Guy’s and St Thomas’ NHS Foundation Trust

Virtual Paediatric Gym: using technology to engage children in exercise


Summary 

With the introduction of the one-stop multidisciplinary fibromyalgia clinic, patients who were previously sent to multiple sites for individual symptoms now receive three 30-minute consultations with a rheumatologist, physiotherapist and psychologist to create a management plan that holistically addresses the symptoms and possible causes of the condition.
  • 74% of patients felt more able to manage their fibromyalgia in the future
  • The assessment operates within the patient tariff, whilst requiring three specialists for 30 minute consultations and a MDT meeting
  • 95% of patients felt they had been involved in the treatment decisions
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The Challenge

  • The Rheumatology Centre at Guy’s and St Thomas’ identified a high proportion of fibromyalgia sufferers among their rheumatology referrals, most of whom had never received a comprehensive assessment.
  • With fibromyalgia presenting multiple symptoms and few dedicated centres to identify and address the condition, patients were being sent to multiple clinics and often failing to have the condition treated in its entirety.
  • The literature suggests that pharmacological therapy for fibromyalgia in isolation is expensive and limited in its effectiveness.

The Solution

  • Based upon published meta-analysis1 and current best-practice guidelines in other countries, the Rheumatology department developed an assessment process for fibromyalgia sufferers, which focusses on a multidisciplinary approach that allows for the creation of a holistic management plan tailored to the individual patient’s needs and symptoms.
  • The multidisciplinary approach consists of three 30-minute consultations with a consultant rheumatologist, a physiotherapist and a psychologist. Several self-reported clinical outcome assessments are completed too.
  • The three specialists then meet as part of a multidisciplinary team (MDT) to discuss each individual patient’s history and biopsychosocial condition. This information is used to form a personalised management-plan which includes self-management strategies, referrals to support services such as physiotherapy, hydrotherapy, psychiatry, psychotherapy and pain management programmes when required. It also sets targets that align with overcoming the every-day impairments as identified by the patient.

Service Performance and Outcomes

  • Over 300 patients are assessed annually which only goes some way to meeting the demand for the service. Of those 300 patients, around 240 (80%) are referred from other parts of the country where such a service is not available.
  • 87% of patients had never attended a multidisciplinary pain clinic or programme previous to Guy’s and St Thomas’, whilst 72% had never seen a physiotherapist and 85% had never seen a psychologist regarding their chronic pain.
  • The assessment itself is considered a form of therapy as distressed patients feel their condition is being properly addressed, with 95% of patients having confidence and trust in the specialists at the clinic. Patients also feel empowered to take control of their condition, with 74% feeling more able to manage their fibromyalgia in the future.

Financial Performance and Outcomes

  • The assessment, whilst requiring three specialists for 30-minute consultations and a MDT meeting, operates within the patient tariff with a financial surplus (5 patients are assessed in each clinic).
  • The clinic required no financial investment to set up and incurs no serious costs outside staffing, with minimal imaging and pathology costing.

Patient Focus and Satisfaction

  • During the assessment, patients are asked what impaired functions reduce their ability to lead normal lives the most. The service then creates patient-specific goals targeting these functions as part of the management plan.
  • Depression or anxiety are strongly associated with fibromyalgia. This service places an emphasis on responding to these psychological conditions, using responses from in-depth, self-reported questionnaires to develop a patient centric response and make referrals to psychological support common practice.
  • 99% of surveyed patients rate their care as either ‘good’ or ‘excellent’ with 95% saying they would recommend the service. 80% better understood their condition as a result of the assessment and 95% felt they had been involved in the treatment decisions.

 

Commissioning Implications


The Guy’s and St Thomas’ one-stop multidisciplinary fibromyalgia assessment clinic is an example of commissioning best practice in rheumatology and meets a number of priorities for commissioners.

 

  • Active support of self-management: The fibromyalgia clinic helps patients develop a portfolio of techniques and strategies to allow patients to manage their pain and increase their physical and psychological functioning.
  • Improving the management of patients with both physical and mental health needs: By forming a MDT to assess each patient, a holistic management-plan is put in place to support patients with common mental health problems (such as anxiety and depression) alongside their physical symptoms (such as chronic pain).
  • Care co-ordination through integrated health and social care teams: Having a fibromyalgia clinic that is closely linked to several residential pain management and physiotherapy courses is an example of coordinating across care settings and providing dedicated assessment facility for patients who might otherwise have to navigate fragmented health care systems for their condition.
  • Canadian Guidelines: the practice at this fibromyalgia clinic adopts the best-practice guidelines as recommended in the 2012 Canadian Guidelines for the diagnosis and management of fibromyalgia syndrome.

The service is therefore a best practice model demonstrating how to provide a one-stop multidisciplinary fibromyalgia assessment that meets the patients’ needs holistically and efficiently. Due to the clinic’s infancy, the full downstream outcomes of the management plans created by the MDT are yet to be fully assessed.

 

Service diagram