Chronic Pain becomes Priority in Spain
Spanish Ministry of Health acknowledges Chronic Pain as one out of 4 main topics for its national strategy for addressing chronic diseases
On 16th October the Spanish Ministry of Health has published its Strategy for addressing Chronic Diseases (“Estrategia para el Abordaje de la Cronicidad en el Sistema Nacional de Salud”).
The concept had been previously approved by the Interterritorial Council of the National Health System (“Consejo Interterritorial del Sistema Nacional de Salud”) on 27 June 2012.
Aim of the new strategy is to set goals and recommendations that will effectively manage health service deliveries to improve population’s health and its determinants, strengthen prevention of health conditions and reduce limitations in chronic and comprehensive care. The concept describes four main pillars on which the strategy for chronicity is based on:
- Stratification of Patients
- Quality indicators in Health Care
- National network of schools for patients
- Improvement of the chronic pain approach
The Strategy was presented at the Ministry of Health in a event opened by Ms. Pilar Farjas (General Secretary for Health), and moderated by Ms. Mercedes Vinuesa (General Director of Public Health and Quality at the MoH) and Ms. Sonia García San José (Deputy Director of Quality and Cohesion at the MoH).
Please read here the full “Estrategia para el Abordaje de la Cronicidad”
Strategies for the improvement of pain care in Andalusia
In Andalusia, in response to national laws and the actual andalusian autonomic law, which includes the right of patients to receive adequate pain treatment and within the Andalusian Quality Plan, integrated care processes (ICP) were developed, like Non- Cancer Chronic Pain ICP, Fibromyalgia ICP and Palliative Care ICP, all of them published in 2005.
These processes are directly related to addressing pain, and in late 2007 a working group was formed to develop a comprehensive strategic plan aimed at pain prevention, care and rehabilitation of patients with pain, which was published in May 2010 with the title "Andalusian Caring Plan for People in Pain" (ACPPP).
The ACPPP was developed by a multidisciplinary group composed of 24 professionals (anesthesiologists, surgeons, nurses, sport experts, pharmacists, A&E physicians, pediatricians, psychologists, psychiatrists, rehabilitation physicians, interventional radiologists, orthopedic surgeons, epidemiologists, technical and administrative personnel led by Reyes Sanz, phD,MD and Juan Antonio Guerra phD,MD.
Once established, the group proceeded to define the scope of the plan and to analyse the situation from a quantitative and qualitative perspective. The state of the existing care situation and needs in our community were established, the objectives were formulated and improvement and implementation actions were designed in relation to training, resources, evaluation and communication; these actions are grouped into 6 major lines consistent with the strategic objectives.
The draft was subsequently sent to external review to both scientific societies and professional experts, the necessary changes were incorporated and the final ACPPP document was published.
The ACPPP was launched in June 2010 and until 2011 it has developed the foundations for the subsequent implementation of other elements, the most important ones developed to date are:
1. The review and update of ICPs: non-cancer chronic pain, fibromyalgia, Palliative Care, and ICP “surgical block” (deals with care to postoperative pain from any mayor surgery procedure) and the development of an evidence based clinical practice guideline about the safe use of opioids for terminal care.
2. The training program, which covers general training on chronic pain and specific training on psycho-education, exercise prescription and physical activity and the safe use of opioid prescriptions.
3. The development of general competencies for all health service professionals, shared skills for groups of professionals in areas related to the scope of the plan and specific skills in relation to the ICPs developed.
4. The development of a sign of quality called: "Centres Against Pain " aimed at GP Centers, hospitals and pain management units.
5. The development of a safety program for the Pain Management Units of hospitals.
The next challenges that will be addressed during the remaining term of the plan (2010-2013), are to incorporate intermediate and final indicators of health outcomes to the digital history to assess changes in healthcare and citizens health, to incorporate aspects of attention to pain in the portfolio of health facilities and improvement goals for these centres, to continue with the training activities and the final evaluation of the ACPPP itself.
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Strategy for the improvement of attention to pain in Galicia
Galicia is a Spanish region with nearly 3 million people, which has complete autonomy in setting health policies to meet the needs of an ageing and largely dispersed population.
In May 2010, Galician Health Minister began working on developing a "comprehensive strategy for patient care in pain". This project is being led by Mercedes Carrera and Dolores Martin, from the General Directorate of patient safety and quality care, and supported both by the General Manager of the Galician Health Service, SERGAS, and the Health Minister herself.
Health staff, professionals and patients have to implement actions to develop the strategy and achieve its main objective, which is "optimal pain management for all Galician citizens and their families."
The actions undertaken during 2011 include: institutional declaration of attention to pain as a fundamental human right, awareness campaigns for professionals and patients, introduction of indicators of pain within the goals of professionals and health managers, including pain as the 5th vital sign on the patient's electronic medical records, creation of committees of pain management in all Galician hospitals and an Advisory Council on Pain Management for the Galician Health Service.
With all these activities, the implementation of the strategy in all Galician hospitals has been achieved, with a significant increase in both, the knowledge of the real intensity of patient pain, the registration in their electronic medical records and the relief of pain among inpatients.
The actions planned for 2012 are focused on the following objectives:
- The development of the strategy and procedures for chronic pain in primary care.
- The implementation of training programs in pain for nurses, GPs and training doctors.
- Analysis, evaluation and definition of the processes for the attention to chronic pain in the Galician Pain Care Units.