Evaluation of a Telementoring Intervention for Pain Management in the Veterans Health Administration. Issue 6 (26th February 2015)

• Record Type: Journal Article
• Authors: Frank, Joseph W.; Carey, Evan P.; Fagan, Katherine M.; Aron, David C.; Todd‐Stenberg, Jeff; Moore, Brent A.; Kerns, Robert D.; Au, David H.; Ho, P. Michael; Kirsh, Susan R.
• Is Part Of: Pain medicine. Volume 16:Issue 6(2015)
• Page Start: 1090
• Page End: 1100
• Publication Date: 2015-02-26
• Subjects: Pain -- Periodicals; Pain -- Treatment -- Periodicals; Analgesics -- Periodicals; Pain -- Periodicals; Pain Management -- Periodicals; Douleur -- Périodiques; Douleur -- Traitement -- Périodiques; Analgésiques -- Périodiques; Analgésique; Soulagement de la douleur; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); 616.047205
• DOI: 10.1111/pme.12715
• Languages: English
• ISSNs: 1526-2375

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="pme12715-sec-0001" sec-type="section"> <title>Objective</title> <p>Half of all Veterans experience chronic pain yet many face geographical barriers to specialty pain care. In 2011, the Veterans Health Administration (VHA) launched the Specialty Care Access Network‐ECHO (SCAN‐ECHO), which uses telehealth technology to provide primary care providers with case‐based specialist consultation and pain management education. Our objective was to evaluate the pilot SCAN‐ECHO pain management program (SCAN‐ECHO‐PM).</p> </sec> <sec id="pme12715-sec-0002" sec-type="section"> <title>Design and Setting</title> <p>This was a longitudinal observational evaluation of SCAN‐ECHO‐PM in seven regional VHA healthcare networks.</p> </sec> <sec id="pme12715-sec-0003" sec-type="section"> <title>Methods</title> <p>We identified the patient panels of primary care providers who submitted a consultation to one or more SCAN‐ECHO‐PM sessions. We constructed multivariable Cox proportional hazards models to assess the association between provider SCAN‐ECHO‐PM consultation and 1) delivery of outpatient care (physical medicine, mental health, substance use disorder, and pain medicine) and 2) medication initiation (antidepressants, anticonvulsants, and opioid analgesics).</p> </sec> <sec id="pme12715-sec-0004" sec-type="section"> <title>Results</title> <p>Primary care providers (<italic>N</italic> = 159) who presented one or more SCAN‐ECHO‐PM sessions had patient panels of 22, 454 patients with chronic noncancer pain (CNCP). Provider consultation to SCAN‐ECHO‐PM was associated with utilization of physical medicine [hazard ratio (HR) 1.10, 95% confidence interval (CI) 1.05–1.14] but not mental health (HR 0.99, 95% CI 0.93–1.05), substance use disorder (HR 0.93, 95% CI 0.84–1.03) or specialty pain clinics (HR 1.01, 95% CI 0.94–1.08). SCAN‐ECHO‐PM consultation was associated with initiation of an antidepressant (HR 1.09, 95% CI 1.02–1.15) or anticonvulsant medication (HR 1.13, 95% CI 1.06–1.19) but not an opioid analgesic (HR 1.05, 0.99–1.10).</p> </sec> <sec id="pme12715-sec-0005" sec-type="section"> <title>Conclusions</title> <p>SCAN‐ECHO‐PM was associated with increased utilization of physical medicine services and initiation of nonopioid medications among patients with CNCP. SCAN‐ECHO‐PM may provide a novel means of building pain management competency among primary care providers.</p> </sec> </abstract>