Patient and general practitioner engagement with an Allied Health and Nursing pathway within an Interdisciplinary Pain Centre: A waitlist reduction initiative

Background and Aims - Persistent Pain continues to challenge healthcare systems with demand exceeding capacity and resulting in extensive waiting times for most Australian public pain services - (1). Patients experience a significant deterioration in health related quality of life and psychological wellbeing while waiting for treatment following referral to pain services - (2). In 2014 an initiative was undertaken at the Gold Coast Interdisciplinary Persistent Pain Centre to develop a new pathway to enhance service access. The pathway utilised existing allied health and nursing staffing, within the context of a GP shared care model, to provide a service entry point that was not contingenton receipt of a pain specialist assessment. The aim of this study was to investigate General Practitioner (GP) and patient engagement with this new pathway. Method - An innovative full scope of practice and first contact allied health and nursing pathway was developed. Adult chronic pain patients on the tertiary-referral service’s waitlist that were triaged as non-urgent who had been waiting >12 months (n=355) were invited to ‘opt In’ to the new pathway. When opting in, patients were advised that this was predominately an allied health pathway and that they would not see a pain specialist upon entry to the service. Patients’ GPs also received information on the alternate pathway, and were asked to confirm that: a) their patient was appropriate for the pathway and, b) they would continue to manage their medical care. In brief, the path- way involved an orientation session, group based assessment and treatment planning sessions and, the development of an individualised treatment plan. - Following entry into the pathway, patients that met pre-determined criteria were re-prioritised and waitlisted to see a pain specialist. Results - 264 of 355 (74%) patients responded to opt-In letters. The remaining 94 (26%) were discharged due to no response following multiple contact attempts. Of the responders, 70% (n=183) opted in to the pathway, 20% (n=54) self-discharged (no longer requiring the service), 8% were not eligible because their GP did not opt into the shared care model and 2% chose to remain on the waitlist. The majority of patients that opted in to the path-way actively engaged, with 82% establishing a pain management plan. GP and patient satisfaction data is being collected as patients exit the pathway. - Factors relating to GP and patient engagement and satisfaction (length of time on waitlist, triage score and demographic characteristics) are being explored and will be presented. Conclusions - The allied health and nursing pathway was well received by GPs and patients. Implementation of the pathway improved service capacity and significantly reduced the time that patients needed to wait to access the service. Further research is planned focusing on clinical effectiveness outcomes.