Virtual Pain Care Management (COVID-19)

Not Applicable

Completed

Brief Summary: The COVID-19 pandemic is exacerbating the challenges faced by Veterans at risk of opioid overdose including Veterans prescribed moderate-to-high dose long-term opioid therapy (LTOT) whose usual treatment resources and coping strategies may be inaccessible. This project combines established VA care components to deploy and evaluate virtual models of care for Veterans on high-risk LTOT to meet the dual challenges of maintaining social distancing and delivery high quality care.

Recruitment & Eligibility

Inclusion Criteria

Eligible participants must currently receive LTOT for chronic pain at 50 mg morphine equivalent daily dose

Exclusion Criteria

Exclusion criteria at baseline are:

dementia diagnosis or moderate-severe cognitive impairment
unstable or severe untreated psychiatric disorder or medical disease that requires hospitalization
documentation of suspected controlled substance diversion
inability to communicate by phone

Arm && Interventions

Group	Intervention	Description
VCPM	VCPM	VCPM is a multi-component intervention consisting of already-established care processes and materials. First, the patient is mailed or emailed (based on their preference) an informational packet prior to intake appointment. Second, using the collaborative medication management model established in VHA,3 the intake appointment is led by the CPS using a standardized intake evaluation. The CPS and physician design a plan presented to the patient. If BUP switch is offered and accepted, the physician completes additional brief evaluations, including a history, medication review, treatment planning, and discussion of other VCPM components, using two-way audio-video visits (with telephone as a back-up).

Primary Outcome Measures

Name	Time	Method
The Number of Patients Who Agree to Change in Their Opioid Regimen, Including Buprenorphine Transfer	30 days	Using shared decision-making with Veterans, we will based the measure on clinical reports of patient change in opioid regimen. This would be tapering (reducing opioid dose), discontinuation, or transfer to buprenorphine. Any reduction or change was considered positive for change, even if the patients returned to their initial dose. The number of patients who agree to change their opioid regimen provides a realistic indicator of overall feasibility/acceptability.

Secondary Outcome Measures

Name	Time	Method
Number of Participants Retained in Care at End of Study	60 days	Of participants who engaged in initial treatment the number who completed or were retained in care at the end of the study provides a outcome measure of engagement

Locations (2): Rocky Mountain Regional VA Medical Center, Aurora, CO
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Aurora, Colorado, United States
VA Connecticut Healthcare System West Haven Campus, West Haven, CT
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West Haven, Connecticut, United States