title: Evaluation of a telementoring intervention for pain management in the Veterans Health Administration.
abstract: OBJECTIVE
  Half 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).
  
  
  METHODS
  This was a longitudinal observational evaluation of SCAN-ECHO-PM in seven regional VHA healthcare networks.
  
  
  METHODS
  We 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).
  
  
  RESULTS
  Primary 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).
  
  
  CONCLUSIONS
  SCAN-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.
authors.affiliation: VA Eastern Colorado Health Care System, Denver, Colorado.|Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Frank
authors.affiliation: VA Eastern Colorado Health Care System, Denver, Colorado.
authors.forename: Evan P
authors.initials: EP
authors.lastname: Carey
authors.affiliation: VA Eastern Colorado Health Care System, Denver, Colorado.
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Fagan
authors.affiliation: Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio.|Department of Medicine, School of Medicine, Case Western Reserve University, Cleveland, Ohio.
authors.forename: David C
authors.initials: DC
authors.lastname: Aron
authors.affiliation: VA Puget Sound Health Care System, Seattle, Washington.
authors.forename: Jeff
authors.initials: J
authors.lastname: Todd-Stenberg
authors.affiliation: Yale University School of Medicine, New Haven, Connecticut.|VA Connecticut Healthcare System, West Haven, Connecticut.
authors.forename: Brent A
authors.initials: BA
authors.lastname: Moore
authors.affiliation: Yale University School of Medicine, New Haven, Connecticut.|VA Connecticut Healthcare System, West Haven, Connecticut.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Kerns
authors.affiliation: VA Puget Sound Health Care System, Seattle, Washington.
authors.forename: David H
authors.initials: DH
authors.lastname: Au
authors.affiliation: VA Eastern Colorado Health Care System, Denver, Colorado.|Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: P Michael
authors.initials: PM
authors.lastname: Ho
authors.affiliation: Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio.|Department of Medicine, School of Medicine, Case Western Reserve University, Cleveland, Ohio.|Office of Specialty Care, Veterans Health Administration, Washington, DC, USA.
authors.forename: Susan R
authors.initials: SR
authors.lastname: Kirsh
mesh_terms: D000328:Adult; D000368:Aged; D061345:Early Medical Intervention / Q000379:methods / Q000592:standards*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods / Q000592:standards*; D017216:Telemedicine / Q000379:methods / Q000592:standards*; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000592:standards*; D058014:Veterans Health / Q000592:standards*
keywords: Anticonvulsants; Antidepressants; Opioids and Physical Therapy; Pain Management; Primary Care; Telehealth