TelePain: Primary care chronic pain management through weekly didactic and case‐based telementoring

Abstract

Chronic pain is a significant problem among military personnel and a priority of the military health system. The U.S. Army Surgeon General's Pain Management Task Force recommends using telehealth capabilities to enhance pain management. This article describes the development and evaluation of a telehealth intervention (TelePain) designed to improve access to pain specialist consultation in the military health system. The study uses a wait-list cluster controlled clinical trial to test: 1) effectiveness of the intervention, and 2) interviews to assess barriers and facilitators of the intervention implementation. The intervention involves a didactic presentation based on the Joint Pain Education Curriculum followed by patient case presentations and multi-disciplinary discussion via videoconference by clinicians working in the military health system. A panel of pain specialists representing pain medicine, internal medicine, anesthesiology, rehabilitation medicine, psychiatry, addiction medicine, health psychology, pharmacology, nursing, and complementary and integrative pain management provide pain management recommendations for each patient case. We use the Pain Assessment Screening Tool and Outcomes Registry (PASTOR) to measure patient outcomes, including pain, sleep, fatigue, anxiety, and depression. This article reports some of the challenges and lessons learned during early implementation of the TelePain intervention. Weekly telephone meetings among the multisite research team were instrumental in problem solving, identifying problem areas, and developing solutions. Solutions for recruitment challenges included additional outreach and networking to military health providers, both building on existing relationships and new relationships.

Extension for Community Healthcare Outcomes (ECHO) as a tool for continuing medical education on opioid use disorder and comorbidities

“…It is grounded in adult learning principles and includes aspects of case‐based learning, didactic education and interprofessional consultation . Pilot research on ECHO for topics such as pain management and hepatitis C has identified measurable increases in provider self‐efficacy and knowledge, and one study found an association between New Mexico's SUD ECHO implementation and number of per‐capita physicians with the DATA‐2000 buprenorphine waiver . Recently, the New Mexico SUD ECHO was included in a scoping review of models for integrating treatment of OUD into primary care settings .…”

Virtual Access to Subspecialty Care

“… 78 Integrated care models with primary care using pain management services via telehealth have been described but not studied. 79 , 80 , 81 In one study, military PCPs were given access to video consults with pain management specialists as well as an online pain management curriculum. Patients were asked to assess their pain at various intervals up until 8 weeks after their visit with a PCP.…”

“…Data are still pending from this study. 79 In a qualitative assessment, 48 e-consults to pain management specialists from PCPs were assessed for the types of patients who were most likely to be referred via this form of consultation. The most common patient diagnoses included chronic pain patients with mental health diagnoses, substance dependence, and social complexity.…”