APMA feedback regarding the draft WA Chronic Health Conditions Framework 2011-2016

3. Do you believe the guiding principles are appropriate?

No. The Framework needs to be informed by and incorporate the issues identified in the 2010 National Pain Strategy, which is endorsed by WA Health.

An explicit identification of persistent pain as a chronic condition in its own right - particularly in view of its prevalence within the community - is necessary. The current draft mentions other - less prevalent conditions -  APMA cannot understand or accept the reluctance to do so demonstrated in previous communications with WA Health officers.

Currently, the draft states (at p10)



"The chronic conditions relevant to the Framework include, but are not limited to, chronic kidney disease (CKD), chronic respiratory disease (COPD and asthma), diabetes, cardiovascular disease (heart failure and stroke) and chronic musculoskeletal conditions (osteoporosis, osteoarthritis, rheumatoid arthritis). A snapshot of the epidemiology and health impact of these chronic conditions is provided in Appendix 2."

In light of these references to specific diseases, and WA Health's endorsement of the NPS, the inclusion of a reference to persistent pain would be a concrete and necessary demonstration of that endorsement.



Persistent pain is not the same as musculoskeletal or back pain. It is far wider - and to imply that persistent pain has been addressed via the development of a Model of Care for spinal pain, inflammatory arthritis, osteoporosis and elective joint replacement services is not consistent with a commitment to the National Pain Strategy.

The epidemiology and health impact of persistent pain, to a level comparable with the snapshot of chronic conditions currently provided in Appendix 2, can be extrapolated from the 2007 Access Economics report 'The High Price of Pain'. The absence of details and information for persistent pain comparable to the conditions currently described in part reflects the current national health priority areas, and in part reflects the lack of a brief universal standardised/assessment tool(s) for pain. Strategic action 9.1 of the National Pain Strategy, particularly 'pain as a 5th vital sign' and pain histories, should be identified in the Framework as something all patients of all conditions can and should expect as part of their health interactions.

4. Do you believe the priority areas (in Section 2.1) identify the key areas for action across chronic health conditions?

No. See above comments re training and supporting health practitioners in best-practice pain assessment and management (Goal 3 of the National Pain Strategy).

5. Do you believe the key service components (in Section 2.2) across the continuum of care are appropriate?

No. The importance of community-based consumer health organisations (CHOs) as a critical part of the 'right care' and 'right team' is ignored. CHOs (such as APMA and many others) which are committed to evidence-based practice have a critical role to play, and need to be involved in an integrated way. See Jordan et al, "Enhancing patient engagement in chronic disease self-management support initiatives in Australia" MJA Vol 189 No 10 17/11/08 for a discussion of these issues.

6. Do you believe recommendation1 (in Section 2.3) is an appropriate first step towards implementing the draft framework?

Yes. APMA believes that given the prevalence of persistent pain, across the disease spectrum, that it is a key stakeholder group.

7. Do you believe recommendation 2 of the framework (in Section 2.3) is an effective approach for implementing the draft framework?

Unsure. Subject to adequate support for effective and meaningful CHO involvement being provided.

8. Do you believe the draft framework will be a useful guide in providing the right care at the right time by the right team in the right place for Western Australia with chronic health conditions?

Not very useful : Unless the above comments are incorporated and the framework is redrafted, the vast majority of the enormous number of people in WA suffering persistent pain will continue to be unable to access effective management and assistance with their chronic condition, as is unfortunately currently the case.

Australian Pain Management Association (Inc. (APMA)

8 November 2011

APMA feedback regarding the draft

WA Chronic Conditions Self-management Strategic Framework 2011-2015

3. What, if any, are the strengths in the Chronic Condition Self –management Strategic Framework?

The goal, vision, principles, key drivers, outcomes and objectives (p5).

4. What, if any, are the gaps or limitations in the Chronic Condition Self –management Strategic Framework?

The Framework needs to be informed by and incorporate the issues identified in the 2010 National Pain Strategy, which is endorsed by WA Health. An explicit identification of persistent pain as a chronic condition in its own right - particularly in view of its prevalence within the community - is necessary. The current draft framework identifies other - less prevalent - conditions as priorities in its scope -  APMA cannot understand or accept the reluctance to recognise persistent pain as a condition in its own right and as a priority area.



Persistent pain is not the same as musculoskeletal or back pain. It is far wider - and to imply that persistent pain has been addressed via the development of a Model of Care for spinal pain, inflammatory arthritis, osteoporosis and elective joint replacement services is not consistent with a commitment to the National Pain Strategy.

The importance of community-based consumer health organisations (CHOs) as a critical part of the 'team' needs more emphasis, and needs to be systematically developed with health practitioners and their organisations. CHOs (such as APMA and many others) which are committed to evidence-based practice have a critical role to play, and need to be involved in an integrated way. See Jordan et al, "Enhancing patient engagement in chronic disease self-management support initiatives in Australia" MJA Vol 189 No 10 17/11/08 for a discussion of these issues. CHO self-management training (and other support services especially) are stand-alone initiatives which are not seen as a part of an integrated health service.

5. What, if any, will be implementation issues or barriers for the Chronic Condition Self –management Strategic Framework?

Recognition by health practitioners of the importance of CHO training and support services, in partnership with their care and management. Acceptable accreditation of delivery, and appropriate evaluation and research of effectiveness of CHO services (which will have funding implications) will assist in this regard.

6. Any other comments concerning any aspect of the Chronic Condition Self –management Strategic Framework?

S3 refers to peer led programs, support groups and community networks - where these are well designed, structured and appropriately resourced and delivered, they are an important aspect of a sustainable health system which supports self-management.

Australian Pain Management Association (Inc. (APMA)

9 November 2011