Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jan 5:16:55-69.
doi: 10.2147/JPR.S383212. eCollection 2023.

Implementation and Preliminary Effectiveness of a Multidisciplinary Telemedicine Pilot Initiative for Patients with Chronic Non-Cancer Pain in Rural and Underserved Areas at a Major Academic Medical Center

Corey J Hayes  1   2 , Matthew A Gannon  3 , Eva N Woodward  2   4 , Christopher R Long  3 , Masil George  5 , Shona Ray-Griffith  6   7 , Leah R Tobey  4 , Johnathan Goree  8
Affiliations

Implementation and Preliminary Effectiveness of a Multidisciplinary Telemedicine Pilot Initiative for Patients with Chronic Non-Cancer Pain in Rural and Underserved Areas at a Major Academic Medical Center

Corey J Hayes et al. J Pain Res. .

Abstract

Background: Arkansas lacks adequate access to high-quality pain care, as evidenced, in part, by it having the second highest opioid prescribing rate in the United States. To improve access to high-quality treatment of chronic pain, we developed the Arkansas Improving Multidisciplinary Pain Care and Treatment (AR-IMPACT) Telemedicine Clinic, a multidisciplinary and interprofessional team of specialists who provide evidence-based pain management for patients with chronic pain.

Methods: We conducted a single-arm pilot trial of the AR-IMPACT Telemedicine Clinic with rural, university-affiliated primary care clinics. We assessed the AR-IMPACT Telemedicine Clinic using an implementation framework and preliminary effectiveness measures. Specifically, we assessed 5 of the 8 implementation outcomes of the framework (ie, penetration, adoption, acceptability, appropriateness, and feasibility) using a mixed methods approach. To evaluate implementation outcomes, we used surveys, interviews, and administrative data. We used electronic health record data to measure preliminary effectiveness (ie, changes in average morphine milligram equivalents per day and pain and depression scores).

Results: The AR-IMPACT team saw 23 patients that were referred by 13 primary care physicians from three rural, university-affiliated primary care clinics over one year. Of the 19 patients willing to participate in the pilot study, 12 identified as women, 31.6% identified as Black, and over 50% had less than a bachelor's level education. Patients rated the clinic positively with high overall satisfaction. Referring physicians indicated high levels of appropriateness, acceptability, and feasibility of the program. AR-IMPACT team members identified several barriers and facilitators to the feasibility of implementing the program. No changes in preliminary effectiveness measures were statistically significant.

Conclusion: Overall, the AR-IMPACT Telemedicine Clinic obtained moderate penetration and adoption, was highly acceptable to patients, was highly acceptable and appropriate to providers, and was moderately feasible to providers and AR-IMPACT team members.

Keywords: chronic; multidisciplinary team; non-cancer pain; opioid therapy; telehealth.

PubMed Disclaimer

Conflict of interest statement

Dr Shona Ray-Griffith reports grants from Blue Cross Blue Shield of Arkansas, during the conduct of the study; other from Neuronetics, Inc., outside the submitted work. Dr Johnathan Goree reports personal fees from Abbott, personal fees from Stratus medical, other from Mainstay Medical, other from SPR Therapeutics, outside the submitted work. The authors report no conflicts of interest in this work.

References

    1. Patel I, Walter LA, Li L. Opioid overdose crises during the COVID-19 pandemic: implication of health disparities. Harm Reduct J. 2021;18(1):1–5. doi:10.1186/S12954-021-00534-Z/FIGURES/1 - DOI - PMC - PubMed
    1. Rudd RA, Aleshire N, Zibbell JE, Gladden RM. Increases in Drug and Opioid Overdose Deaths — United States, 2000–2014. MMWR Morb Mortal Wkly Rep. 2016;64(50–51):1378–1382. doi:10.15585/mmwr.mm6450a3 - DOI - PubMed
    1. Davis CS, Carr D. Physician continuing education to reduce opioid misuse, abuse, and overdose: many opportunities, few requirements. Drug Alcohol Depend. 2016;163:100–107. doi:10.1016/j.drugalcdep.2016.04.002 - DOI - PubMed
    1. Ballantyne JC, Mao J. Opioid Therapy for Chronic Pain. N Eng J Med. 2003;349(20):1943–1953. doi:10.1056/NEJMra025411 - DOI - PubMed
    1. Savage SR. Long-term opioid therapy: assessment of consequences and risks. J Pain Symptom Manage. 1996;11(5):274–286. doi:10.1016/0885-3924(95)00202-2 - DOI - PubMed