Page 73 - HA Convention 2015

Plenary Sessions

P2.1 People-centred Elderly Services 13:15 Convention Hall B

How to Disseminate the Acute Care for Elders Model of Care Beyond One Unit Monday, 18 May
Wong RYM
Faculty of Medicine, The University of British Columbia, Canada

The Acute Care for Elders (ACE) model is one of the best practice models that incorporates the principles of patient-
centred care, frequent medical review, prepared elder-friendly environment, early rehabilitation, and enhanced discharge
planning. The ACE model can be especially effective in the management of frail older people in the hospital. While the ACE
model has been implemented in many jurisdictions, there is great interest in disseminating the ACE model of care beyond a
single hospital unit. Widespread knowledge translation of this proven effective model of care is necessary at a system and
institutional level so that ACE can become the preferred and sustainable way of delivering healthcare to older people in the
hospital. The resource requirements for ACE dissemination can be categorised into equipment and staffing needs. Innovation
can support ACE dissemination, and examples include the ACE tracker tool and ACE pocket card. Process reengineering
(such as implementation of the e-geriatrician and ACE advisory team) can be helpful for ACE dissemination. Last but not
least, a robust communication strategy, with appropriate key messages, is important to help stakeholders understand the
significance of ACE dissemination. In summary, dissemination of the ACE model of care beyond one hospital unit is an
example of continuous quality improvement that helps to optimise care for older patients during hospitalisation.

P2.2 People-centred Elderly Services 13:15 Convention Hall B

Pain Management in Chronic Care HOSPITAL AUTHORITY CONVENTION 2015
Price C
Southampton Pain Team, Solent NHS Trust, UK

Chronic care refers to medical care for long term conditions. There is frequently a trade-off between reducing symptoms
from the burden of diseases and maintaining a quality of life. The ethos of primary care fits well with the approach needed
with the use of disease registers, the opportunity for continuity of care within a biopsychosocial model. However primary
care frequently needs help and support in achieving that trade off.

Epidemiological studies have indicated that most people have three or more chronic conditions – so called multi-morbidity.
Pain is a feature of many of the common conditions contributing to multi-morbidity for example, osteoarthritis and diabetes.
Depression impacts the person’s ability to cope with pain.

Patients often feel overwhelmed with management of all these conditions as do providers. As “painkillers” rarely wholly kill
pain, self-management skills are vital if a person is not to be overwhelmed. Medical treatment needs to minimise side effects
and avoid interactions taking into account multi-morbidity. Considerable support is often needed.

The UK National Pain Audit reported a very poor quality of life for those attending pain clinics. Most have multi-morbidity
and a poor understanding of their pain which changes very little through treatment. Specialist Pain Management therefore
currently is failing to address the needs of many people with chronic conditions. A new focus is needed by pain management
specialists that provides imaginative support of patients and primary care givers with outcomes that focus on meaningful
outcomes for the individual perhaps using some of the newer psychological models.

This lecture will explore some of the evidence for the above, look at potential options to support primary care and explore
what skills might be needed on the part of the healthcare professional to deliver more effective solutions for the management
of pain in chronic care.

71