313 An innovative approach for fibromyalgia care in the community: the Aneurin Bevan University Health Board experience

Abstract

Background: Fibromyalgia affects 2 - 5% of the population. ABUHB has c. 586,200 patients indicating a fibromyalgia population of 11,724 -29,310. A snapshot poll showed 1:3 new rheumatology patients had fibromyalgia. Most patient care was in primary care. We describe a multi-agency programme for consistent advice and multimodal care in the community. Method(s): Phase I - Launch: a steering group was formed including rheumatology, pain management, occupational therapy, physiotherapy, and general practice. A rheumatology departmental fibromyalgia pathway was developed. We organised a workshop to disseminate the protocol amongst key players. We identified resources in the community: the national exercise scheme, the education programme for patients, and the road to wellbeing psychology programme. The challenge was to link the elements into a cohesive programme. Phase II - Linking the elements: the rheumatology occupational therapists developed an options booklet signposting resources with a selfreferral form for patients. Issues remained with inconsistency across GP practices. An information sheet for GPs was created. We presented to the GP neighbourhood care network leads and a GP interested in fibromyalgia was identified. We became aware that in Torfaen borough the role of the social prescriber was being developed. Services also included a collaboration and improvement officer, a physical wellbeing officer who could provide 1:1 support to help patients start exercise, and an employability delivery manager. Phase III - Building the service in the community: the initiative to develop care in the community was launched with an open afternoon to engage fibromyalgia patients in Torfaen, organised by the Communities First team. Services present included mental health, housing, financial advice, a rheumatologist, and occupational therapist from secondary care. 93 patients attended and 59 answered the question: why have you looked for support? Common themes identified included: how to deal with and understand the condition (13), isolation (12), and the need for support (10) Results: Phase IV - The Pilot: we are working on a three month community pilot programme. Introductory morning: FAQs in fibromyalgia. Exercise/activity tracker. Signposting support services. Review morning after three months - outcomes, ongoing selfmanagement, set-back management. Conclusion(s): A diagnosis of fibromyalgia reduces NHS utilisation. We hope that a structured programme will provide ongoing successful self management in the community with high quality support services to give patients the opportunity to pro-actively self-manage this disabling condition. Summary: completed: FMS pathway for ABUHB. Workshop for core partners. Development of links: NERS, EPP, RTW. Development of links with GP NCNs. Development of links with Communities First staff delivering holistic care including finance and housing advice. Planned: pilot to trial a programme of care in the community bookended by an introductory and debriefing course delivered by OT with appropriate multimodal care between courses and assessed through patient evaluation, mFIQ, and NHS utilisation.