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2023 HSR&D/QUERI National Conference Abstract

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4090 — Video-Telecare Collaborative Pain Management during COVID-19: Implications for expanding access to care

Lead/Presenter: Daniel Rogers,  COIN - West Haven
All Authors: Rogers DG (VA Connecticut Healthcare System, Yale School of Medicine), Edmond SN (VA Connecticut Healthcare System, Yale School of Medicine) Frank JW (VA Eastern Colorado Health Care System, University of Colorado School of Medicine) Wesolowicz DM (VA Connecticut Healthcare System, Yale School of Medicine) Nolan C (VA Eastern Colorado Health Care System) Schroeder A (VA Eastern Colorado Health Care System) Falker C (VA Connecticut Healthcare System, Yale School of Medicine) Abelleira A (VA Connecticut Healthcare System, Yale School of Medicine) Moore BA (VA Connecticut Healthcare System, Yale School of Medicine) Becker W (VA Connecticut Healthcare System, Yale School of Medicine)

Objectives:
Clinical practice guidelines recommend patient-centered, interdisciplinary approaches for management of chronic pain, though these services are often less accessible for rural individuals. The onset of COVID-19 necessitated a shift from traditional in-person models of care to telemedicine models, which hold significant promise for expanding care to traditionally underserved populations. The present study aimed to assess the feasibility and acceptability of a novel virtual care model, Video-Telecare Collaborative Pain Management (VCPM), harnessing innovative clinical approaches including opioid reassessment and tapering, buprenorphine switch and maintenance, and behavioral pain self-management.

Methods:
The current study was deemed quality improvement by two participating VAs. VCPM is a multimodal intervention delivered by clinical pharmacy practitioners (CPPs) with support of a collaborating physician. Participants were veterans on long-term opioid therapy for chronic pain at ?50 mg morphine equivalent daily dose identified using a VA dashboard. Patients from rural community-based outpatient clinics were oversampled in recruitment, which consisted of mailing eligible patients letters describing the program, then inviting to schedule a virtual appointment with a CPP. Following a standardized intake, a treatment plan was presented to patients consisting of virtual follow-up for up to 90 days via video or phone, based on patient preference. We assessed feasibility and acceptability based on 1) enrollment rate, defined as completion of initial visit; 2) retention rate, as indicated by engagement in follow-up care; 3) willingness to trial buprenorphine when recommended; and 4) treatment satisfaction measured at three months post intake. We assessed pain and other measures at 3-month follow up.

Results:
133 patients were contacted, 44 completed an initial visit (33%), and 19 engaged in follow-up care with VCPM (14%). 58% of those engaged with VCPM trialed buprenorphine, 37% reduced opioid dose, and 5% were lost to follow-up. 73% of patients that completed an initial visit completed the 3-month survey. High satisfaction was found for video (M = 4.3/5) and phone visits (M = 4.0/5). Patients followed by VCPM viewed it as successful (M = 7.0/10) and would recommend (M = 7.6/10). Patients followed by VCPM, compared to those who only completing the initial visit, reported lower pain intensity (6.1 vs. 7.1/10), lower interference with enjoyment of life (6.0 vs 8.3/10) and general activities (5.9 vs 7.3/10), higher rates of improvement in pain severity compared to 3 months ago (44% vs 19%), and higher quality of patient-provider interactions (70.2 vs 64.1/75).

Implications:
VCPM appears to be an acceptable intervention, though feasibility was only partially supported as evidenced by low enrollment and retention rates. Alternative recruitment strategies are being explored including peer outreach. VCPM was satisfactory among those enrolled and showed potential improvements in pain-related outcomes. Larger effectiveness trials are underway.

Impacts:
Video-Telecare Collaborative Pain Management is an innovative model of care for individuals with chronic pain that may be particularly well-suited to expanding access to care to underserved populations (e.g., rural patients). Initial data suggests the care model is well-received by patients and has showed potential improvements in pain-related outcomes.