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


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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.

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