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MSK Initiative
Orientation Webinar
Low Back Pain
December 6, 2011
Agenda
 Webinar Housekeeping
 Participant Introductions
 Polling Questions
 Overview of the Pilot Project
 Role of Participants
 Overview Algorithms
 Case Application of Key Tools
 Questions
 Summary
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Webinar Opportunities
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Audio and Visual
Sound
Polling Questions
Chat Function
Save
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GPs to participate in testing / trial of clinical practice tools
First Name
Last Name
Location of Practice
Topic Area
Herb
Chang
Coquitlam
LBP
David
Steinson
Coquitlam
LBP
Helene
Bertrand
North Vancouver
LBP
Mona
Lee
North Vancouver
LBP
Jane
Donaldson
Richmond
LBP
Richard
Backus
Victoria
OA + PSM
Jackie
Fowler
North Vancouver
OA + PSM
Kathleen
Bell-Irving
North Vancouver
OA + PSM
Janet
Ames
Prince George
OA+ PSM
Michael
Look
Burnaby
OA+ PSM
Selena
Lawrie
Kamloops
RA
Bruce
Newmarch
Kamloops
RA
Patrick
Chan
North Vancouver
RA
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Polling Questions 2, 4,5, 6, 7,
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Purpose of MSK Initiative
 To design and pilot an evidence-based, best practice system of
MSK care:
 For four conditions (RA, JIA, OA, LBP)
 Reflecting the needs of urban, rural and remote areas of British
Columbia
 Engaging the diverse network of service providers
 Suggesting tools and strategies for improvement in clinical
practice and access to MSK services/supports
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Recap – Areas of MSK Focus
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Screening tools for early identification of inflammatory arthritis
Red flags and criteria for expedited referral
Supports for dealing with complex and chronic pain
Practical, simple point of care tools / checklists
Timely access to specialists for quick advice
Criteria for appropriate referrals
Tools for responding to psychosocial patient needs
Patient educational resources and community supports for patient
self-management
 Building network of relationships at local / community level
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Support Roles for GP Trial
Dr. Julia Alleyne
• Webinar facilitator, adult education
consultant
Liza Kallstrom
• Oversight of GP trial and questions
relating to next steps
Support Resources
• Dr. Brenda Lau
• Dr. Chris Rauscher
• Dr. Dianne Lacaille
• Clinical resource
• Check-in with the trial GPs
Laura Reeves
• Respond to questions re: toolkit
materials or tools to be tested.
Dr. Bruce Hobson
• Provide support for electronic
algorithm
Pamela Hinada
• Encourage GPs to submit their
feedback forms
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Your Role
 Test the tools in your practice
– Explore the Tool Kit (Algorithm)
– Test all tools as they fit your patient/practice
– Feedback on all tools
– Webinars will focus on selected tools
 Send feedback form to PSP Central Weekly
 Participate in the webinars and use supports
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Background Information
Low Back Guidelines
• Summary
• Rationale
• Seeded Guidelines
Http://www.topalbertadoctors.org
www.gpscbc.ca/psp_msk
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Inventory of MSK TOOLS & their classification
 Clinical Practice Tools – used at point of care and tools we want tested
during trial period
 Reference Tools – checklists and other materials that can be looked up in
hard copy binder or in electronic format as physician interest and time permit
 Patient Tools – to be completed by patient either jointly with GP, in the
waiting room, or at home. These tools should be tested via GP pilot or with
patient focus groups
 Teaching Tools – optional for use in the learning / teaching sessions as aids
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LBP Tool Selections
Tools
Patient Process
Tuesday December 6, 2011
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Patient Questionnaire
Red Flags
Yellow Flags
Assessment of Pain and
Function
Patient History
Monday, January 9, 2012
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Monitoring and Management
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DN4
Opioid Manager
RACE
Green Light
Patient Self-Management
Tools
Personal Action Plan
Low Back Patient Handout
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Feedback
Low Back Pain
Webinar Date
Tuesday, March 6, 2012
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Toolkit Implemenation
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Patient to complete
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Medical Office Assistant
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Mailed out prior to appt.
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Interactive with Assessment
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Feedback Forms
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Complete for each patient interaction, multiple tools
per patient
Fax in every Friday
Easy Evaluation Tick Sheet
Open Boxes to add tools that are in the Tool kit but
not selected for testing
Composite trends to be feed forward to support
group
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The Patient in our Project
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Mr. Donald Dorn is a 45 year old accountant who has
come to see you on Tuesday morning in your family
practice for new onset low back pain. He was cycling over
the weekend and began to feel some mild stiffness when
he completed his 1 hour ride. The following morning, he
awoke and had difficulty getting out of bed with morning
stiffness lasting 30 minutes located in his right and left
low back area. He describes his pain as intermittent but
frequent episodes of moderate intensity aching with
sharp shooting back pain more pronounced on his left
side with occasional radiation to his buttock and upper
posterior thigh.
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Donald Dorn
His symptoms are exacerbated with sitting longer
than 15 minutes and somewhat eased when he
walks up and down his hallway. He has called in
sick to work today as he feels that his symptoms
are worsening overall. This has occurred twice
before in the last year and he has used over the
counter medications for relief .
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What other Questions would
you like to ask Donald ?
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Patient Questionnaire
Are any of your joint swollen ? No
How would you rate the intensity of your pain ? 6-9/10
Do your symptoms interfere with your general daily activity,
mood or relationships ?
Yes, not working, feeling irritable
What is currently giving you relief ?
Medications not working, tried ice for 10 min/heat 10
Are you getting treatment for any other health problems ? No
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How do you approach the Red Flags ?
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Mr. Dorn becomes inpatient with your line of
questioning and says, he told you that he was
otherwise healthy and beside you know his history, he
asks you, "are you going to give me anything for the
pain? ". He tells you that he has an insurance plan and
needs a prescription for massage also. He is very
concerned that his "workaholic boss" will not tolerate
any more sick time from him since he has already taken
5 days this year for a previous episode of back pain
and a flu bug . He had been looking at a self employed
job opportunity before this happened but is afraid to let
his health benefits go.
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Follow-Up Visits:
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Pain
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Worst
Least
Average
Right Now
Function
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Appreciate variation of pain intensity
Social/Physical/ Mood/ Work
Delve into various functional examples
Opportunity for educational intervention
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Summary
1.
2.
We appreciate your participation
You have Support !
3.
You have patients with Low Back Pain.
4.
Try the Tools
5.
Feedback Tracking Sheets
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End of Session- 2 Polling Questions
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Next Webinar Dates for Low Back Pain
Monday, January 9: 5 – 6:30 pm
Tuesday, March 6: 5 – 6:30 pm
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