Claims data analysis of provider-to-provider tele-mentoring program impact on opioid prescribing in Missouri
DOI:
https://doi.org/10.5055/jom.0825Keywords:
telehealth, claims analyses, Extension for Community Healthcare Outcomes, continuing medical education, pain management, opioid analgesicsAbstract
Objective: The objective of this study was to assess opioid prescribing patterns of primary care providers (PCPs) participating in a virtual tele-mentoring program for patients with chronic pain as compared to nonparticipants.
Design: We utilized Missouri Medicaid claims from 2013 to 2021 to compare opioid prescription dosages and daily supply of opioids prescribed by PCPs. Participants and nonparticipants were matched using propensity score matching.
Setting: Missouri Medicaid data were received through partnership with the Center for Health Policy's MO HealthNet Data Project, the state's leading provider of Medicaid data.
Participants: Missouri-based prescribers.
Intervention: Show-Me Project Extension for Community Healthcare Outcomes (ECHO), an evidence-based provider-to-provider telehealth intervention that connects PCPs with a team of specialists.
Main outcome measures: We compared the rate of prescription opioid >50 morphine milligram equivalents (MMEs), mean MMEs/day, and mean number of daily supply to understand the impact of the ECHO model on providers' opioid prescribing.
Results: Patients treated by ECHO providers have 33 percent lower odds of being prescribed opioid dose >50 MME/day (p < 0.001) compared to non-ECHO providers. There is also a 14 percent reduction in the average opioid dose prescribed to patients of ECHO providers (p < 0.001). We observed a 3 percent (p < 0.001) reduction in average daily supply of opioids among patients of ECHO providers compared to the comparison group.
Conclusions: Pain Management ECHO supports PCPs with needed education and skills to provide specialty care in the management of pain conditions and safe prescribing of opioid medications.
References
Nahin RL: Estimates of pain prevalence and severity in adults: United States, 2012. J Pain. 2015; 16(8): 769-780. DOI: 10.1016/j.jpain.2015.05.002. DOI: https://doi.org/10.1016/j.jpain.2015.05.002
Raffaeli W, Arnaudo E: Pain as a disease: An overview. J Pain Res. 2017; 10: 2003-2008. DOI: 10.2147/JPR.S138864. DOI: https://doi.org/10.2147/JPR.S138864
Institute of Medicine (US) Committee on Advancing Pain Research: Pain as a Public Health Challenge. Washington, DC: National Academies Press, 2011. Available at https://www.ncbi.nlm.nih.gov/books/NBK92516/. Accessed April 12, 2023.
IPRCC: Available at https://www.iprcc.nih.gov/. Accessed April 12, 2023.
Institute of Medicine (US) Committee on Advancing Pain Research C: Care of People with Pain. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. National Academies Press (US), 2011.
Breuer B, Cruciani R, Portenoy RK: Pain management by primary care physicians, pain physicians, chiropractors, and acupuncturists: A national survey. South Med J. 2010; 103(8): 738-747. DOI: 10.1097/SMJ.0b013e3181e74ede. DOI: https://doi.org/10.1097/SMJ.0b013e3181e74ede
Dobscha SK, Corson K, Flores JA, et al.: Veterans affairs primary care clinicians' attitudes toward chronic pain and correlates of opioid prescribing rates. Pain Med. 2008; 9(5): 564-571. DOI: 10.1111/j.1526-4637.2007.00330.x. DOI: https://doi.org/10.1111/j.1526-4637.2007.00330.x
Matthias MS, Parpart AL, Nyland KA, et al.: The patient–provider relationship in chronic pain care: Providers' perspectives. Pain Med. 2010; 11(11): 1688-1697. DOI: 10.1111/j.1526-4637.2010.00980.x. DOI: https://doi.org/10.1111/j.1526-4637.2010.00980.x
Starrels JL, Fox AD, Kunins HV, et al.: They don't know what they don't know: Internal medicine residents' knowledge and confidence in urine drug test interpretation for patients with chronic pain. J Gen Intern Med. 2012; 27(11): 1521-1527. DOI: 10.1007/s11606-012-2165-7. DOI: https://doi.org/10.1007/s11606-012-2165-7
Barry DT, Irwin KS, Jones ES, et al.: Opioids, chronic pain, and addiction in primary care. J Pain. 2010; 11(12): 1442-1450. DOI: 10.1016/j.jpain.2010.04.002. DOI: https://doi.org/10.1016/j.jpain.2010.04.002
Rosenblum A, Marsch LA, Joseph H, et al.: Opioids and the treatment of chronic pain: Controversies, current status, and future directions. Exp Clin Psychopharmacol. 2008; 16(5): 405-416. DOI: 10.1037/a0013628. DOI: https://doi.org/10.1037/a0013628
Martell BA, O'Connor PG, Kerns RD, et al.: Systematic review: Opioid treatment for chronic back pain: Prevalence, efficacy, and association with addiction. Ann Intern Med. 2007; 146(2): 116-127. DOI: 10.7326/0003-4819-146-2-200701160-00006. DOI: https://doi.org/10.7326/0003-4819-146-2-200701160-00006
Chou R, Turner JA, Devine EB, et al.: The effectiveness and risks of long-term opioid therapy for chronic pain: A systematic review for a national institutes of health pathways to prevention workshop. Ann Intern Med. 2015; 162(4): 276-286. DOI: 10.7326/M14-2559. DOI: https://doi.org/10.7326/M14-2559
Von Korff M, Kolodny A, Deyo RA, et al.: Long-term opioid therapy reconsidered. Ann Intern Med. 2011; 155(5): 325-328. DOI: 10.7326/0003-4819-155-5-201109060-00011. DOI: https://doi.org/10.7326/0003-4819-155-5-201109060-00011
Sites BD, Beach ML, Davis MA: Increases in the use of prescription opioid analgesics and the lack of improvement in disability metrics among users. Reg Anesth Pain Med. 2014; 39(1): 6-12. DOI: 10.1097/AAP.0000000000000022. DOI: https://doi.org/10.1097/AAP.0000000000000022
Zacny J, Bigelow G, Compton P, et al.: College on problems of drug dependence taskforce on prescription opioid non-medical use and abuse: Position statement. Drug Alcohol Depend. 2003; 69(3): 215-232. DOI: 10.1016/s0376-8716(03)00003-6. DOI: https://doi.org/10.1016/S0376-8716(03)00003-6
Katzman JG, Qualls CR, Satterfield WA, et al.: Army and navy ECHO pain telementoring improves clinician opioid prescribing for military patients: An observational cohort study. J Gen Intern Med. 2019; 34(3): 387-395. DOI: 10.1007/s11606-018-4710-5. DOI: https://doi.org/10.1007/s11606-018-4710-5
Arora S, Kalishman S, Dion D, et al.: Partnering urban academic medical centers and rural primary care clinicians to provide complex chronic disease care. Health Aff (Millwood). 2011; 30(6): 1176-1184. DOI: 10.1377/hlthaff.2011.0278. DOI: https://doi.org/10.1377/hlthaff.2011.0278
Frank JW, Carey EP, Fagan KM, et al.: Evaluation of a telementoring intervention for pain management in the Veterans health administration. Pain Med. 2015; 16(6): 1090-1100. DOI: 10.1111/pme.12715. DOI: https://doi.org/10.1111/pme.12715
Hubs & Programs: Available at https://hsc.unm.edu/echo/partner-portal/data-marketplace/interactive-dashboards/. Accessed April 12, 2023.
Milgrom ZZ, Severance TS, Scanlon CM, et al.: Enhancing cancer prevention and survivorship care with a videoconferencing model for continuing education: A mixed-methods study to identify barriers and incentives to participation. JAMIA Open. 2022; 5(1): ooac004. DOI: 10.1093/jamiaopen/ooac004. DOI: https://doi.org/10.1093/jamiaopen/ooac004
McBain RK, Sousa JL, Rose AJ, et al.: Impact of project ECHO models of medical tele-education: A systematic review. J Gen Intern Med. 2019; 34(12): 2842-2857. DOI: 10.1007/s11606-019-05291-1. DOI: https://doi.org/10.1007/s11606-019-05291-1
Arora S, Thornton K, Murata G, et al.: Outcomes of treatment for hepatitis C virus infection by primary care providers. N Engl J Med. 2011; 364(23): 2199-2207. DOI: 10.1056/NEJMoa1009370. DOI: https://doi.org/10.1056/NEJMoa1009370
Su GL, Glass L, Tapper EB, et al.: Virtual consultations through the Veterans administration SCAN-ECHO project improves survival for veterans with liver disease. Hepatology. 2018; 68(6): 2317-2324. DOI: 10.1002/hep.30074. DOI: https://doi.org/10.1002/hep.30074
Lindauer A, Wild K, Natonson A: Dementia 360 ECHO: Using technology to facilitate diagnosis and treatment. Gerontol Geriatr Educ. 2023; 43(2). DOI: 10.1080/02701960.2020.1835658. Available at https://www.tandfonline.com/doi/abs/10.1080/02701960.2020.1835658. Accessed April 12, 2023. DOI: https://doi.org/10.1080/02701960.2020.1835658
Bouchonville MF, Paul MM, Billings J, et al.: Taking telemedicine to the next level in diabetes population management: A review of the endo ECHO model. Curr Diab Rep. 2016; 16(10): 96. DOI: 10.1007/s11892-016-0784-9. DOI: https://doi.org/10.1007/s11892-016-0784-9
Catic AG, Mattison MLP, Bakaev I, et al.: ECHO-AGE: An innovative model of geriatric care for long-term care residents with dementia and behavioral issues. J Am Med Directors Assoc. 2014; 15(12): 938-942. DOI: 10.1016/j.jamda.2014.08.014. DOI: https://doi.org/10.1016/j.jamda.2014.08.014
Flynn D, Doorenbos AZ, Steffen A, et al.: Pain management telementoring, long-term opioid prescribing, and patient-reported outcomes. Pain Med. 2020; 21(2): 266-273. DOI: 10.1093/pm/pnz338. DOI: https://doi.org/10.1093/pm/pnz338
MO HealthNet Division | Missouri Department of Social Services: Available at https://dss.mo.gov/mhd/. Accessed May 26, 2023.
Dowell D, Haegerich TM, Chou R: CDC guideline for prescribing opioids for chronic pain—United States, 2016. JAMA. 2016; 315(15): 1624-1645. DOI: 10.1001/jama.2016.1464. DOI: https://doi.org/10.1001/jama.2016.1464
Donaldson MS, Yordy KD, Lohr KN, et al.: Defining Primary Care. Washington, DC: National Academies Press, 1996. Available at https://www.ncbi.nlm.nih.gov/books/NBK232631/. Accessed April 12, 2023.
Missouri Telehealth Network: Pain management. Show-Me ECHO. Available at https://showmeecho.org/clinics/pain-management/. Accessed April 12, 2023.
Morgan CJ: Reducing bias using propensity score matching. J Nucl Cardiol. 2018; 25(2): 404-406. DOI: 10.1007/s12350-017-1012-y. DOI: https://doi.org/10.1007/s12350-017-1012-y
Becevic M, Wallach E, Sheets LR, et al.: Accelerating care through ECHO: Case examples from the field. Mo Med. 2020; 117(3): 235-240.
Ladd R, Becevic M, Misterovich H, et al.: Dermatology ECHO: A case presentation demonstrating benefits of specialty telementoring in primary care. J Telemed Telecare. 2019; 25(8): 506-509. DOI: 10.1177/1357633X18780562. DOI: https://doi.org/10.1177/1357633X18780562
Becevic M, Mutrux R, Edison K: Show-Me ECHO: Complex disease care capacity-building telehealth program. Stud Health Technol Inform. 2016; 226: 233-236.
Anderson D, Zlateva I, Davis B, et al.: Improving pain care with project ECHO in community health centers. Pain Med. 2017; 18(10): 1882-1889. DOI: 10.1093/pm/pnx187. DOI: https://doi.org/10.1093/pm/pnx187
Katzman JG, Comerci GD, Landen M, et al.: Rules and values: A coordinated regulatory and educational approach to the public health crises of chronic pain and addiction. Am J Public Health. 2014; 104(8): 1356-1362. DOI: 10.2105/AJPH.2014.301881. DOI: https://doi.org/10.2105/AJPH.2014.301881
Alexandridis AA, McCort A, Ringwalt CL, et al.: A statewide evaluation of seven strategies to reduce opioid overdose in North Carolina. Inj Prev. 2018; 24(1): 48-54. DOI: 10.1136/injuryprev-2017-042396. DOI: https://doi.org/10.1136/injuryprev-2017-042396
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