on a scale from 0 to 10) do you feel about carrying out your plan?” “When would you like to check in with me to review how you are doing with your plan?” Steven Cole, et. al. SMART Behavioral Contracting Elicitation of Commitment Statement If Confidence >7

26. Brief Action Planning (B.A.P.) “Is there anything you would like to do for your health In the next week or two?” “How confident (on a scale from 0 to 10) do you feel about carrying out your plan?” “When would you like to check in with me to review how you are doing with your plan?” Steven Cole, et. al. SMART Behavioral Contracting Elicitation of Commitment Statement If Confidence <7, problem solve barriers Behavioral Menu

27. 27 Personal Action Plan 1.What is about your current health that worries you ? 2. How do you feel about this ? 3. What can you personally do about this issue ?

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29. 29 National Resources: NGOs  Exercising with Arthritis  Managing pain  Eating healthy  Preventing fatigue  Protecting joints  Arthritis medications and working with your healthcare team  Dealing with stress and depression  Problem-solving

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32. 32 Feedback Forms  Complete for each patient interaction, multiple tools per patient  Fax in every Friday  Easy Evaluation Tick Sheet  Open Boxes to add tools that are in the Tool kit but not selected for testing  Composite trends to be fed forward to support group

33. Feedback Form 33

34. 34 Summary 1.Connect with your Support Physician 2. We need more data ! 3. Keep the comments coming. 4. Your participation is appreciated.

35. 35 Next Webinar Date for Low Back Pain Tuesday, March 6: 5 – 6:00 pm