Evaluation of a Telementoring Intervention for Pain Management in the Veterans Health Administration
Evaluation of a Telementoring Intervention for Pain Management in the Veterans Health Administration
复制标题
DOI：
10.1111/pme.12715
复制
发表时间：
2015-06-01
期刊：
影响因子：
3.1
通讯作者：
Kirsh, Susan R.
中科院分区：
文献类型：
--
作者：
Frank, Joseph W.;Carey, Evan P.;Kirsh, Susan R.
一半的退伍军人经历慢性疼痛，但许多人面临专业疼痛护理的地理障碍。2011年，退伍军人健康管理局（VHA）推出了专业护理接入网络-ECHO（SCAN-ECHO），该网络使用远程医疗技术为初级保健提供者提供基于病例的专家咨询和疼痛管理教育。我们的目标是评估试点扫描-回波疼痛管理程序（扫描-回波-PM）。设计和SettingThis是一个纵向的观察评估扫描-回波-PM在七个区域VHA healthcare networks.MethodsWe确定了患者小组的初级保健提供者谁提交了一个或多个扫描-回波-PM会议咨询。我们构建了多变量考克斯比例风险模型，以评估供应商SCAN-ECHO-PM咨询与1）提供门诊护理之间的关联（物理医学、心理健康、物质使用障碍和疼痛医学）和2）开始用药（抗抑郁药，抗惊厥药，结果初级保健提供者（N = 159）谁提出了一个或多个SCAN-ECHO-PM会话有22名患者面板，454例慢性非癌性疼痛患者。提供者对SCAN-ECHO-PM的咨询与物理药物的使用相关[风险比（HR）1.10，95%置信区间（CI）1.05-1.14]，但与心理健康无关（HR 0.99，95% CI 0.93-1.05）、物质使用障碍（HR 0.93，95% CI 0.84-1.03）或专科疼痛诊所（HR 1.01，95% CI 0.94-1.08）。SCAN-ECHO-PM咨询与开始使用抗抑郁药相关（HR 1.09，95% CI 1.02-1.15）或抗惊厥药物（HR 1.13，95% CI 1.06-1.19）但非阿片类镇痛药（人力资源1.05，结论PM与CNCP患者增加使用物理医学服务和开始使用非阿片类药物相关。SCAN-ECHO-PM可以提供一种在初级保健提供者中建立疼痛管理能力的新方法。
ObjectiveHalf 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 SettingThis was a longitudinal observational evaluation of SCAN-ECHO-PM in seven regional VHA healthcare networks.MethodsWe 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).ResultsPrimary 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).ConclusionsSCAN-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.