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Start and run a pain clinic
The document outlines the establishment and operation of pain clinics in Indonesia, emphasizing the need for interventional pain management, multidisciplinary approaches, and proper resources. It discusses the preparation of pain clinics, including human resources, systems, and facilities, advocating for a holistic view on pain management and training for medical professionals. Additionally, it highlights the importance of collaboration between various specialties, guidelines for clinical practices, and the challenges faced in pain management.
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Start and run a pain clinic
- 1. START AND RUNA PAIN CLINIC A.M.TAKDIR MUSBA PROGRAM FELLOWSHIP OF INTERVENTIONAL PAIN MANAGEMENT KOLEGIUM ANESESIOLOGI DAN TERAPI INTENSIF
- 2. • Koord PainServices di RS Wahidin • Kerja di Pain Clinic • Perwakilan KATI di KKI ttg IPM • Pokja Nyeri di Kemkes • Indonesia Pain Society • Program FIPM Anestesi • Komisi Fellowship di KATI
- 3. Blueprint of PMDevelopment in Indonesia Nurse School Medical Faculty Specialist Program •Pain Subject in curriculum •Pain education in every degree •Role of professional health care provider Primary Care Centre •Pain as priority ( 5th vital sign ) •Pain training and competency •Available of drug •Guidelines and Clinical Pathway •Pain Palliative Care •Pain in medical system and referral system •MoH Support •Pain organization support •Pain CME Secondary and Tertier Care Centre •Pain Competency for Medical provider •Acute Pain Services •Guidelines and Clinical pathway •Procedures standardize (SOP) •Available of drug and equipment •Interdisciplinary collaboration •Hospital accreditation •RESEARCH GOOD PAIN MANAGEMENT IN COMMUNITY Medical Education System Collegium Role in Competency Medical Council (KKI ) regulation Pain Society Organization ( IPS ) Hospital Organization ( PERSI ) Ministry of Health Policy
- 5. OUTLINE • A SHORTHISTORY • THE NEED OF PAIN CLINIC • TYPE OF PAIN CLINIC • PREPARING PAIN CLINIC – HUMAN RESOURCES – SYSTEM – EQUIPMENT – FINANCING • IDEAL CONCEPT OF PAIN CLINIC
- 6. PAIN CLINIC HISTORY •Pre- Bonica era – Pain Management concept – Scholleser, 1903 : injecting specific nerve for analgesia – Rovenstine, 1936 : first nerve block in pain clinic – Pain practice and centres unorganized and a sngle disciplinary approach • Bonica, Waldman and Raj ( 1947 till now ) in Seattle – Bonica, 1947 : First Multidiscplinary pain clinic – Waldman, 1995 : Interventional pain management term – Prithvi Raj, 1993 : World Institute of Pain ( WIP )
- 7. We need PAINCLINIC • PLACE FOR START IN PAIN PRACTICE • PREREQUISITE FOR INVOLVE IN PAIN • PATIENT KNOW WHERE THEY GO • PLACE FOR CONSULTATION, DIAGNOSTIC, FOLLOW-UP AND OTHERS • SOME PROCEDURES CAN BE DONE
- 8. PAIN CLINIC ANESTESI(IPM)
- 9. TYPE OF PAINCLINIC • MODALITY ORIENTED PAIN CLINIC • SINGLE-DISCIPLINARY PAIN CLINIC • MULTI-DISCIPLINARY PAIN CLINIC • MULTI-DISCIPLINARY PAIN CENTRES • HOSPITAL-BASED PAIN CLINIC • SOLO PAIN CLINICS
- 10. ADVANTAGES AND DIS-ADVANTAGES OFPAIN CLINIC TYPE
- 11. PREPARING PAIN CLINIC 1.HUMAN RESOURCES 2. SYSTEM 3. FACILITY
- 12. 1. HUMAN RESOURCES •DOCTORS • NURSES • RADIOGRAFERS • REHABILITATION TEAM • PSYCHOLOGIC TEAM • NON-MEDICAL SUPPORTING TEAM
- 13. – Doctor’s holisticview on pain management ? – Every Specialty have Specific Modality, but collaboration ? – Willingness and preparedness to work in Pain ? – Well trained interventionist ? – Pain Specialist ? – Nurse Pain ? Some question in HUMAN RESOURCES
- 14. DOCTOR COMPETENCY INPAIN • IDEALLY – ASSSESSMENT TO TREATMENT – HOLISTIC POINT OF VIEW – PAIN SPECIALIST • COMPETENCIES IN PAIN MANAGEMENT – MEDICAL DOCTOR in SKDI 2012 – PROGRAMMES FOR SPECIALIST TRAINING AND CERTIFICATION • ACGME “Subspecialty Certification in Pain Medicine”, 1992 • ACGME-accredited Pain Fellowship, 2005 • Fellowship of Interventional Pain Practice,WIP, 2001 • ASIPP ( American Society of Interventional Pain Physicians), 1998 • EFIC ( European Federation IASP Chapter )
- 15. Indonesia conditions • Legalfundament for IPM procedures ? • Medical competencies for pain management ? • Standard Procedures IPM technique ?
- 16. Clinical Privileges • Collegiumbased – Program kompetensi tambahan • Komite medik credential • Self-assessment
- 17. PENDIDIKAN KONSULTAN MANAJEMENNYERI - KATI Lulusan : 33 orang Dr.SpAn-KMN
- 18.
- 19. CLINICAL PRIVILAGE Dr.SpAndi RS berdasar Buku Kewenangan Klinis •Pengajuan Kewenangan Klinis •Credential Komite Medik RS •Surat Penugasan Klinik dari Direktur RS
- 20. Muatan Nyeri dikurikulum PPDS, 2017 Kewenangan Klinis Manajemen Nyeri bagi Spesialis Anestesi
- 21. 2. SYSTEM • HOSPITALPOLICY • PPK, CLINICAL PATHWAY • FINANCIAL COVERAGE • REFERRAL AND INTERDISCIPLINARY COLLABORATION • MONITORING AND EVALUATION
- 22. Pain Clinic plan UNI-DISCIPLINARYPAIN CLINIC MULTI-DISCIPLINARY PAIN CLINIC
- 23. Pain Clinic inHospital IT System
- 24. Financial system • Investment •Insurance coverage – ICD 10 diagnosis, ICD 9-CM procedures • Fee and reward system
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- 27. Multidisciplinary team Pergolizzi J.TOWARDS A MULTIDISCIPLINARY TEAM APPROACH IN CHRONIC PAIN MANAGEMENT
- 28. 3. FACILITIES • OPD –Equipmet tools for pain measurement – Basic equipment at OPD • PROCEDURES ROOM – Fluoroscope / C-arm machine – Radio-protective equipment – Surgical table c-arm compatible – Ultrasound machine – Radiofrequency generators – Equipment for CPR – Vital parameter monitoring – Medicine /Drugs – Advanced equipment
- 29. Some deficiencies ofPain Clinic • Over-dependencies on interventional procedures • Lack of evidence practice • Lack of multidisciplinary model • Lack of safer drug for long term used • Failure to establish palliative care model for chronic pain • Vague and restricted criteria for reimbursement
- 30. Ideal pain clinic •Promoting multidisciplinary team approach • Coordinating all specialist effort • Measuring the outcome of treatment offered • Promoting palliative model rather than curative models of pain treatments • Identifying complications of IPM and promoting safe and base-evidence intervention
- 31. • Thank youvery much for your kind attention