A whole-person model of care for persistent pain: from conceptual framework to practical application.

Abstract

SETTING: The study was set in an Australian tertiary public hospital multidisciplinary pain center.

OBJECTIVES: The objectives of the study were to describe the conceptual shift undertaken by a multidisciplinary team in moving from a traditional approach to an emerging paradigm in pain medicine and to describe the practical application of a whole-person model of care and report outcomes over the period 2003-2010.

DESIGN: The study design was descriptive, including a brief review of current evidence base, consideration of models of service delivery, and analysis of the impact of applying a new, whole-person model of care for persistent pain.

INTERVENTION: Since 2004, a series of changes led to significant health system redesign. The process involved development of a broader, whole-person understanding of the individual with pain and a more integrated approach to service delivery across the spectrum from community to tertiary care.

RESULTS: Broad trends in the period 2003-2010 included a modest reduction in referral rate, marked reduction in waiting times, more efficient staff utilization, inversion of the ratio of new assessments to review appointments, increased telephone contact with primary care, increased use of personalized pain management plans, reduced procedural interventions and increased attendance at and clinically significant gains from shorter and more flexible group programs.

CONCLUSIONS: Changes to conceptual framework inevitably influence the practicalities of service delivery. The application of a whole-person model for persistent pain brought improved engagement with the individual in pain and more efficient delivery of care at a systems level.