Army and Navy ECHO Pain Telementoring Improves Clinician Opioid Prescribing for Military Patients: an Observational Cohort Study.

Authors

Joanna G. Katzman, ECHO Institute, University of New Mexico, Albuquerque, NM USA
Clifford R. Qualls, Department of Statistics, University of New Mexico School of Medicine, Albuquerque, NM USA
William A. Satterfield, Defense Health Agency, Falls Church, VA USA; University of New Mexico, Albuquerque, NM USA
Martin Kistin, ECHO Institute, University of New Mexico, Albuquerque, NM USA
Keith Hofmann, Kennell and Associates, Falls Church, VA USA
Nina Greenberg, Department of Mathematics, University of New Mexico, Albuquerque, NM USA
Robin Swift, ECHO Institute, University of New Mexico, Albuquerque, NM USA
George D. Comerci, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM USA
Rebecca Fowler, Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, NM USA
Sanjeev Arora, ECHO Institute, University of New Mexico, Albuquerque, NM USA

Document Type

Article

Publication Date

3-1-2019

Abstract

BACKGROUND: Opioid overdose deaths occur in civilian and military populations and are the leading cause of accidental death in the USA.

OBJECTIVE: To determine whether ECHO Pain telementoring regarding best practices in pain management and safe opioid prescribing yielded significant declines in opioid prescribing.

DESIGN: A 4-year observational cohort study at military medical treatment facilities worldwide.

PARTICIPANTS: Patients included 54.6% females and 46.4% males whose primary care clinicians (PCCs) opted to participate in ECHO Pain; the comparison group included 39.9% females and 60.1% males whose PCCs opted not to participate in ECHO Pain.

INTERVENTION: PCCs attended 2-h weekly Chronic Pain and Opioid Management TeleECHO Clinic (ECHO Pain), which included pain and addiction didactics, case-based learning, and evidence-based recommendations. ECHO Pain sessions were offered 46 weeks per year. Attendance ranged from 1 to 3 sessions (47.7%), 4-19 (32.1%, or > 20 (20.2%).

MAIN MEASURES: This study assessed whether clinician participation in Army and Navy Chronic Pain and Opioid Management TeleECHO Clinic (ECHO Pain) resulted in decreased prescription rates of opioid analgesics and co-prescribing of opioids and benzodiazepines. Measures included opioid prescriptions, morphine milligram equivalents (MME), and days of opioid and benzodiazepine co-prescribing per patient per year.

KEY RESULTS: PCCs participating in ECHO Pain had greater percent declines than the comparison group in (a) annual opioid prescriptions per patient (- 23% vs. - 9%, P < 0.001), (b) average MME prescribed per patient/year (-28% vs. -7%, p < .02), (c) days of co-prescribed opioid and benzodiazepine per opioid user per year (-53% vs. -1%, p < .001), and (d) the number of opioid users (-20.2% vs. -8%, p < .001). Propensity scoring transformation-adjusted results were consistent with the opioid prescribing and MME results.

CONCLUSIONS: Patients treated by PCCs who opted to participate in ECHO Pain had greater declines in opioid-related prescriptions than patients whose PCCs opted not to participate.

Recommended Citation

Katzman JG, Qualls CR, Satterfield WA, Kistin M, Hofmann K, Greenberg N, Swift R, Comerci GD Jr, Fowler R, Arora S. Army and Navy ECHO Pain Telementoring Improves Clinician Opioid Prescribing for Military Patients: an Observational Cohort Study. J Gen Intern Med. 2019 Mar;34(3):387-395. doi: 10.1007/s11606-018-4710-5. Epub 2018 Oct 31. PMID: 30382471; PMCID: PMC6420488.