New model for managing pain could ease the burden on patients and health systemsResearchers in Italy and Portugal are testing a multidisciplinary approach to managing older people living with pain and at risk of frailty
Chronic pain can have a profound impact on quality of life and is associated with frailty in older people,. It is more than a physical condition: pain also affects mood, social and cognitive function. Managing pain adds to the burden on caregivers and increases costs related to physician referrals and long-term institutionalisation.
While it affects between 45% and 80% of older people, pain is not always well managed,. Experts say the complexity of pain makes it challenging for health systems to offer the kind of multidisciplinary care patients need. Improving adherence to medication and addressing wider psychosocial issues could help to improve outcomes,.
A new project by researchers in Italy and Portugal aims to address these service gaps using a more holistic approach to the management of pain in older people. ‘Pain in older people is multidimensional,’ explains Professor Graziano Onder of the UCSC Department of Geriatrics in Rome. ‘Patients usually present not only with physical pain but with depression, disability and reduced social function. To target frailty in older and complex patients, we need to think multidimensionally.’
New model of care
The research is part of a broader programme called Project chAnGE, supported by Upjohn, a Pfizer division, launched under the European Innovation Partnership Action on Health Ageing (EIP on AHA). Project chAnGE aims to identify gaps in Europe in relation to healthy ageing in people with non-communicable diseases and support the necessary changes in clinical practice.
The Italian-Portuguese collaboration will focus on community-based patients attending day care centres for older people where rates of chronic pain, and the risk of needing hospital-based or nursing home care, is high. ‘It’s very important to link chronic pain and frailty,’ says Dr Elisio Costa of Porto4Ageing and the Faculty of Pharmacy, UPORTO. ‘The risk of death related to frailty is very high. By offering an integrated care model, we hope to prevent frailty and mortality.’
People with chronic pain and complex needs often see a range of health professionals, including GPs, nurses, psychologists, physiotherapies, pain specialists, neurologists and others. Joining the dots between these services can help to address fragmentation in patient care. ‘We need to develop new models of care that integrate health and social services,’ Dr Costa says.
This is echoed by Prof Onder, who was a leading participant in CHRODIS+ the EU Joint Action on chronic diseases. ‘I believe the way we organise care for people with chronic pain should be similar to how we treat multimorbidity in people with several NCDs,’ he explains. ‘Through CHRODIS & CHRODIS+, we have developed an approach that enhances continuity of care and manage the person instead of tackling their conditions in isolation.’
Case managers are key
The team will apply the CHRODIS model in approximately 400 patients in a community setting. Teams of specialists will be coordinated by a case manager who will act as a gatekeeper and a key contact point for patients. Technology will be used to facilitate tele-consultations and ensure appropriate referrals and follow-up.
Not only could this enhance adherence to treatment and improve continuity of care, it could shift the mindset of patients and care providers to view the person holistically. ‘Patients receiving this kind of care may be less likely to be hospitalised,’ Prof Onder says. ‘They can be cared for very well while living at home instead of in a nursing home.’
Patients are ready to take a more active role in their own care: ‘This ‘baby boomer’ generation of older patient is very open to being involved,’ he adds. ‘In fact, they expect it.’ To help empower service users, courses will be provided to patients and caregivers to deepen their understanding of pain and its management.
Inspiring healthcare professionals to embrace new ways of working will also be vital to transforming pain management. That is why testing this new multidisciplinary model in a real-world community care setting is so important, says Prof Onder.
‘Changing healthcare professionals’ minds and ways of working is the biggest barrier to changing how we organise care,’ he says. ‘But if we can demonstrate that working together improves the health of patients and is more efficient, there is an opportunity to bring people with us.’
Dr Costa says the new project is a chance for a broad coalition of stakeholders to work together towards the common goal of improving the delivery of care. ‘The new model we envisage requires innovation across the healthcare ecosystem,’ he says. ‘That’s why it is crucial to bring together all the key decision-makers: healthcare professionals, hospital and day centre managers, universities – and patients. It’s the only way forward.’