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Abstract
Specialists and primary care physicians play an integral role in treating the twin epidemics of pain and addiction. But inadequate access to specialists causes much of the treatment burden to fall on primary physicians. This article chronicles the differences between treatment contexts for both pain and addiction - in the specialty and primary care contexts - and derives a series of reforms that would empower primary care physicians and better leverage specialists.
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Affiliation(s)
- Joseph R Schottenfeld
- Joseph Schottenfeld, is a member of the Yale Law School class of 2019. Abbe R. Gluck, J.D., is Professor of Law and Faculty Director of the Solomon Center for Health Law and Policy at Yale Law School. She earned her J.D. from Yale Law School. Seth A. Waldman, M.D., is Director, Division of Pain Management, Department of Anesthesiology, Critical Care & Pain Management, at the Hospital for Special Surgery in New York. He completed his his internships in surgery and medicine at Mount Sinai Medical School - Beth Israel Medical Center, his residency training in anesthesiology at Harvard Medical School - Beth Israel Hospital, and his fellowship training in pain management at Massachusetts General Hospital. Daniel G. Tobin, M.D., F.A.C.P., is an Associate Professor of Medicine at the Yale University School of Medicine (New Haven, CT) and the Medical Director for the Yale-New Haven Hospital SRC Adult Primary Care Center. He earned his medical degree from Cornell University Medical College (New York, NY) before completing his Internal Medicine Internship and Residency at Yale-New Haven Hospital
| | - Seth A Waldman
- Joseph Schottenfeld, is a member of the Yale Law School class of 2019. Abbe R. Gluck, J.D., is Professor of Law and Faculty Director of the Solomon Center for Health Law and Policy at Yale Law School. She earned her J.D. from Yale Law School. Seth A. Waldman, M.D., is Director, Division of Pain Management, Department of Anesthesiology, Critical Care & Pain Management, at the Hospital for Special Surgery in New York. He completed his his internships in surgery and medicine at Mount Sinai Medical School - Beth Israel Medical Center, his residency training in anesthesiology at Harvard Medical School - Beth Israel Hospital, and his fellowship training in pain management at Massachusetts General Hospital. Daniel G. Tobin, M.D., F.A.C.P., is an Associate Professor of Medicine at the Yale University School of Medicine (New Haven, CT) and the Medical Director for the Yale-New Haven Hospital SRC Adult Primary Care Center. He earned his medical degree from Cornell University Medical College (New York, NY) before completing his Internal Medicine Internship and Residency at Yale-New Haven Hospital
| | - Abbe R Gluck
- Joseph Schottenfeld, is a member of the Yale Law School class of 2019. Abbe R. Gluck, J.D., is Professor of Law and Faculty Director of the Solomon Center for Health Law and Policy at Yale Law School. She earned her J.D. from Yale Law School. Seth A. Waldman, M.D., is Director, Division of Pain Management, Department of Anesthesiology, Critical Care & Pain Management, at the Hospital for Special Surgery in New York. He completed his his internships in surgery and medicine at Mount Sinai Medical School - Beth Israel Medical Center, his residency training in anesthesiology at Harvard Medical School - Beth Israel Hospital, and his fellowship training in pain management at Massachusetts General Hospital. Daniel G. Tobin, M.D., F.A.C.P., is an Associate Professor of Medicine at the Yale University School of Medicine (New Haven, CT) and the Medical Director for the Yale-New Haven Hospital SRC Adult Primary Care Center. He earned his medical degree from Cornell University Medical College (New York, NY) before completing his Internal Medicine Internship and Residency at Yale-New Haven Hospital
| | - Daniel G Tobin
- Joseph Schottenfeld, is a member of the Yale Law School class of 2019. Abbe R. Gluck, J.D., is Professor of Law and Faculty Director of the Solomon Center for Health Law and Policy at Yale Law School. She earned her J.D. from Yale Law School. Seth A. Waldman, M.D., is Director, Division of Pain Management, Department of Anesthesiology, Critical Care & Pain Management, at the Hospital for Special Surgery in New York. He completed his his internships in surgery and medicine at Mount Sinai Medical School - Beth Israel Medical Center, his residency training in anesthesiology at Harvard Medical School - Beth Israel Hospital, and his fellowship training in pain management at Massachusetts General Hospital. Daniel G. Tobin, M.D., F.A.C.P., is an Associate Professor of Medicine at the Yale University School of Medicine (New Haven, CT) and the Medical Director for the Yale-New Haven Hospital SRC Adult Primary Care Center. He earned his medical degree from Cornell University Medical College (New York, NY) before completing his Internal Medicine Internship and Residency at Yale-New Haven Hospital
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Flynn DM, Eaton LH, McQuinn H, Alden A, Meins AR, Rue T, Tauben DJ, Doorenbos AZ. TelePain: Primary Care Chronic Pain Management through Weekly Didactic and Case-based Telementoring. Contemp Clin Trials Commun 2017; 8:162-6. [PMID: 29497708 DOI: 10.1016/j.conctc.2017.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Chronic pain is a significant problem among military personnel and a priority of the military health system. The U.S. Army Surgeon General's Pain Management Task Force recommends using telehealth capabilities to enhance pain management. This article describes the development and evaluation of a telehealth intervention (TelePain) designed to improve access to pain specialist consultation in the military health system. The study uses a wait-list cluster controlled clinical trial to test: 1) effectiveness of the intervention, and 2) interviews to assess barriers and facilitators of the intervention implementation. The intervention involves a didactic presentation based on the Joint Pain Education Curriculum followed by patient case presentations and multi-disciplinary discussion via videoconference by clinicians working in the military health system. A panel of pain specialists representing pain medicine, internal medicine, anesthesiology, rehabilitation medicine, psychiatry, addiction medicine, health psychology, pharmacology, nursing, and complementary and integrative pain management provide pain management recommendations for each patient case. We use the Pain Assessment Screening Tool and Outcomes Registry (PASTOR) to measure patient outcomes, including pain, sleep, fatigue, anxiety, and depression. This article reports some of the challenges and lessons learned during early implementation of the TelePain intervention. Weekly telephone meetings among the multisite research team were instrumental in problem solving, identifying problem areas, and developing solutions. Solutions for recruitment challenges included additional outreach and networking to military health providers, both building on existing relationships and new relationships.
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