June 17, 2015

Sometimes you have to look back in order to realize how far you have come. A recent message received (below) from Dr Keith Phillips highlights the value of the Practice Support Program (PSP).  As the GP champion of the PSP Pain Management module in Nanaimo, and former President of the Society of General Practitioners, Dr Phillips recently uncovered a letter he wrote in 2007 about an essential need for resources to help family physicians treat patients with chronic pain. In his recent message to the Doctors of BC President, PSP support staff, and Vancouver Island Health Authority staff, Dr Phillips references the critical need he saw then for the health authority to help physicians in their practices, and lauds the collaborative approach between the profession and government for having developed a quality improvement initiative like PSP to address that critical need he identified nearly eight years ago.

Launched in 2007 – the same year Dr Phillips wrote his original letter to then Department Head Dr Ed Cancade – PSP now offers a range of innovative clinical and practice management tools and strategies. Resources are often developed using a collaborative, multidisciplinary approach that aims to support effective shared care of patients between providers.

To further help physicians with quality improvement efforts, practice support services are changing with increased collaboration in planning and expanded regional support teams, considering small group learning sessions, and continuing with modules, in-practice coaching, and initiative support. 

Letter from Dr Keith Phillips, 2007:

Patients with Chronic Pain: A Huge Service Gap on Central Vancouver Island

For a few months last year, family physicians in Nanaimo were able to refer patients suffering chronic pain to a local pilot pain management service. This service was provided by inspired occupational therapists in the Rehabilitation Medicine Department as a pilot study, but which has now ended because of the lack of ongoing support from VIHA. This service was welcomed with enthusiasm, as it offered a much needed resource to which family doctors could refer chronic pain patients.

Under-treatment of pain is a serious problem throughout Canada, and Central Vancouver Island is no exception. Family physicians feel very frustrated in working with chronic pain patients who universally demonstrate severe impairment in their sense of well-being, level of function, sleep, and quality of life. Their physicians observe altered mood including depression and anxiety accompanied by feelings of anger, hopelessness, sadness and despair. We see disrupted interpersonal relationships, loss of employment and income, lost productivity, absenteeism, and significant medication costs. Patients suffering chronic pain often become highly marginalized in the healthcare system. In doing so, they then often become an unnecessary burden on health and social resources. We know that chronic pain deserves better treatment than we can offer as solo practitioners from our office setting. It is highly demoralizing for physicians to have little to offer patients suffering chronic pain but pills and encouragement to seek out a better lifestyle. Many chronic pain patients have spiraled into the “chronic pain trap” because they are unaware of what a positive lifestyle looks like. There is good solid evidence that patients engaged in multidisciplinary chronic pain programs can function much better, and with lower amounts of opioid and other pain medication.

VIHA places great emphasis on offering chronic disease management encouragement in the areas of congestive heart failure, hypertension and diabetes. But we see no ongoing offerings from VIHA in the Central Island for a condition which involves ongoing severe depression issues, disability, and marked suffering. Chronic pain deserves and needs an integrated chronic disease management approach. Yet our region now offers no such approach for our patients.

Family physicians are well aware that attempting to deal alone without a treatment resource with this often challenging, frustrating and disabled patient population produces sub-optimal results, as well as having a demoralizing effect on the practitioner. The burden of most chronic pain management currently lies on the shoulders of primary care physicians. Patients with chronic pain are at risk to either be under-treated, or continue to suffer, or to be exposed to medications which can lead to over-prescribing of addictive medication such at Oxycontin, morphine, and other opioid analgesics. These medications used on a chronic basis in chronic pain sufferers often lead to a paradoxical increase in the perception of pain, as well as triggering addictive behavior in vulnerable patients.

Effective pain management should be an integral and important aspect of quality medical care. We strongly encourage VIHA to reinstate at least the previous basic chronic pain service for patients in Central Island, many of whom are currently unnecessarily suffering. We would encourage a quick and timely re-establishment of a much needed resource, and exploration of expanding this role into an even more integrative pain service.

Keith Phillips MD, Nanaimo