Telehealth acceptability and opioid prescribing patterns of providers of painful chronic diseases during the COVID-19 pandemic: A survey of sickle cell providers

Martha O. Kenney, MD; Benjamin Becerra, DrPH; MBA, MPH, MS; Sean Alexander Beatty, BA; Wally R. Smith, MD

doi:10.5055/jom.2021.0683

Authors

Martha O. Kenney, MD https://orcid.org/0000-0002-0079-2488
Benjamin Becerra, DrPH; MBA, MPH, MS
Sean Alexander Beatty, BA
Wally R. Smith, MD

DOI:

https://doi.org/10.5055/jom.2021.0683

Keywords:

sickle cell disease, opioid prescribing, telemedicine, telehealth, COVD-19 pandemic, chronic pain

Abstract

Objective: The coronavirus disease 2019 (COVID-19) has led to a rapid transition to telehealth services. It is unclear how subspecialists managing painful chronic diseases—such as sickle cell disease (SCD), an inherited hemoglobinopathy with significant disparities in access and outcomes—have viewed the transition to telehealth or altered their pain management practices. This study elicits the views of sickle cell providers regarding their transition to telehealth and their opioid prescribing patterns during the COVID-19 pandemic.

Design: An anonymous online survey was sent to eligible sickle cell providers.

Setting: Comprehensive sickle cell centers and/or clinics across the United States.

Participants: Physicians and advanced practice providers providing care to SCD patients.

Main outcome measures: Respondents answered questions regarding their (1) views of telehealth compared to in-person encounters and (2) opioid prescribing practices during the early months of the pandemic.

Results: Of the 130 eligible participants, 53 respondents from 35 different sickle cell centers completed at least 90 percent of the survey. Respondents reported a significant increase in telehealth encounters for routine and acute appointments (mean difference and standard deviation: 57.6 ± 31.9 percent, p < 0.001 and 24.4 ± 34.1 percent, p < 0.001, respectively) since COVID-19. The overwhelming majority of respondents reported no changes in their opioid prescribing patterns since COVID-19, despite increased telehealth use. Only a minority coprescribed naloxone as a risk mitigation strategy.

Conclusion: The rapid uptake of telehealth has not suppressed ambulatory providers’ prescribing of opioids for SCD. Studies assessing the impact of the COVID-19 pandemic and telehealth on opioid prescribing practices in other painful chronic diseases are needed to ensure health equity for vulnerable pain patients.

Author Biographies

Martha O. Kenney, MD

Division of Pediatric Anesthesiology, Department of Anesthesiology, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina

Benjamin Becerra, DrPH; MBA, MPH, MS

Department of Information & Decision Sciences, Center for Health Equity, California State University, San Bernardino, California

Sean Alexander Beatty, BA

Blood Research Center, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina

Wally R. Smith, MD

Division of General Internal Medicine, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia

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