Study Finds E-Consult an Effective tool for Pain Management

The recent retrospective cohort study, “Clinical Effectiveness of an Outpatient Multidisciplinary Chronic Pain Management Telementoring Service,” published in the Clinical Journal of Pain, demonstrates the effectiveness of e-consult in reducing opioid use. The pain e-consult program (PEP) used in the study is a multidisciplinary telementoring service based on the ECHO model. The findings indicate that PEP patients had a significantly greater decrease in morphine milligram equivalents per day during the 6 and 12-month follow-ups and found no differences in the rates of initiation of non-opioid alternative medications when compared to the control group. 

Abstract:

Objective: To assess the effectiveness of a pain e-consult program (PEP), a multidisciplinary telementoring service based on the ECHO model to reduce opioid use, in the outpatient setting.

Methods: This was a retrospective, matched, cohort study conducted in an integrated healthcare delivery system. Adult patients without cancer and with a 90-day morphine milligram equivalent (MEE) ≥30▒mg/d between April 1, 2016 and June 30, 2017 were included. Patients whose primary care clinician received the PEP (observation) were compared to usual care (control) patients. Observation patients were matched up to 1:5 to control patients. Outcomes included change in MME and initiation of non-opioid alternative medications. Multivariable regression analyses were performed.

Results: 665 patients were matched: 125 and 540 in the observation and control groups, respectively. Patients were primarily female, white, and Medicare beneficiaries. The observation group had a greater decrease in median MME/day during the 6- (-7.4▒mg vs. 1.5▒mg, P=0.002) and 12-month (-15.1▒mg vs. -2.8▒mg, P<0.001) follow-up and rates of ≥20% decrease (6-month: 41.6% vs. 24.6%, P=0.003) 12-month: 48.0% vs. 32.6%, P=0.017). There were no differences in the rates of initiation of non-opioid alternative medications.

Conclusions: A pain e-consult program was associated with greater reductions in MME/day compared to usual care despite similar rates of non-opioid alternative medication initiation. A prospective, randomized study of this program should be undertaken to confirm these findings.

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