Background to the
PainSense was introduced in May 2015 by the three CCGs in Leeds as part of the new care pathway for chronic pain, covering 144 GP practices and serving a population in excess of 750,000.
Up until 2012, there was no dedicated community service for people who live with chronic pain. This led to patients being referred into a multitude of different services, such as MSK Physiotherapy, Orthopaedics, Rheumatology and Neurosurgery. These services often over medicalised patient’s care and failed to promote self-management- something key for people living with persistent pain.
The secondary care pain team in Leeds had a long waiting list and were unable to offer the non-interventional support needed due to the vast numbers of people referred in. Additionally, often these people expected interventional treatment, such as injections as well.
GPs tended to prescribe large amounts of analgesic medication, including opioids, which are expensive and not always effective, potentially leading to addiction in some cases.
In 2012, the CCGs commissioned a new community chronic pain service for Leeds to fill the void to assist these patients to self-manage.
In the 2014 review of the pain pathway, the CCGs were keen to include the use of digital tools to assist both clinicians and patients in improving self-management. The change in the pathway was aimed at further reducing referrals to the secondary care pain service, A&E visits, GP appointments and opioid prescriptions.
Impact of the
PainSense enables patients to send the services information regarding their condition prior to their initial face to face appointment. This allows the teams to triage the patients to the correct service (if community pain management is not suitable) and book them to see the most appropriate clinician within the service to set their care plan. This information syncs smoothly and securely into the patient’s care record through our partner links.
Included in the Pain Toolkit app are two patient reported outcome measures (PROMs). These allow the services to provide details on the changes patients have during treatment, this is used to show their effectiveness to the CCG. The PROMs also allow the patient to track their own changes over time and treating clinicians can review the patient scores remotely allowing reviews to occur over the phone, this reduction of face to face consultations improves the efficiency of service increasing their capacity to see more patients and income generate.
A recent review of the statistics from Leeds have shown:
- An increase in the number of patients entering the pathway in the 11 months for which we have comparable data.
- Annualised savings in the total cost of pathway of circa £280,000, representing a 9% reduction in total pathway spend of £2.9 million.
- A switch from 58% of 1st OPs being seen in acute trusts to 29%; representing substantial transfer of care to community sector. This trend is expected to continue further.
- A reduction in patient and day case procedures of 6%, with an associated cost reduction of 15%, indicating fewer and lower complexity medical pain interventions.
- A substantial improvement in patient reported outcomes. Sample patient reported data from 216 discharged patients from our key community provider has demonstrated an average 27.5% reduction in the level and extent of their pain (using DOLO scoring) and a 34% improvement in their confidence and ability to cope with their pain (Using PSEQ). On their Friends and Family test outcomes, 66% of 119 patients responded that they would be extremely likely to recommend the service to their friends and family, with a further 29% likely to– an overall positive response of 95%.
I have introduced this app to several patients who have unanimously provided positive feedback and I am very confident that we will see improved outcomes for this cohort of patients.
It is a very slick way of collecting the information.
Having a diary allows me to improve my understanding of what triggers my pain getting worse or better.
Allowing me to share the data reports to those who are part of my care team is great.
I’ve had a good look through this app – it’s great. We will include in our help table for all to benefit from.