Can Integrated Pain Care Save Money?

Transcription

1 Can Integrated Pain Care Save Money? Copenhagen May Gerhard H.H. Müller-Schwefe Deutsche Gesellschaft für Schmerztherapie e.v.

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3 Patients suffering from Chronic Pain in Germany Total number of inhabitants 80,000,000 Total number of patients with chronic pain 15,000,000 Prevalence of chronic pain 23,5 % Daily Back Pain 1,8000,000 EMNID Survey 2002

4 Prevalence of Pain Syndromes in German Practice 5% 10% 10% 10% 30% Painsyndrome Back Pain Migraine, Headache Rheumatic Pain Neuropathic pain Cancer Pain Osteoporosis, Osteoarthroseis Phantompain 15% 20% Der Allgemeinarzt / dpa / August 2001

5 Back Pain Prevalence and Relevance Back pain is worldwide #1 reason for medical treatment M40 M54 (ICD-10) Life time prevalence 85 % Point prevalence 40 % - approx.. 10 % become chronic - approx. 5 % severe problems 5 % of patients responsable for 50 % of total costs Anual loss of 600,000 working-years Hildebrand J und Mense S, Der Schmerz 6: , 2001

6 Total Cost of Back Pain in Germany: annually Indirect Costs (Sick-Leave and Disability) 71,7% Direct Costs 28,3% Medication 1,4% Physiotherapy 5,3% Rehabilitation 6,1 % Hospital 6,4% Examinations, Diagnostic 9,1% Bolten W, Med. Klinik 1998;93(6): Wenig,C;Schmidt, C et al. EJP 2008,13(3):

7 Back Pain Prevalence and Relevance in TK Inability to work due to Back Pain 2008 Deformitäten der Wirbelsäule (M40-M43) 0,4% Spondylopathien (M45-M49) 0,7% übrige Diagnosen 90,0% 10,0% Zervikale Bandscheiben-schäden (M50) 0,3% Sonstige Bandscheibenschäden (M51) 2,5% Sonstige Krankheiten der Wirbelsäule und des Rückens (M53) 0,8% TK-Gesundheitsreport 2009 Back Pain (M54) 5,3%

8 Patient Centered Care of Back Pain International Comparison Regarding outcome of back pain treatment Germany is in international comparison with US, Sweden, Netherlands, Israel and Denmark the taillight with the highest rate of early retirement After sickleave of longer than 3 month only 35% of back pain patients return to work after two years On the other hand no other country has such a comprehensive and expensive cure and rehab-system! The German Spa System Hildebrandt, Mense, Lendenwirbelsäule 1. Auflage 2005 Urban & Fischer

9 Patient Centered Care of Back Pain International Comparison Hildebrandt, Mense, Lendenwirbelsäule 1. Auflage 2005 Urban & Fischer

10 Back Pain Treatment Intensity and Expenses Current Situation E x p e n s e s Thus our healthcaresystem creates with highest financial efforts poorest results weeks

11 Back Pain Treatment Intensity and Expenses E x p e n s e s Necessity Specific employment of resources in high risk patients weeks

12 Back Pain Relevance in TK

13 Back Pain Relevance in TK

14 Integrated Pain Care: The Claim less Pain better QoL, higher patients autonomy and self-competence less hospitalisation, less surgery early intervention against chronification access based on timelines Reduction of sick-leave costs

15 Integrated Pain Care: IMC Conception Networking of primary care, specialists incl. painspecialist, in- and outpatient treatment DGS accredited multidisciplinary pain-centers Interdisciplinary diagnostic screening prior to inclusion Individual multimodal, multidisciplinary treatment schedule for patients including comprehensive pain management, psycho/behavioral therapy and physiotherapy Health insurance is assigning patients Seperate Care-giving, management and documentation/benchmarking Goal: Prevention of back pain chronification

16 Integrated Pain Care: IMC Conception Conception of Integrated Pain Care LevelI: Admission GP/Specialist Sec.Op Level II: Admission Health Insurance Diagnostic Screening: Multiprofessional team decides: Integrated care or standard care best for patient? Level III : outpatient Care Pain centre Pain ambulance Pain clinic Level IV: partly inpatient care Pain Centre Pain Clinic Hospital Level V: Inpatient Treatment Pain Clinic Pain Hospital Recall after 6 months

17 Integrated Pain Care: Inclusion Criteria Inclusion Criteria : Diagnosis M40-M54 (if applicable relevant F diagnoses) Minimum of 4 weeks working inability related to M No sufficient pain control in standard care Insurant is motivated and wants to participate End of sick-leave is not foreseeable Exclusion Criteria: Malignant tumor Inflamatory rheumatic disease Prokected inpatient rehabilitation treatment Lack of motivation of patient

18 Integrated Pain Care: Process Diagnostic Screening suitable not suitable alternative treatment proposal Four weeks multimodal treatment Return to work five to eight weeks IC Return to work Unable to work Malus Bonus Sustained working ability Ongoing working disability After 4 treatment weeks sustained working ability longer than 6 months

19 Integrated Pain Care: Screening Screening Team Mandatory Specialities Pain medicine 1 h Psychology 1 h Physiotherapy 1 h Additional specialties on demand Pain related diagnosis Treatment proposal according bio-psycho-social concept

20 Integrated Pain Care: Screening Team Conference Individual Recommendation

21 -All effective treatment options (not only common to GHC) -Education, relaxation techniques, attentiveness, biofeedback -Continuous team conference -Consistent and common documentation platform -Treatment regulation by patients reports -Daily standardized documentation (German pain questionnaire, German pain diary) Reevaluation after 6 months External QA Integrated Pain Care: Treatment Workflow Treatment 1 (max) 2 months every 2. day including -psycho/behavioral therapy -Physiotherapy (coordination, strength and endurance) -Pain therapy

22 für Sie bündeln wir Schmerzkompetenz

23 für Sie bündeln wir Schmerzkompetenz

24 für Sie bündeln wir Schmerzkompetenz

25 für Sie bündeln wir Schmerzkompetenz QA: Patient Reported Outcome Screening Woche 1-4 Woche 4 Woche 5-8 Woche 8 Monat 6

26 für Sie bündeln wir Schmerzkompetenz Reprts: Fax-Datasheet Permanent Information about Status and Progress for Case Manager and IMC GmbH After Screening After 4 weeks After 8 weeks After 6 months

27 für Sie bündeln wir Schmerzkompetenz

28 für Sie bündeln wir Schmerzkompetenz

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30 für Sie bündeln wir Schmerzkompetenz Integrated Back Pain Care Results

31 für Sie bündeln wir Schmerzkompetenz IVR-ERGEBNISSE 2012 ( N = 5533 )

32 für Sie bündeln wir Schmerzkompetenz

33 Integrated Pain Care: Results Results IVR 41 Pain Centers in Germany > 5800 Patients ( ) 24 % Screening failure 86,3 % Working ability after 4 8 weeks treatment 52 % Reduction of working disability days (treatment group 86 days, control 172days) After 6 months further improvement of QL

34 Integrated Pain Care: Results Can Integrated Pain Care Save Money? Avr. Working disability control 172 days at 55.- /day % reduction of Working disability days Expenses for IPC treatment aver../ Savings per patient in IPC >1000.-

35 Integrated Pain Care: Results May be we sometimes have to change old habits

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37 Deutsche Gesellschaft für Schmerztherapie e.v.