Pain Management Telementoring, Long-term Opioid Prescribing, and Patient-Reported Outcomes

被引:9
作者
Flynn, Diane [1 ]
Doorenbos, Ardith Z. [2 ]
Steffen, Alana [3 ]
McQuinn, Honor [1 ]
Langford, Dale J. [4 ]
机构
[1] Madigan Army Med Ctr, Tacoma, WA 98431 USA
[2] Univ Illinois, Coll Nursing, Dept Biobehav Hlth Sci, Chicago, IL USA
[3] Univ Illinois, Coll Nursing, Dept Hlth Syst Sci, Chicago, IL USA
[4] Univ Washington, Sch Med, Dept Anesthesiol & Pain Med, Seattle, WA USA
基金
美国国家卫生研究院;
关键词
Pain Management; Telementoring; Long-term Opioid Therapy; Pain Impact; Depression; Anxiety; DOSE REDUCTION; PROJECT ECHO; SCAN-ECHO; ITEM BANK; CARE; VETERANS; ACCESS; THERAPY;
D O I
10.1093/pm/pnz338
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Objective Benefits of primary care provider (PCP) participation in pain management telementoring have been reported; however, no studies have examined within-patient changes in dose or discontinuation of long-term opioid therapy (LOT). The objectives of this nonrandomized study were to evaluate the relationship between telementoring participation and 1) LOT dose reduction and 2) LOT discontinuation and to 3) explore the relationship between LOT dose changes and patient-reported outcomes. Methods PCPs were recruited from a US Army medical center. Intervention group PCPs (N=12) attended telementoring sessions; control group providers (N=13) did not. Morphine equivalent daily doses (MEDD) for patients of study providers (N=396) were extracted from the study site's opioid database. The intervention group was subdivided based on number of sessions attended (i.e., active and low participation). Intent-to-treat and as-treated analyses were conducted using generalized estimating equations. Separate analyses evaluated the association between within-patient changes in MEDD and pain impact, depression, and anxiety (N=40). Results Intent-to-treat analysis revealed no significant difference in MEDD reduction; however, a higher proportion of patients of intervention PCPs discontinued LOT (25%3.6%) compared with control PCPs (16%+/- 3.6%, P<0.05). As-treated analyses revealed differences in MEDD reduction between active (13.2 +/- 3.0) and low-participating (2.6 +/- 3.0) PCPs (P<0.01). Further, a higher proportion of patients of actively participating PCPs discontinued LOT (29%+/- 4.9%) compared with control PCPs (16%+/- 3.6%, P=0.01). We found no evidence that decreased MEDD was associated with poorer self-reported outcomes within patients. Conclusions Pain management telementoring supports PCPs' efforts to reduce reliance on LOT for chronic pain management and highlights the need for actively engaged PCP pain champions.
引用
收藏
页码:266 / 273
页数:8
相关论文
共 30 条
[1]   Development of a PROMIS item bank to measure pain interference [J].
Amtmann, Dagmar ;
Cook, Karon F. ;
Jensen, Mark P. ;
Chen, Wen-Hung ;
Choi, Seung ;
Revicki, Dennis ;
Cella, David ;
Rothrock, Nan ;
Keefe, Francis ;
Callahan, Leigh ;
Lai, Jin-Shei .
PAIN, 2010, 150 (01) :173-182
[2]   Improving Pain Care with Project ECHO in Community Health Centers [J].
Anderson, Daren ;
Zlateva, Ianita ;
Davis, Bennet ;
Bifulco, Lauren ;
Giannotti, Tierney ;
Coman, Emil ;
Spegman, Douglas .
PAIN MEDICINE, 2017, 18 (10) :1882-1889
[3]  
[Anonymous], 2015, INT GUID PRESCR OP P
[4]   Academic Health Center management of chronic diseases through knowledge networks: Project ECHO [J].
Arora, Sanjeev ;
Geppert, Cynthia M. A. ;
Kalishman, Summers ;
Dion, Denise ;
Pullara, Frank ;
Bjeletich, Barbara ;
Simpson, Gary ;
Alverson, Dale C. ;
Moore, Lori B. ;
Kuhl, Dave ;
Scaletti, Joseph V. .
ACADEMIC MEDICINE, 2007, 82 (02) :154-160
[5]   SCAN-ECHO for Pain Management: Implementing a Regional Telementoring Training for Primary Care Providers [J].
Ball, Sherry ;
Wilson, Brigid ;
Ober, Scott ;
Mchaourab, Ali .
PAIN MEDICINE, 2018, 19 (02) :262-268
[6]   Preliminary Validation of the Defense and Veterans Pain Rating Scale (DVPRS) in a Military Population [J].
Buckenmaier, Chester C., III ;
Galloway, Kevin T. ;
Polomano, Rosemary C. ;
McDuffie, Mary ;
Kwon, Nancy ;
Gallagher, Rollin M. .
PAIN MEDICINE, 2013, 14 (01) :110-123
[7]   Project ECHO Telementoring Intervention for Managing Chronic Pain in Primary Care: Insights from a Qualitative Study [J].
Carlin, Leslie ;
Zhao, Jane ;
Dubin, Ruth ;
Taenzer, Paul ;
Sidrak, Hannah ;
Furlan, Andrea .
PAIN MEDICINE, 2018, 19 (06) :1140-1146
[8]  
Defense and Veterans Center for Integrative Pain Management, 2019, JOINT PAIN ED PROGR
[9]   Report of the NIH Task Force on Research Standards for Chronic Low Back Pain [J].
Deyo, Richard A. ;
Dworkin, Samuel F. ;
Amtmann, Dagmar ;
Andersson, Gunnar ;
Borenstein, David ;
Carragee, Eugene ;
Carrino, John ;
Chou, Roger ;
Cook, Karon ;
DeLitto, Anthony ;
Goertz, Christine ;
Khalsa, Partap ;
Loeser, John ;
Mackey, Sean ;
Panagis, James ;
Rainville, James ;
Tosteson, Tor ;
Turk, Dennis ;
Von Korff, Michael ;
Weiner, Debra K. .
PAIN MEDICINE, 2014, 15 (08) :1249-1267
[10]   A Blueprint of Pain Curriculum Across Prelicensure Health Sciences Programs: One NIH Pain Consortium Center of Excellence in Pain Education (CoEPE) Experience [J].
Doorenbos, Ardith Z. ;
Gordon, Deborah B. ;
Tauben, David ;
Palisoc, Jenny ;
Drangsholt, Mark ;
Lindhorst, Taryn ;
Danielson, Jennifer ;
Spector, June ;
Ballweg, Ruth ;
Vorvick, Linda ;
Loeser, John D. .
JOURNAL OF PAIN, 2013, 14 (12) :1533-1538