Referral-- Specialists

From Clinicaltools.com

Contents 1 Course 3: Referral and Co-Management of Chronic Pain Patients with Substance Use Disorders 1.1 Need 1.2 Goal 1.3 Objectives 1.3.1 A. Refer pain patients who have substance use disorders (or those who are at risk) for specialized treatment 1.3.2 B. Co-manage patients with specialists and other healthcare providers 1.3.3 C. Provide ongoing care management within the practice 1.4 Case Study/Simulated Patients - IN DEVELOPMENT 1.4.1 Nora Neuropathy: 72 YOWF 1.4.2 Tina TMJ: 27 YOBF

Course 3: Referral and Co-Management of Chronic Pain Patients with Substance Use Disorders

Need

Clinicians need to be able to appropriately refer and co-manage chronic pain patients who have substance use disorders; patients may be referred for treatment of their substance use disorder, pain, or both.

Goal

The learner will be able to refer patients with substance use disorders to specialist healthcare providers and, when appropriate, participate in ongoing co-management with the specialists.

Objectives

After completing this course, the learner will be able to:

A. Refer pain patients who have substance use disorders (or those who are at risk) for specialized treatment

1. Determine when referral is possible, timely, or appropriate
2. Determine which type of pain or addiction specialist is appropriate
3. Refer patients to pain and addiction specialists when appropriate
4. Refer patients to other medical and mental health specialists when appropriate
5. Include all key patient information (history and current status) in referral report

B. Co-manage patients with specialists and other healthcare providers

1. Obtain legal permission to share patient information with all parties involved including addiction and pain specialists, other healthcare providers, family members, and friends
2. Distinguish between cases requiring a simple initial consultation versus ongoing co-management
3. Establish an agreement between primary care, specialist healthcare providers, and other members of the treatment team that describes the care that each clinician will provide and includes a communication protocol and schedule of visits
4. Continually share information as appropriate with other healthcare providers throughout the patient's treatment

C. Provide ongoing care management within the practice

1. Query patient about status and treatment of pain at each visit
2. Query patient about status of addiction treatment or recovery and treatment by other members of the treatment team at each visit
3. Continually re-assess risk and screen for substance abuse and refer back to the addiction specialist as needed

Case Study/Simulated Patients - IN DEVELOPMENT

Nora Neuropathy: 72 YOWF

• Chief Complaint: Diabetic neuropathy is worsening
• Narrative: The neuropathic pain is not responding as well to her usual medications. She has been on controlled-release oxycodone for over a year for moderately severe diabetic neuropathy. She's been self medicating with opioids from multiples sources. She had some left over pain medication from having a kidney stone twice last year and sometimes she takes a few of her busband's "pain pills" or a friend sometimes "helps her out."
• Past Medical History: Her diabetes is moderately well-controlled and she has had a number of hospitalizations for various diabetes-related complications
• Objective Addressed: 1. Refer pain patients with substance use disorders or high risk of substance use disorders for treatment or comanagement by specialist(s)
• Skills-Training Goals:

Tina TMJ: 27 YOBF

• Chief Complaint: She lost her prescription for a refill on pain medication for chronic TMJ pain
• Narrative: Tina has had temporomandibular joint problems since college. She says that a surgical procedure to relieve the pain instead left her with constant pain. She uses a fentanyl patch.
• Challenges: During the interview she admitted that she started using two patches simultaneously, when one patch was not working. Then she found that she liked the euphoric effect and started wearing 2 patches all the time. Now she has pain if she does not use 2 patches. She obtained the second patch by seeing a second doctor.
• Objective Addressed: 2. Refer patients with substance use disorders co-occurring with chronic pain
• Skills-Training Goals:

1. Refer patients to pain and addiction specialists when appropriate
2. Refer patients who have built up to an overly complex polypharmacy pain medication treatment or unnecessarily high dosage

• Objective Addressed: 3. Provide ongoing care management of patients with substance use disorders co-occurring with chronic pain
• Skills-Training Goals:

1. Co-manage patients with specialists
2. Follow-up with patients and other care providers after referral
3. Maintain accurate medical records to reflect patient history and treatment