Pain Management Annual Meeting Handbook

Timeline Overview

Presenters: PCP, Behaviorist (B)
Support: Health Coach (HC), MEA, Registration

Months Before:

PCP/HC: Develop pt. list, HC checks with PCP repeatedly—give plenty of time (2 months)-- for additions and edits.

PCP/B/HC/MEA/Reg: Choose date/timethen registration opens a group meeting in LCR

HC: Create pt. roster for individual provider, update phone numbers, addresses, last agreement date, UTOX date, etc.

Weeks Before:

HC/PCP
Send out pt. letters, monitor responses each week and call delinquent patients

Send out reminder letters, monitor responses each week and call delinquent patients

Create proposed agenda

Get provider’s preferences for patient packets, create prototype (don’t forget to contact all presenters!)

Days Before:

PCP/B/HC/MEA
Meet with all presenters to finalize agenda/flow

HC:Create patient packets, Pull confirmed patient charts, Purchase refreshments (day before)

Day of:

HC:Set up snacks, packets, water, pens

HC:Acts as administrative support—fetch charts, welcome patients, collect completed forms

HC:Fill out Utox forms

B/HC: While patients arrive initiates completion of PHQ-9 and pain inventory.

PCP: After 15 minutes, Opens meeting does intro and orientation to the group.

B: While PCP does intro, collects PHQ-9s and tabulates results. High scores or suicidal patients are tagged for the PCP to review with the Pt in 1:1.

B: Lead Agreement/Consent Review and Group Discussion.

PCP: While B is reviewing agreement and consent, PCP pulls individuals for 1:1s

MEA : Provides support to PCP during 1:1 visits, (collect UTOX sample etc…)

Following:

PCP/B/HC/MEA: Debrief pros and cons of group

PCP: Documents and bills for individual visits.

HC: Assist with clean up, Update rosters, Patient Follow Up (Attended/Not Attended)

Months Before

PCP/ Health Coach

  1. Compile a patient roster for the hosting provider. Obtain a list of patients currently receiving prescription narcotics for pain management from the provider who is hosting the group visit. Leave plenty of time for the provider to edit his/her list. Providers may appreciate a hard copy of the previous year’s roster to edit. Check in with the provider weekly for updates to the patient list. This should be the first step in the planning process and should be initiated no later than 2 months prior to the event date. Choose date/time, clear YOUR schedule, ask registration to open a group meeting in computer program
  1. Use the information from the provider to compile a patient roster. This roster should be a working document, as the provider is likely to have additions and deletions up until the last week before the event. As you obtain patient names to be included in the roster, use the LCR system to look up their MRN, address and phone number and include this on the roster. Make sure to save the roster to the appropriate year and provider in the share drive.

Rosters are found in the share drive as follows:

MAXINE Pain Management Project  Annual Pain Meetings  Meeting Rosters  (Appropriate Year)

ProviderRosterDateofEvent

Please name new rosters as indicated above.

Choose date/time, clear YOUR schedule, ask registration to open a group meeting in computer program

PCP/Behaviorist/Health Coach/MEA

  1. Set an event date and time. Ask the provider for a list of dates and times that work for him or her. You will need to select a date that works with the provider’s schedule, your own and those of any presenters at the group visit. Presenters may include Behaviorists, Behaviorist Interns or other professionals. It may be useful to start an email chain with all parties involved in the group visit in order to discuss the best possible date and time.

Health Coach

  1. Book the conference room and contact registration. Make sure that the conference room on the first floor is available and blocked out for the provider at the chosen time. Contact registration and request that a “group visit” slot be opened in the MHHC scheduling software so that patients are able to contact the front desk and register for the event.

Weeks Before

PCP/ Health Coach

  1. Invite patients to the event. Mail each patient on the approved roster a formal written invitation. The invitation can be found in the share drive as follows:

MAXINE Pain Management Project  Annual Pain Meetings Pain Management Patient Invitation

Before printing out the invitations, you will need to update the date, date and time of the event, and the name of the provider. Some providers may wish to make additional changes to the document, and a copy of the document should be submitted to the provider a week before invitations must go out so that he/she has ample time to make any desired edits. Letters should be printed on letterhead and signed by the hosting provider.

After letters have been mailed, check once per week with registration to see which patients have confirmed their attendance at the event and update the patient roster accordingly using the “Confirmed” column. An “x” in the confirmed column indicates the patient has contacted registration with his/her intent to attend the group visit. An “o” in the confirmed column indicates the patient has contacted registration, his/her provider or you, the health coach, to inform you that he/she will not be able to attend the meeting and should not be contacted again until after the event.

Patients who have not contacted registration to confirm attendance or send regrets should be contacted weekly by phone. Phone calls should be approached as information-based outreach and not accusatory. Do not leave voice mails or answering machine messages regarding the visit under any circumstances.

  1. Send out reminder letters and continue to monitor responses. Continue this process of weekly attempts at contacting delinquent patients throughout the planning process. If you experience 3-4 weeks of unsuccessful attempts, you may send a second invitation in the mail, highlighting or “bolding” that the meeting is mandatory.
  2. Create proposed agenda. Use the models found in:

MAXINE Pain Management Project  Annual Pain Meetings Patient PacketsPain Management Agenda Provider Date

Create a proposed agenda for the hosting provider and submit a hard and electronic copy to him/her for editing. This document should also be sent to the presenters on your email chain. Edit accordingly until those presenting are in agreement. Name new agendas following the example above.

  1. Begin compilation of patient packets. Providers will likely have an assortment of handouts that he/she wishes to distribute to the patients at the meeting. Begin collecting provider’s preferred handouts and creating a master patient packet for the meeting. It is important to contact all of the presenters for the meeting as they may each need different handouts included in the patient packets. Most providers will want a copy of the Patient/Provider Agreement and Informed Consent forms, downloadable from the DOPH website and also saved to the share drive under:

MAXINE Pain Management Project  Annual Pain Meetings Patient PacketsLow Literacy Consent and Patient-Provider Agreement

Any additional forms that may be useful in patient packets to future hosting providers or health coaches should be saved in this location on the share drive.

Current contents for the patient packets include:

  • Depression Screening (PHQ-9)
  • Pain Inventory
  • “The Truth About Pain”
  • Opioid Risk Charts
  • Informed Consent
  • Patient-Provider Agreement

Extra copies of the patient packets are in a file folder in the volunteer office. Try to obtainalternative language Consent and Agreement forms.

Days Before

PCP/Behaviorist/Health Coach/MEA

  1. Meet with all presenters to finalize agenda. At least 1 week prior to the event date, schedule a meeting with all the presenters for the group visit. Go over the event agenda and review and finalize the contents of the master patient packet, including the order of the handouts.

Health Coach

  1. Create patient packets. Use the approved master patient packet to make enough copies of the handouts for each patient to have his/her own set. Packets should be stored in a manila folder or envelope. Make sure to make copies for each of the presenters as well as an extra for yourself. You should also print a copy of the Patient Sign In Sheet for the day of the event. It is found in:

MAXINE Pain Management Project  Annual Pain Meetings Pain Agreement Meeting Sign-In

  1. Purchase refreshments (day before). The day of the event can be very hectic and with the parking challenges in the MHHC neighborhood purchasing refreshments the day or night before the event can be a lifesaver! Ask the provider if he/she has any specific requests for refreshments. Typical refreshments are strawberries, grapes, bananas and water.
  1. Pull confirmed attendees charts. Print out the schedule of confirmed attendees and bundle all the charts for the meeting and put them into the provider’s bin.

On the Day of the Event

Health Coach/Registration

  1. Arrive very early. Leave ample time for driving to the clinic and parking, if applicable. Arrive at least one hour prior to the scheduled start of the event.
  1. Set up refreshments, patient packets, UTOX forms, water, pens, and clipboards. Make sure there are enough pens for all the patients and presenters. Water pitchers can be found in the kitchen. Paper and plastic cups can be found in the volunteer office. Patient packets should be handed to each patient as he/she arrives. UTOX forms should be given to the hosting provider.
  1. Act as administrative support. Although you are encouraged to observe the Pain Management Group Visit, your job is to support the presenters however possible. Tasks may include—but are not limited to—fetching charts, welcoming patients, and collecting urine samples.
  1. Have patients register at the front desk. Greet patients as they arrive and direct them to registration. The registration nurse will print patient labels for UTOX screening. Even if patient is not screened at time of the meeting a UTOX will be required at the next visit. The provider will decide how they would like to proceed with UTOX screening. The best option may be for patients to provide the sample following the 5 minute visit with the provider during the meeting.
  1. Fill out Utox forms. All patients attending the group visit will need to give a urine sample to test for the presence of the appropriate narcotics. Fill out one Utox form for each patient attending. Forms can be found on the first floor in the dispensary above the provider’s desks. Check with the hosting provider for the appropriate codes to use on each form. Utox forms are not included in patient packets. They are given to the provider on the morning of the event.
  1. Have patients fill out PHQ-9 and pain inventory. Prior to the start of the meeting have patients write their name at the top of each form and complete. Once completed collect the forms and provide to Dr. Coyne for evaluation.
  1. Collect signed forms. At the end of the meeting collect all signed patient forms and verify completion. Notify the patient they may take a copy of the signed agreement with them at the end of the meeting. If a copy is requested, make the copy and return to the patient

PCP

  1. Introduction. Open the meeting by welcoming the patients. Elaborate on the information provided in the invitation and the reasons for meeting. Lay out the meeting agenda and goals.
  1. 5-Minute Visit. During the Behaviorist discussion take patients out of the conference room 1 by 1 for a brief visit. Explain the necessity of the UTOX and consequences of not completing the screening. Allow the patient the option to provide a urine sample now or at a future drop-in clinic. If the patient declines the screening at the time of visit provide a completion date and reiterate what happens if a sample is not received by that time. If the patient chooses to provide a sample at that time direct the patient to the MEA who will provide a labeled cup to the patient and collect the completed sample.

Behaviorist

  1. Review PHQ-9s. During the PCP Intro, review PHQ-9s and leave evaluation and comments on document for PCP to use during the 5-minute visit.
  1. Lead Agreement/Consent Review and Group Discussion. Following PCP Intro, provide psycho-education and facilitate group discussion on managing pain. Review Consent and Agreement forms in detail and answer any patient questions regarding documents prior to signing.

MEA

  1. Support PCP 5-Minute Visit. Collect UTOX forms from Health Coach and prepare cups and labels for UTOX screening. Collect samples for screening and support provider visit as needed.

Following the Event

PCP/Behaviorist/Health Coach/MEA

  1. Debrief. Immediately following the event, you should meet with the hosting provider and all presenters to discuss positives and areas for improvement. Make sure to take notes at this meeting and update the documents in the share drive and this document accordingly.
  1. Determine follow-up protocol for patients who did not attend the meeting.

Health Coach

  1. Clean up. Make sure all refreshments and patient packets have been removed from the conference room.
  1. Update rosters. Enter the attendance information in the provider’s roster in the share drive. Enter “x” for every patient who attends. You may want to note the reasons for a patients truancy if they are known.
  1. Send out thank you notes. Allow the provider to review the standard thank you note document found in the share drive under:

MAXINE Pain Management Project  Annual Pain Meetings Patient ContactPain Meeting Attendance Thank You

Thank you notes should be printed on letterhead and signed by the Medical Director. Mail the thank you notes within 1-2 weeks of the event date.

PCP/Behaviorist

  1. Bill and Document. PCP should bill for individual patient visits and Behaviorist document group visit.