Authors (including presenting author) :
LO KC(1), LAI KW(1), TANG SF(1), Wong WLM(1), Chan KLP(1), Chan CWT(2)
Affiliation :
(1) Department of Psychiatry, Queen Mary Hospital, (2) Department of Anesthesiology, Queen Mary Hospital
Introduction :
Chronic pain is defined as pain lasting beyond normal tissue healing time, generally lasted, or recurred for more than 3 months. Chronic Pain contributes to disability, anxiety, depression, sleep disturbances, poor quality of life, and increased health care costs. Pain and mental illness are highly correlated. One study reported that 65% of patients with depression have chronic pain and 5-85% of patient with pain have depression (Geneen & et al, 2007). A new model involving collaboration between Department of Anesthesiology and Psychiatry in the HKWC was developed since October 2019.
Objectives :
(1) To liaise health care professionals for both Departments to formulate and review care plan for patients with both pain condition and mental health issues
(2) To synergize the expertise on both managements of pain and mental illness to provide efficacious and effective care
(3) To provide psychiatric consultation nursing service
(4) To advise on self-management skills to cope with pain conditions and psychiatric symptom management
Methodology :
An inter-departmental working group was formed in August 2019. Since October 2019, quarterly inter-departmental meetings and case conferences were conducted for case discussion and clinical teaching of complex cases. Incorporation of routine screening on depression and anxiety symptoms (i.e., PHQ-9 and GAD-7) to all patients attending pain clinic as facilitated by Pain Nurse. Psychiatric Consultation Liaison Nurse (PCLN) would conduct assessment and brief intervention for patients screened with moderate to high level of depression or anxiety symptoms. PCLN would also provide brief psychoeducation, counselling, and intervention, including stress management, relaxation, and mindfulness strategies etc. Referrals to Psychiatric outpatient services or AED would be made if indicated.
Result & Outcome :
Since October 2019, 6 case conferences and 30 patients were discussed. Some difficult cases were discussed and shared on management strategies, including devising pain management strategies, adjustment of psychiatric medication, referrals to ambulatory service or community services in Department of Psychiatry as appropriate.
170 patients were screened with moderate to severe symptom levels. 51(30%) was referred to PCLN. Patients responded positively to the assessment, brief psychoeducation and intervention. All patients attended the consultation were satisfied with the service.
Conclusions:
IPPCC is a new interdepartmental and interdisciplinary care model to provide better care for patients with chronic pain and mental health problems.
