Here’s how the TelePain program reaches patients
CMs, others can listen in
The University of Washington in Seattle addresses the need for pain management experts to reach underserved communities through a TelePain program that incorporates case management practices and a community of practice.
Here is how it works:
• Ask providers to complete a referral form/survey. The form’s purpose is to give the panel of experts a better idea of what’s going on in a particular patient’s life. Providers whose patient cases will be discussed email their responses 24 hours in advance of the meeting, says Ardith Z. Doorenbos, PhD, RN, FAAN, professor in the department of anesthesiology and pain medicine in the School of Medicine and School of Nursing at the University of Washington.
It asks questions about the patient’s pain, including these types:
- Where is the patient’s pain located?
- How does the pain affect the patient’s enjoyment of life?
- Does the patient have difficulty with sleep?
- How is the patient’s mood?
- What kind of medication is the patient using?
- Is medication controlling the pain?
- How many bad days has the patient had?
- How satisfied is the patient with the pain treatment?
• Healthcare professionals connect via technology to weekly sessions about pain management. The program is designated for health professionals, and any health provider can connect to it, says David Tauben, MD, chief of the division of pain medicine at the University of Washington.
“We prefer a video connect, and all they need is a laptop computer with a camera,” Tauben says. “There’s also an opportunity to connect through the telephone or Adobe if you don’t want to be on the camera as you eat lunch.”
Although connecting with the program is free, health providers who wish to earn continuing education credits for their attendance are charged a $40 annual fee, he adds.
“The information is evidence-based and high quality with internationally known experts, many of whom are doing research on pain,” Tauben says.
• Provide educational content first. “The first 30 minutes of the session is didactic, covering important issues related to pain management,” says Alexa Meins, PhD candidate, research assistant in biobehavioral nursing and health systems at the University of Washington.
“And then the session is translated into a PDF and put on YouTube, so people who arrived late can refer to the educational piece at a later time,” Meins adds. “A lot of times, the specialist panel will refer to certain citations and resources that the provider then can look up after the session.”
An example of the educational content includes a review of motivational interviewing, Doorenbos says.
An expert discusses how to do motivational interviewing with patients, following evidence-based techniques, she adds.
• Have community providers present their case studies. “Other providers can see on their screens the pain tracker, so everyone gets information about the patient’s pain intensity, the impact of pain on their lives, physical activity impairments, mood impairments, and how well the pain is managed with medications,” Doorenbos explains.
They do not show X-rays or medical chart information, and they rely on the community provider to present important details, she adds.
These case presentations typically take 10 to 15 minutes. Here’s one example: “There was a fisherman who was referred to us from Alaska,” Doorenbos says. “The man, who was an owner-operator, was having trouble doing physical labor on his boat because of pain, and he was having trouble with taking pain medication because they caused a lot of nausea.”
The nausea was most acute when he was standing on the moving boat, so he’d stop his pain medication when he went out to sea. This resulted in his returning to land in acute pain. A nurse practitioner sought the TelePain expert panel’s advice for how to treat his pain while respecting his lifestyle/work decision.
“Our rehab specialists said to give the fisherman information on how to lift equipment correctly, and the anesthesiologist, who is board-certified in acupuncture/acupressure, gave advice on using acupuncture to control nausea,” Doorenbos says. “And the pharmacist gave advice on how to control the medications.”
The provider hadn’t considered any of these pain strategies before the teleconference and decided to try all of them, she notes.
“We ask for a follow-up in six to eight weeks, and in this case it worked really well,” Doorenbos says. “The fisherman was able to manage his pain much better while on the boat.”
The TelePain program’s benefits extend beyond the single cases that are heard at a particular session, Tauben says.
For individual patients and families, there are immediate benefits to their pain management, and they can achieve this help from the community provider they trust, he says.
It also saves healthcare costs because patients do not have to travel to distant hospitals and providers to find relief from their pain, and their treatments typically are more effective, requiring fewer medical resources, he adds.
But there also are benefits to all of the healthcare providers who are listening in to the sessions. They can learn tips that they can use with their own patient populations. “It’s value-based care, and the value we add is cost-avoidance and fulfilling the goal of reducing the total expense of pain care delivery,” Tauben says.
The University of Washington in Seattle addresses the need for pain management experts to reach underserved communities through a TelePain program that incorporates case management practices and a community of practice.
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