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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... Full description

Journal Title: Pain medicine (Malden Mass.), 2015-06, Vol.16 (6), p.1090-1100
Main Author: Frank, Joseph W.
Other Authors: 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: Electronic Article Electronic Article
Language: English
Subjects:
Publisher: England: Oxford University Press
ID: ISSN: 1526-2375
Link: https://www.ncbi.nlm.nih.gov/pubmed/25716075
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title: Evaluation of a Telementoring Intervention for Pain Management in the Veterans Health Administration
format: Article
creator:
  • 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.
subjects:
  • Adult
  • Aged
  • Analysis
  • Anticonvulsants
  • Antidepressants
  • Business education
  • Care and treatment
  • Chronic pain
  • 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
  • Opioids and Physical Therapy
  • Pain
  • 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
  • Veterans Health - standards
ispartof: Pain medicine (Malden, Mass.), 2015-06, Vol.16 (6), p.1090-1100
description: 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.
language: eng
source:
identifier: ISSN: 1526-2375
fulltext: no_fulltext
issn:
  • 1526-2375
  • 1526-4637
url: Link


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titleEvaluation of a Telementoring Intervention for Pain Management in the Veterans Health Administration
creatorFrank, 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.
creatorcontribFrank, 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.
descriptionObjective 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.
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subjectAdult ; Aged ; Analysis ; Anticonvulsants ; Antidepressants ; Business education ; Care and treatment ; Chronic pain ; 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 ; Opioids and Physical Therapy ; Pain ; 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 ; Veterans Health - standards
ispartofPain medicine (Malden, Mass.), 2015-06, Vol.16 (6), p.1090-1100
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descriptionObjective 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.
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9Drug use
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titleEvaluation of a Telementoring Intervention for Pain Management in the Veterans Health Administration
authorFrank, 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.
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0Authorship 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).
1Conflict of interest: The authors report no conflicts of interest, including relevant financial interests, activities, relationships, and affiliations.
2Previous 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.
3Role 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.
4Sources 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.
5Disclaimer: 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.
abstractObjective 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.
copEngland
pubOxford University Press
pmid25716075
doi10.1111/pme.12715
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