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20 th Annual Pain Management Symposium 10/14/2016 1 SHARED MEDICAL APPOINTMENTS Gordon Irving MD Attending Swedish Pain Services Clinical Associate Professor U.W. Medical School Becca Taylor RN PhD Nurse educator Swedish Functional Restoration Program
Transcript of SHARED MEDICAL APPOINTMENTS › ~ › media › Images › Swedish › CME1 › ...20th Annual Pain...
20th Annual Pain Management Symposium 10/14/2016
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SHARED MEDICAL APPOINTMENTS
Gordon Irving MDAttending Swedish Pain ServicesClinical Associate Professor U.W. Medical School
Becca Taylor RN PhDNurse educator Swedish Functional Restoration Program
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TYPES OF CHRONIC PAIN APPOINTMENT
• Individual w/wo family or friends• Group• Shared medical appointments (SMA)
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GROUP/SMA
Similar syndromes• Fibromyalgia• Spinal pain• Headaches• Irritable bowel or abdominal pain• Diabetes
Similar medications• Opioids
• Similar Behavior problems• Alcohol/Drugs• Smoking• Eating problems
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DIFFERENCE GROUP VS SMA
• Charting: same as follow up– Assessment– Plan/counseling– Subjective– Objective
• Billing: not by time but complexity– Usually 99213– If changing medications consider 99214
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SETTING UP THE SMA: THE AGENDA
• By phone• By letter• By Mychart
• Can send reminders• Patient books the SMA consider once a month for 60
minutes• Max number 12 patients minimal 6
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PATIENT INFORMATION
Before the class•Sign the non-disclosure form•Get your blood pressure and weight checked and any change in your medications or allergies noted•Complete the follow up questionnaire•Complete your pain related changes form•If requesting change in medications make sure this is clearly noted
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PATIENT INFORMATION
During the classBe considerate and mindful, do not interrupt someone elseDo not use the word PAIN, can use “discomfort” No complaining.If you need to discuss medication or personal health or symptoms do not do it during the class. Consider making a separate appointmentKeep your comments and discussion concise, NO long stories.Try to bring some knowledge with you that has helped you and may help others, eg a smart phone app, a book from the library
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PATIENT INFORMATION
After the class•Review your notes of anything you felt helped you•You can see a summary of the discussion on your Mychart “After visit summary”•Watch for Mychart messages in your email inbox•Send to Dr Irving any useful website/pod cast hyperlink, book title or article, before the next class.
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SMA FORMATS
• 2 minute mindful breathing technique • Discussion on pre-selected topic• After the discussion go round the room and ask each
person to give something positive that they do for their pain that may help others cope. Could be exercise, cooking, web site, book etc.
• Need to keep rough notes, or have a scribe documenting the individual responses
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FOR CHARTING: BEFORE SMA
Please complete and hand in to Dr IrvingFor documentation I need to know how you are doing.Do you need changes in any of the medications I have been prescribing? YES NOIf yes: Which ones?_________________________________
If medication changes consider increase billing from 99213-99214
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SMA CHARTING: ASSESSMENT/SUBJECTIVE
I have printed out the diagnoses I made on you the last time I saw you By the side of each diagnosis please indicate whether it is improved, worse or about the same (stable) since last seenGive it back to me directly
Name Date
Diagnosis Improved since last visit The same Worse
Comments, anything that you feel has been important to you and your pain problem:
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SMA CHARTING: PLAN
•Summary of the general discussion identifying main points•Medications refilled
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SMA CHARTING: SUBJECTIVE
•From patient’s form where comments have been left•From participation in the discussion
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SMA CHARTING: OBJECTIVE
• Can cut and paste from previous examination • But no actual physical exam has taken place• Vitals should go in here
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PATIENT EDUCATION RESOURCES
Resources for education material: – Workbooks– Videos– Websites– Swedish Patient Education Material
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WORKBOOKS
3 workbooks with similar approach and content: Managing Chronic Pain Before It Manages You
– Dr. Margaret Caudill, 4th Edition 2016
Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach
– John D. Otis Phd, 2007
Chronic Pain Survival Guide: Reclaiming your life– Dennis Turk PhD and Fritz Winter PhD, 2006
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MANAGING CHRONIC PAIN BEFORE IT MANAGES YOU!
• Dr. Margaret Caudill MD, PhD, MPH• BioPsychoSocial approach to chronic pain
management • Written to support a “10 visit group medical program”.• Chapters: Content and exploration exercises
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CHAPTERS
Appendix: Letter to Health Care Professionals 1: Beginning to take control of your pain
– Acceptance, Awareness of patterns & goal setting
2: Understanding Pain– Acute vs Chronic, pain pathways, Tx, meaning
3: The Mind-Body Connection– Chronic pain as stress, Relaxation Response
4: The Body-Mind ConnectionIncreasing activity, pacing, activity improving mood
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CHAPTERS
5: Harnessing the power of the mind– Automatic thoughts, changing your thoughts
6: Adopting Healthy Attitudes– Attitude and coping styles
7: Nutrition and Pain– Basic guidelines & managing pain through diet
8: Effective CommunicationIncreasing activity, pacing, activity improving mood
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CHAPTERS9: Effective Problem Solving
– Revisiting goal setting and coping strategies
10: End of the Beginning– Relapse prevention & Coping with a pain flare
Appendix: Common Pain Conditions, CAM, Working Comfortably at a Computer, Electronic Resources, Worksheets
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ADDITIONAL RESOURCES
Videos: (search on YouTube)
“Understanding pain in less than 5 minutes in less than 5 minutes and what to do about it!”
“The Drug Cabinet in your Brain” David Butler
TED talks by: Lorimer Moseley, David Butler, Kelly McGonagall….
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ADDITIONAL RESOURCES
Websites: American Chronic Pain Association https://theacpa.org/
National Center for Complementary and Integrative Healthhttps://nccih.nih.gov/health/pain/chronic.htm
Relaxationhttps://www.calm.com/
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RESOURCES
Swedish Patient Education Material:
•Swedish Pain Clinic STOMPhttp://www.swedish.org/services/pain-services/pain-management-guide
•Swedish.org/blog (search for pain, relaxation)•Swedish Sleep Medicine
http://www.swedish.org/services/sleep-medicine/patient-resources
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CONTACT INFORMATION
Becca Taylor RN [email protected]
