• Pain Med · Mar 2022

    Telehealth and rural-urban differences in receipt of pain care in the Veterans Health Administration.

    • Jessica A Chen, Rian J DeFaccio, Hannah Gelman, Eva R Thomas, Jess A Indresano, Timothy C Dawson, Lisa H Glynn, Friedhelm Sandbrink, and Steven B Zeliadt.
    • Veterans Affairs (VA) Puget Sound Health Care System, Seattle-Denver Center of Innovation (COIN) for Veteran-Centered Value-Driven Care, Health Services Research & Development (HSR&D), Seattle, Washington.
    • Pain Med. 2022 Mar 2; 23 (3): 466-474.

    ObjectiveExamine changes in specialty pain utilization in the Veterans Health Administration (VHA) after establishing a virtual interdisciplinary pain team (TelePain).DesignRetrospective cohort study.SettingA single VHA healthcare system, 2015-2019.Subjects33,169 patients with chronic pain-related diagnoses.MethodsWe measured specialty pain utilization (in-person and telehealth) among patients with moderate to severe chronic pain. We used generalized estimating equations to test the association of time (pre- or post-TelePain) and rurality on receipt of specialty pain care.ResultsAmong patients with moderate to severe chronic pain, the reach of specialty pain care increased from 11.1% to 16.2% in the pre- to post-TelePain periods (adjusted odds ratio [aOR]: 1.37, 95% confidence interval [CI]: 1.26-1.49). This was true of both urban patients (aOR: 1.62, 95% CI: 1.53-1.71) and rural patients (aOR: 1.16, 95% CI: 0.99-1.36), although the difference for rural patients was not statistically significant. Among rural patients who received specialty pain care, a high percentage of the visits were delivered by telehealth (nearly 12% in the post-TelePain period), much higher than among urban patients (3%).ConclusionsWe observed increased use of specialty pain services among all patients with chronic pain. Although rural patients did not achieve the same degree of access and utilization overall as urban patients, their use of pain telehealth increased substantially and may have substituted for in-person visits. Targeted implementation efforts may be needed to further increase the reach of services to patients living in areas with limited specialty pain care options.Published by Oxford University Press on behalf of the American Academy of Pain Medicine. This work is written by US Government employees and is in the public domain in the US.

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