Evaluation of a Telementoring Intervention for Pain Management in the Veterans Health Administration

Objective 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 ca...

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Published inPain medicine (Malden, Mass.) Vol. 16; no. 6; pp. 1090 - 1100
Main 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.
Format Journal Article
LanguageEnglish
Published England Oxford University Press 01.06.2015
Subjects
Adult
Aged
Anticonvulsants
Antidepressants
Confidence intervals
Drug use
Early Medical Intervention - methods
Early Medical Intervention - standards
Female
Hospital administration
Humans
Longitudinal Studies
Male
Medicine
Mental health
Middle Aged
Opioids and Physical Therapy
Pain Management
Pain Management - methods
Pain Management - standards
Primary Care
Telehealth
Telemedicine - methods
Telemedicine - standards
United States - epidemiology
United States Department of Veterans Affairs - standards
Veterans Health - standards
United States
Opioids and Physical Therapy
Anticonvulsants
Telehealth
Primary Care
Antidepressants
Pain Management
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Summary:Objective 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). Design and Setting This was a longitudinal observational evaluation of SCAN‐ECHO‐PM in seven regional VHA healthcare networks. Methods 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). Results Primary care providers (N = 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). Conclusions 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.
Bibliography:Authorship information: Concept and design (all authors); data collection (EPC, JTS); data analysis (EPC); data interpretation (all authors); drafting of the manuscript (JWF); critical revision of the manuscript for important intellectual content (all authors).
Conflict of interest: The authors report no conflicts of interest, including relevant financial interests, activities, relationships, and affiliations.
Previous presentations: An abstract of this study was presented at the Mountain West Regional Meeting of the Society of General Internal Medicine in Denver, CO on October 10, 2014.
Role of Funders/Sponsors: This project was conducted as part of VHA health care operations in compliance with VHA Handbook 1058.05. The project team had full responsibility for the design and conduct of the operational evaluation activities, as focused on the implementation of transformational initiatives of interest to the VA Office of Specialty Care Services (SCS)\Specialty Care Transformation (OSCT); collection, management, analysis, and interpretation of the data; and preparation of the manuscript. One of the co‐authors of the manuscript is employed by OSCT.
Sources of funding: This work was supported by T‐21 funds and the Office of Specialty Care Services/Specialty Care Transformation, Office of Specialty Care Services, Patient Care Services, Veterans Health Administration, Washington DC. Dr. Frank was supported by the VA Eastern Colorado Health Care System and the University of Colorado School of Medicine. Drs. Ho and Au were supported by the Denver‐Seattle Center of Innovation for Veteran‐Centered and Value‐Driven Care (DiSCoVVR). Drs. Kerns and Moore were supported by the Pain Research, Informatics, Multi‐morbidities, and Education (PRIME) Center of Innovation at the VA Connecticut Healthcare System, West Haven, CT.
Disclaimer: The views expressed in this article are those of the authors and do not necessarily represent the views of the US Department of Veterans Affairs.
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ISSN:1526-2375
1526-4637
DOI:10.1111/pme.12715