Health and service needs, priorities and initiatives of primary health networks related to chronic pain

Abstract

Background. Chronic pain is a major and growing public health issue. Multidisciplinary tertiary pain services cannot meet patient demand and greater involvement of primary care is needed. The aims of this study were to understand the needs and priorities of Australian primary health networks (PHNs) related to the management and secondary prevention of chronic pain; map current PHN chronic pain initiatives and identify gaps; highlight key enablers to implementation; and highlight solutions identified by PHNs to increase capacity to commission initiatives. Methods. Mixed methods were used, including: a review of PHN needs assessments; and consultation with PHN executive-level staff and program managers from 27 out of the 28 PHNs, and the WA Primary Health Alliance (WAPHAa state alliance between three Western Australian PHNs) via telephone interviews, online surveys, a workshop, a deliberative dialogue and email consultation. Results. Chronic pain was identified as a health and/or service need by approximately half of PHNs. Barriers for PHNs to identifying chronic pain as a need or priority are highlighted. Gaps identified by the mapping included: initiatives related to the secondary prevention of chronic pain (post-surgery or post-injury), digitally enabled consumer and health professional chronic pain initiatives, and chronic pain initiatives for specific populations groups such as Aboriginal and Torres Strait Islander people. Among existing PHN practice, two exemplar evidence-based initiatives suitable for scale-up across PHNs in Australia were identified: multidisciplinary community-based pain programs, and an online health professional capacity-building initiative, Project ECHO (chronic pain). Solutions identified by PHNs to increase capacity to commission initiatives included: co-funding initiatives across different PHN funding streams, collaborative initiatives between PHNs, and co-commissioning with government and non-government partners. Conclusions. Chronic pain has been classified as a disease in itself through the World Health Organization. PHNs recognising chronic pain as a distinct condition in PHN needs analysis and data collection would lead to more dedicated funding. PHNs could do more to improve the secondary prevention and management of chronic pain. A self-identified need for greater collaboration across PHNs and co-commissioning with local and state governments and non-government partners would help to build PHN capacity.

Understanding the costs of co‐commissioning: Early experiences with co‐commissioning in Australia

“…The PHN Program, contracted by the Department of Health (DoH), specifically asks PHNs to consider co‐commissioning primary healthcare services with other stakeholders. Co‐commissioning has also been identified as a priority by PHN staff—both in terms of co‐commissioning with other PHNs and with other PSOs and non‐government organisations (De Morgan et al., 2022). Given the slow initial uptake of co‐commissioning in the PHN Program's early years, and further efforts introduced to promote co‐commissioning in primary health, this article uses a case study of one PHN's early experiences with co‐commissioning to (1) understand the need for co‐commissioning of primary healthcare services in Australia, (2) identify enablers and barriers to co‐commissioning, and (3) identify considerations for future co‐commissioning.…”