Development and implementation of a telehealth-enhanced intervention for pain and symptom management.
Managing chronic pain effectively is often challenging for health care providers and patients. Telehealth technologies can bridge geographic distance and improve patients' quality of care in communities where access to pain specialists has previously been unavailable. This paper describes the development and evaluation of a telehealth intervention (TelePain) designed to address the need for pain specialist consultation regarding pain and symptom management issues in non-academic medical centers. We describe the theoretical foundation and development of a multifaceted intervention using a cluster randomized clinical trial design. Health care providers and their patients with chronic pain are enrolled in the study. Patient participants receive the intervention (report of symptoms and receipt of a pain graph) weekly for 8 weeks and are contacted at 12 weeks for completion of post-intervention follow-up measures. Their providers attend TelePain sessions which involve a didactic presentation on an evidence-based topic related to pain management followed by patient case presentations and discussion by community clinicians. Symptom management recommendations for each patient case are made by a panel of pain specialists representing internal medicine, addiction medicine, rehabilitation medicine, anesthesiology, psychiatry, and nursing. The outcomes assessed in this randomized trial focus on pain intensity, pain's interference on function and sleep, and anxiety, depression, and cost-effectiveness. Some of the challenges and lessons that we have learned early in implementing the TelePain intervention are also reported.
School of Nursing, University of Washington, Box 357266, Seattle, WA 98195, USA. Electronic address: lineaton@uw.edu.
Linda H
LH
Eaton
School of Nursing, University of Washington, Box 357266, Seattle, WA 98195, USA; School of Medicine, University of Washington, Box 356340, Seattle, WA, USA. Electronic address: debrag3@uw.edu.
Debra B
DB
Gordon
School of Nursing, University of Washington, Box 357266, Seattle, WA 98195, USA. Electronic address: swyant@uw.edu.
Sheryl
S
Wyant
School of Medicine, University of Washington, Box 356340, Seattle, WA, USA. Electronic address: brianrt@uw.edu.
Brian R
BR
Theodore
School of Nursing, University of Washington, Box 357266, Seattle, WA 98195, USA. Electronic address: ameins@uw.edu.
Alexa R
AR
Meins
School of Nursing, University of Washington, Box 357266, Seattle, WA 98195, USA. Electronic address: ruet@uw.edu.
Tessa
T
Rue
School of Medicine, University of Washington, Box 356340, Seattle, WA, USA. Electronic address: ctowle@uw.edu.
Cara
C
Towle
School of Nursing, University of Washington, Box 357266, Seattle, WA 98195, USA. Electronic address: tauben@uw.edu.
David
D
Tauben
School of Nursing, University of Washington, Box 357266, Seattle, WA 98195, USA; School of Medicine, University of Washington, Box 356340, Seattle, WA, USA. Electronic address: doorenbo@uw.edu.
Ardith Z
AZ
Doorenbos
D059350:Chronic Pain / Q000628:therapy*; D003362:Cost-Benefit Analysis; D006801:Humans; D059408:Pain Management / Q000191:economics / Q000379:methods*; D010147:Pain Measurement; D010348:Patient Care Team / Q000458:organization & administration; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012107:Research Design; D019035:Rural Health Services / Q000191:economics / Q000458:organization & administration*; D017216:Telemedicine / Q000191:economics / Q000458:organization & administration*; D049269:Videoconferencing / Q000458:organization & administration
Pain; Randomized trial; Symptom management; Telehealth