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Automating Symptom Management Monitoring in an RCT: Strategies for Prescribing Analgesics Comparative Effectiveness (SPACE) Trial

Nugent SM, Krebs EE, Jensen AC, DeRonne BM, Rutks IR, Leverty DM. Automating Symptom Management Monitoring in an RCT: Strategies for Prescribing Analgesics Comparative Effectiveness (SPACE) Trial. Poster session presented at: VA HSR&D / QUERI National Meeting; 2015 Jul 10; Philadelphia, PA.


Objective:To automate symptom monitoring for study patients using results from interactive voice response (IVR) telephone surveys to generate clinical CPRS progress notes. Methods: SPACE is a pragmatic randomized clinical trial (RCT) comparing the effectiveness of two medication prescribing strategies delivered within a care management model for chronic musculoskeletal pain (opioid-intensive versus opioid-avoidant) over 12 months. The clinical pharmacist care manager (CPCM) implements the intervention by developing an analgesic treatment plan (according to assigned treatment arm), monitoring response, and adjusting medications based on that response. Information is shared with primary care providers via CPRS. CPCM clinical visits are supplemented by interval reassessment of pain, adverse effects, mood, and medication adherence through automated symptom monitoring, via a 16-item IVR survey scheduled between study clinic visits, after medications changes, and at time points customized by the CPCM. IVR survey results are posted back to CPRS as progress notes. To automate the creation of progress notes, the study programmer built a custom application using AudioCare (a VA-purchased commercial product). AudioCare systems are currently connected to local VistA systems and used clinically to conduct appointment reminder calls and automate prescription renewals. The custom application allows study staff to import IVR results into a database, generate text, and create a CPRS progress note, which is reviewed and signed by the CPCM. Results: Of the initial 119 participants, 96% received IVR calls. Participants averaged 6 calls each. Of more than 600 calls, > 70% were answered; of which 89% resulted in a generated CPRS progress note. Participants averaged 4 progress notes (mean = 3.7, SD 2.1, range 1-10). Calls took approximately 5 minutes to complete (mean = 4.82, SD 0.86, range 3.2-8.9). One quarter of participants (26.5%) requested a change to their medication during their IVR phone survey. Conclusion: The Audio-Care IVR system was successfully used to automate symptom monitoring between study visits and to generate CPRS progress note documentation. Impact: Automated IVR technology is an efficient tool to facilitate collection and CPRS documentation of patient-reported measures in a manner that is highly acceptable to patients allowing the CPCM to better anticipate the pain management needs of the patients.

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