COMmunity PAin Service of Singhealth (COMPASS) Singapore

Background & Aims

Patients with uncontrolled chronic pain and multiple comorbidities tend to require repeated healthcare visits and admissions for pain related issues. A pilot survey done in the Pain Management Center (PMC) in Singapore General Hospital showed that 30% of patients had emergency department visits and admissions, resulting in increased healthcare cost and poor satisfaction level. Through a cause-and-effect analysis, factors leading to multiple admissions include poor medication compliance, inadequate support in the community and lack of a hospital contact point. Our project aimed to improve patients’ self-efficacy in pain management, provide holistic pain management support and reduce emergency department visits due to pain.

Methods

COMmunity PAin Service of Singhealth (COMPASS) is a community care programme established in April 2022. Our target population is the chronic pain patients from PMC with poorly controlled pain, multiple comorbidities, mobility impairment and poor social support, at risk of repeated admissions. We gathered a team comprising of pain physicians, nurses, a care coordinator, pharmacists, and stakeholders from various community services. Our initiative is a nurse-led telephonic follow up service conducted at preset intervals between clinic visits for 6 months. A Pharmacist-led Pain Management Service (PPMS) was also started to enhance medication adherence and educate patients on appropriate analgesic usage. Deployment of appropriate community services aided in our patients’ social support. Outcome measures assessed include 1) Number of emergency department visits due to pain 2) Pain scores as measured by Brief Pain Inventory (BPI) questionnaire 3) Medication adherence 4)Satisfaction scores.

Results

From April 2022 to December 2023, we have recruited a total number of 148 patients with a median age of 78 years old. More than 60% of these patients have 5 or more medical comorbidities with a clinical frailty score of more than 4. We observed a reduction in number of emergency department visits for pain per patient from a median (IQR) of 1 (1-2) pre-intervention to 0 (0-0) at 6 months post-intervention. For hospital admissions, we noted a reduction of median (IQR) number of admissions from 1 (1-1) pre-intervention to 0 (0-0) 6 months post-intervention. In terms of pain scores, there is a reduction in median (IQR) BPI Pain Severity Score from 5.25 (3.5-6.75) at pre-intervention to 4.13 (2.5-6) at 6 months post-intervention. Similarly, median BPI Pain Interference Score reduced from 5.57 (3.14-7.57) at pre-intervention to 2.86 (1.11-5.07) at 6 months post-intervention. There was a significant improvement in Excellent Satisfaction scores from 67.4% at pre-intervention to 90% by 4th nurse follow-up call. Improvement in medication adherence was reflected by the increase in percentage of patients achieving 100% Medtake Score from 59.7% at pre-intervention to 74.3% by 4th nurse follow-up call.

Conclusions

Through COMPASS, our chronic pain patients have been empowered to manage their pain within safe limits in the community. The collaboration with tertiary healthcare providers, nursing and community teams has enhanced the delivery of care within the community, leading to reduced emergency department admissions, improved medication compliance, improved pain score and satisfaction levels in chronic pain patients.

References

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