Collaboration between a tertiary pain centre and community teams during the pandemic
People with chronic pain faced potential treatment disruption during the COVID-19 pandemic in Singapore, as the focus of healthcare shifted. A model of rapid integration of a pain centre with community healthcare teams was implemented to care for vulnerable older patients with chronic pain and multiple comorbidities. Telemedicine and home visits by community nurses were used, with risk-mitigation measures, ensuring comprehensive assessment and treatment compliance. Medications from pain physicians were delivered at home through a hospital pharmacy. A secure national electronic health records system used by all teams ensured seamless access and documentation. Potential emergency department visits, admissions and delayed discharges were thus avoided. Integration of community teams with chronic pain management services can be recommended to ensure pandemic preparedness.
The COVID-19 pandemic has caused unprecedented stress on healthcare systems worldwide. At least 27 million people have been infected globally, with at least 881 000 fatalities at the time of writing. As of 7 September 2020, Singapore recorded 57 022 cases with 27 fatalities.
In an environment of scarce healthcare resources and overburdened infrastructure, there is a need to prioritise the provision of medical care, conserve resources, reduce spread within the community, protect health workers and ramp up pandemic preparedness. With the focus shifted to treating those with COVID-19 and those needing emergency care, there is a potential risk of neglecting those with chronic conditions, including pain. Many sectors of healthcare have had to re-organise and respond to the challenges of COVID-19, and pain management centres, too, need to have an effective response.
The holistic and wide-scale response of any pain management service to a pandemic would involve a multi-faceted approach, including continuity of patient care, resource optimisation, reviewing potential immunosuppressive treatments and collaborations for patient management. The authors report a collaboration between a pain management service and community healthcare teams, which greatly benefitted the former in the management of vulnerable older people with chronic pain.
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