Joseph W Frank1,2, Evan P Carey1, Katherine M Fagan1, David C Aron3,4, Jeff Todd-Stenberg5, Brent A Moore6,7, Robert D Kerns6,7, David H Au5, P Michael Ho1,8, Susan R Kirsh3,4,9. 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. Wiley Periodicals, Inc.
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. Wiley Periodicals, Inc.
Authors: Ivana A Vaughn; Rebecca Beyth; Mary Lynn Ayers; Joseph E Thornton; Rajiv Tandon; Ted Gingrich; Stephen A Mudra Journal: Fed Pract Date: 2019-09
Authors: George M Hanna; Irina Fishman; David A Edwards; Shiqian Shen; Cheryl Kram; Xulei Liu; Matthew Shotwell; Christopher Gilligan Journal: Pain Med Date: 2016-04-27 Impact factor: 3.750