Can pain be helpful as a quality indicator for health care systems?

Transcription

1 Can pain be helpful as a quality indicator for health care systems? Brussels May. 4 th 2010 Dr. Alberto Grua Grunenthal

2 Why is pain important? Pain is independent of social status, sex or ethnic origin Pain is present in many disease states In most medical disciplines pain is more than merely a symptom of disease. In many instances pain should be considered a serious disease also able to influence the outcome of medical and surgical treatment 1 Pain has a very high prevalence Pain is the most common reason why patients seek medical attention and presents a serious problem for a large proportion of the population 2 1 Gerbershagen K. et al.: Pain prevalence and risk distribution among inpatients in a german teaching hospital. Clinical Journal of Pain. 2009; 25 (5): Coda BA, Bonica JJ. General considerations of acute pain. Loeser JD, Butler SH, Chapman CR, Turk DC, eds. Bonica's Management of Pain. 3rd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2001:

3 The prevalence of chronic pain is high Pain affecting muscles, joints, neck or back lasting >3 months is experienced by ~25% of the European population 3 European Commission. Health in the European Union: Special EUROBAROMETER

4 The Belgium KCE estimated cost of back pain. "The global cost of 83.8 million is probably largely underestimated. Moreover, based on the published information, this should be considered to be maximum 30 % of the burden of low back pain for society, which brings the rough estimate to 272 million for the global cost. When using however the highest direct cost ( 164,712,379) and using the assumption that medical costs only represent 10 % of the global burden of low back pain the cost could be as high as 1.6 billion." 4 Chronische lage rugpijn, KCE reports vol.48a, Federaal Kenniscentrum voor de gezondheidszorg, Centre fédéral d expertise des soins de santé, 2006

5 Included Cost estimation of low back pain in Belgium History taking and follow-up Medical imaging Pharmacological treatment Physiotherapy Rehabilitation Epidural steroids Percutaneous radiofrequency Surgery Spinal cord stimulation Not mentioned are the costs related to: informal care by relatives (e.g. loss of earnings) social care (e.g. costs of home care and respite care) absenteeism disability claims adverse events and therapy discontinuations ineffective interventions intangibles associated with deterioration in the QOL of patients and families Therefore the total costs to society will probably exceed the amount of 1.6 billion by far 5 Chronische lage rugpijn, KCE reports vol.48a, Federaal Kenniscentrum voor de gezondheidszorg, Centre fédéral d expertise des soins de santé, 2006

6 Average pain patients seen by general practitioners per month BEL N=60 ES N=70 AUS =68 DE =104 FR N=300 UK N=120 6 Tracking Studies Pain Markets conducted by GfK on behalf of Grünenthal; base: n= 722 GPs (Germany, France, Spain, UK, Belgium, Austria)

7 When is chronic pain severe? There is no common understanding! 35% 30% 25% Physicians 20% 15% 10% 5% 0% No Pain Worst imaginable Pain On a 10-Point Numerical Rating Scale from where on do you perceive chronic non-cancer pain to be severe? N=403 7

8 Amongst physicians in different countries there is a big range of interpretation where severe pain starts 40% 663 physicians where asked: Where does severe pain start using a 100-point Visual-Analogue- Scale (VAS Scale) the range of different pain grades? 35% 30% 25% 20% 15% FR DE IT 10% 5% % 251 PCP/GP 176 Pain Specialists 171 Orthopaedists 65 Oncologist Pain Treatment Pattern Study 2008 conducted by GfK on behalf of Grünenthal; base: n= 663 physicians (Germany, France, Spain, Italy, UK, Sweden, Denmark)

9 Pharmacological treatment approach for severe chronic low back pain has a wide spectrum Antidepressants NSAIDS 93% combination therapy 104 different combinations mentioned 7% monotherapy Paracetamol 10% 7% 18% 49% 14% 7% Fixed Combinations Weak Opioids Classical Weak Opioids 21% 0% 4% 4% Classical Strong Oral Opioids Classical Strong Transdermal Opioids Topical Analgesics 26% 28% 29% 45% 7% 4% 11% 32% Fixed Combinations Strong Opioids N=403 What is your main pharmacological approach for treating your severe chronic low back pain patients? Please choose the combination you most commonly use 9

10 Austria Belgium Czech Republic Denmark France Germany Ireland Italy Netherlands Poland Portugal Slovak Republic Slovenia Spain Sweden United Kingdom 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 10 Prescription behaviour differs between countries M1A3 COXIBS M1A1 "older NSAIDs" PAA (Mono and Combi. of N2B) CAA Combi. (Non Narcotics) CAA Mono (Non Narcotics) NARCOTICS (excl.drug substitution) IMS Midas 2009, retail market only

11 The impact of guidelines differs from country to country Yes, always Yes, in some cases No Total n=663 34,5% 30,2% 34,8% France n=110 27,3% 26,4% 46,4% Germany n=113 53,1% 31,0% 15,9% Italy n=117 38,5% 26,5% 35,0% Spain n=110 20,9% 48,2% 30,0% UK n=110 32,7% 19,1% 48,2% Denmark n=40 30,0% 17,5% 52,5% Sweden n=63 36,5% 38,1% 22,2% 11 Do you use guidelines or standards to determine the pain treatment for patients suffering from? Pain Treatment Pattern Study 2008 conducted by GfK on behalf of Grünenthal; base: n= 663 physicians (Germany, France, Spain, Italy, UK, Sweden, Denmark)

12 12 Strong opioides - PTDs per capita in Europe Central Acting Analgesics - PTDs per capita in Europe IRELAND SWEDEN DENMARK NORWAY BELGIUM FINLAND 16 LUXEMBOURG SPAIN SLOVENIA AUSTRIA GERMANY CROATIA SWITZERLAND CZECH SLOVAK NETHERLANDS HUNGARY PORTUGAL POLAND ITALY ESTONIA GREECE LATVIA ROMANIA LITHUANIA RUSSIAN FED. BULGARIA UKRAINE PTDs per capita 2 0 UK FRANCE IRELAND SWEDEN DENMARK NORWAY BELGIUM FINLAND LUXEMBOURG SPAIN SLOVENIA AUSTRIA GERMANY CROATIA SWITZERLAND CZECH SLOVAK NETHERLANDS HUNGARY PORTUGAL POLAND ITALY ESTONIA GREECE LATVIA ROMANIA LITHUANIA RUSSIAN FED. BULGARIA UKRAINE IMS Midas Kilochem 2009 UK FRANCE There is a very big difference in patient treatment days for opioids in the EU Weak opioides* - PTDs per capita in Europe IRELAND SWEDEN DENMARK NORWAY BELGIUM FINLAND LUXEMBOURG SPAIN SLOVENIA AUSTRIA GERMANY CROATIA SWITZERLAND CZECH SLOVAK NETHERLANDS HUNGARY PORTUGAL POLAND ITALY ESTONIA GREECE LATVIA ROMANIA LITHUANIA RUSSIAN FED. BULGARIA UKRAINE UK FRANCE PTDs per capita PTDs per capita

13 Can pain be helpful as a quality indicator for health care systems? The number of patients affected by pain is very significant. The economic and social burden of chronic severe pain is derived from inherent direct costs and indirect costs. The global cost of pain is probably largely underestimated. Looking at the available data we find a very heterogeneous situation across Europe in the management of pain. This indicates for the health care systems that best practice in prevention and management of pain are sparsely shared over Europe. Because of its high prevalence and impact on patients and society, pain should be recognized as a significant health care quality indicator. Improved knowledge on the societal impact of pain will help us to define measures to improve the clinical and economical burden of pain. The definition of clear health care indicators measuring pain in the population will support the implementation of a best practice approach to improve care. 13

14 THANKS A LOT FOR YOUR KIND ATTENTION 14