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Pain Med. 2015 Jun;16(6):1090-100. doi: 10.1111/pme.12715. Epub 2015 Feb 26.

Evaluation of a telementoring intervention for pain management in the Veterans Health Administration.

Author information

1
VA Eastern Colorado Health Care System, Denver, Colorado.
2
Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado.
3
Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio.
4
Department of Medicine, School of Medicine, Case Western Reserve University, Cleveland, Ohio.
5
VA Puget Sound Health Care System, Seattle, Washington.
6
Yale University School of Medicine, New Haven, Connecticut.
7
VA Connecticut Healthcare System, West Haven, Connecticut.
8
Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado.
9
Office of Specialty Care, Veterans Health Administration, Washington, DC, USA.

Abstract

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.

KEYWORDS:

Anticonvulsants; Antidepressants; Opioids and Physical Therapy; Pain Management; Primary Care; Telehealth

PMID:
25716075
DOI:
10.1111/pme.12715
[Indexed for MEDLINE]

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