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2023 HSR&D/QUERI National Conference Abstract

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1057 — A National Mixed-Methods Evaluation of Pain Management Teams: Preliminary Findings

Lead/Presenter: Sara Edmond,  COIN - West Haven
All Authors: Edmond SN (Pain, Research, Informatics, Multimorbidities and Education (PRIME) Center, West Haven, CT), McMullen T (Pain Management, Opioid Safety, and Prescription Drug Monitoring Program (PMOP), Veterans Health Administration, Washington, DC) Relyea M (Pain, Research, Informatics, Multimorbidities and Education (PRIME) Center, West Haven, CT) Snow JL (Pain, Research, Informatics, Multimorbidities and Education (PRIME) Center, West Haven, CT) Kinney R (VA Central Western Massachusetts) Kroll-Desrosiers (VA Central Western Massachusetts) Murphy JL (Pain Management, Opioid Safety, and Prescription Drug Monitoring Program (PMOP), Veterans Health Administration, Washington, DC) Lange KD (Pain Management, Opioid Safety, and Prescription Drug Monitoring Program (PMOP), Veterans Health Administration, Washington, DC) Sandbrink F (Pain Management, Opioid Safety, and Prescription Drug Monitoring Program (PMOP), Veterans Health Administration, Washington, DC)

Objectives:
The Comprehensive Addiction and Recovery Act of 2016 required each Veterans Health Administration (VHA) facility to have a pain management team (PMT) and defined minimum staffing standards for these teams, which include four required roles: a medical provider with pain expertise, a provider with addiction expertise, a behavioral medicine provider, and rehabilitation medicine provider. The Pain, Research, Informatics, Multimorbidities and Education (PRIME) Center partnered with the Pain Management, Opioid Safety, and Prescription Drug Monitoring Program (PMOP) within the Office of Specialty Care Services to evaluate PMTs and specialty pain services across the VA. The goal of this project was to understand the current structure and function of facility PMTs, as well as barriers and facilitators to PMT implementation.

Methods:
We used a mixed-methods approach including facility-level surveys with 139 VHA facilities and qualitative interviews with 19 PMT clinicians (interviews are ongoing). Facility-level surveys included questions about PMT staffing, functions, patient volume and flow, and services offered within the PMT. Qualitative interview topics included current PMT functioning, perceptions of what makes a high-functioning PMT, and barriers and facilitators to team functioning.

Results:
Preliminary analysis found that while most VHA facilities (91.4%) reported having a PMT, less than half (40.3%) reported having a fully staffed PMT. Facility PMTs on average consisted of 7 unique clinicians (SD = 4.9, range: 0 to 34). Out of the four required PMT roles, the role most often missing on PMTs was a clinician with addiction expertise (missing on 32.3% of teams). About half of PMTs saw more than 20 new patients per month (52.5%) and more than 50 follow-up patients per month (49.6%). In addition to providing evaluations and follow-up appointments, PMTs provided a range of pain treatments within the team, most commonly cognitive-behavioral therapy for chronic pain (57.6% of teams) and interventional pain services (49.6% of teams). On the facility-level survey, the most common reported barrier to implementation was staff recruitment issues (74.1%). One in three facilities (33.1%) identified COVID-19 as a barrier. Preliminary themes from qualitative interviews identified further barriers to implementation including gaps in care (e.g., care coordination, access to addiction specialists) and challenges with time (e.g., the need for protected time). Interviews identified shared language amongst team members in their approach to pain and medication safety and team communication as important facilitators of implementation.

Implications:
There is considerable variation in the structure and function of PMTs across VHA. The absence of a provider with addiction expertise on nearly one-third of teams suggests more work needs to be done to recruit addiction providers and/or integrate them into pain care. Other common barriers included staff recruitment issues, gaps in care, and challenges with time. Future analyses should focus on how best to support facilities and PMTs in overcoming these barriers.

Impacts:
Understanding the structure and function of PMTs, as well as barriers and facilitators to PMT functioning, may provide important insights into how to support facilities in enhancing PMTs and improving pain care.