The Italian Healthcare Program For Pain Management In Adults And Children

Transcription

1 The Italian Healthcare Program For Pain Management In Adults And Children MARCO SPIZZICHINO Director For Palliative Care And Pain Management Policy ITALIAN MINISTRY OF HEALTH Department For The Development Of Healthcare Strategies, Primary Care And Clinical Ethics

2 The World Health Organization Definition of pain: An unpleasant sensory or emotional experience associated with actual or potential tissue damage, or described in terms of such damage

3 Pain is a personal experience, sometimes dramatic, and difficult to describe by those affected

4 Pain affects all age groups, including children It has a huge impact on the quality of life of patients Pain is devastating nothing is easy

5 The pain won t stop...what can I do??? who can help me???

6 The patient with chronic pain is like a derailed train They can get back on track

7 To respond effectively to the needs of patients with chronic pain, appropriate legislation is necessary

8 Legislation

9 Pain and the Law Until 2001, legislation addressing the organizational aspects and issues linked to pain relief was totally lacking

10 May 24 th 2001 Project Pain Free Hospital The first document concerned with the treatment of pain is an agreement between the Ministry of Health and Regional Authorities

11 Project Pain Free Hospital The project was a program for hospitals aimed at providing appropriate solutions for people with chronic pain It involved: The creation of Pain Free Hospital Committees Training for doctors Public awareness campaigns Clinical recognition and assessment of pain

12 Project Pain Free Hospital did not achieve the expected targets

13 The shortcomings of the project: Pain Management support networks were not created Hospitals remained cut off from each other

14 THE USE OF OPIOIDS

15 In Italy The prescription and use of opioids for the treatment of pain is behind compared to other European countries

16 Increases in spending for strong opioids in the European market 2009 vs. 2010

17 2010 Spending for strong Opioids uro per person European Mean, Germany, UK,, France, Spain, Italy. 10 9, ,47 4, ,08 2,68 2 1, Me dia Europa Germania Inghilterra Francia Spagna Italia Fonte IMS MIDAS Dic.2010 dati ISTAT 2010

18 PAIN IN CHILDREN

19 Pain in children Pain is a symptom that affect all ages, including children Children feel pain with the same intensity as adults Pain in children is frequently underassessed and under-treated

20 Epidemiology of pediatric pain Over 80% of admissions to pediatric hospitals are due to conditions involving pain 130 new cases of cancer in children under 15 each year, of which: 50% suffer from pain 100% suffer pain if undergoing invasive practices

21 How many children suffer pain? 60% accessing emergency departments 80% following surgery 100% undergoing invasive diagnostic tests 80% with incurable/terminal illness 20% of children of school age suffer chronic, recurring pain (headache, abdominal pain)

22 Gauging pain in children In order to provide effective solutions for the treatment of pain in children, it is important that it is properly assessed It is essential to: monitor the levels and evolution of pain adopt the most effective pain treatment verify the effects of pain treatments Use a common language by healthcare professionals who take care the pediatric patient

23 Wong-Baker Faces Pain Rating Scale for children > 4 years

24 Alice, 4 years old: it used to hurt but now it s s stopped

25 A change in direction

26 September 2008 Working group on palliative care and pain management Goals: The redefinition of the pain management network A model of care network for pain management at three levels:

27 Specialized centers for pain management (HUB) Outpatient pain management (SPOKE) G P practices that administer pain relief The three levels should complement each other

28 Changes in the networks for pain management in children

29 Care networks for children Children are treated for pain predominantly in hospitals Treatment is provided by hospital doctors The specialized centers for pain management (HUB) are based in hospitals

30 Working Group on palliative care and pain management Training for medical staff: two pain manuals are being distributed to doctors and pediatricians the two handbooks are easy and quick to consult and provide inform on how to treat various types of pain

31 Cronic pain Pain in Children

32 Something new on the horizon

33 15 th March Law 38 Innovative legislation ensuring access to palliative care and pain management it is an important step towards the regulation of pain relief it provides and guarantees patient access to palliative care and pain management, ensuring individual care programs for patients and their families whilst respecting human dignity and autonomy it provides appropriate social and healthcare support by addressing the complex needs of the patients and their families at all levels (not only medical)

34 What s new? Law 38: establishes two separate care networks: for care palliative and pain management stipulates child- specific palliative care and pain management calls for public awareness campaigns institutes a Ministry of Health agency to monitor the palliative care and pain management networks

35 what else? article 7: specifies the documentation of any reported pain, including its nature, evolution and the methods of pain relief and analgesics drugs administered, in the patient s medical records article 10: stipulates simplified procedures for the prescription of opioids for pain relief

36 What has been done

37 Pain-Free Hospital and October 28 th 2010: Local Community (art. 6 paragraph 2) In an agreement between national and regional government the Pain-Free Hospital project is renamed the Pain-Free Hospital and Local Community project This is to broaden the focus from care in hospitals to integrated care in the patients community involving local GPs

38 Guidelines for the promotion, development and coordination of actions undertaken by the regional health authorities (art. 3 paragraph2) To ensure the development of effective palliative care and pain management, an agency has been created for the coordination of healthcare networks in hospitals and local communities

39 Awareness and communication projects (art. 4 paragraph 1) The Ministry of Health, in collaboration with Regional Governments, has launched a competition for the most direct and effective catchphrase, logo, poster and short film to raise awareness of pain relief. awarded the date on march 29th 2011

40 Implementation of Law 38/2010 In order to fully implement the principles of Law 38/2010 ensuring access to palliative care and pain management, the following organizations have been engaged:

41 Ministry of Health Department for Palliative Care and Pain Management Working group for Ministry of Health strategy National Commission L.38/2010 Working group on palliative care Working group on pain management Working group on palliative care and pain management in children

42 Work in progress

43 Definition of essential healthcare services necessary for palliative care and pain management (Art. 5 paragraph 3) A document establishing minimum standards for services and providers of palliative care and pain management networks is currently being finalized

44 Professional figures working in palliative care and pain management (Art. 5 paragraph 2) The Ministry of Health is currently developing a proposal for the professional configuration of the multidisciplinary palliative care and pain management teams for adults and children

45 In collaboration with key scientific societies and non-profit organizations, homogenous training programs will be defined for volunteers working throughout the country in both care networks Volunteers working in palliative care and pain management (Art. 8 paragraph 4)

46 Thank you