Sustained participation in the VA SCAN ECHO pain management telementoring program enhances pain care quality

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VA SCAN ECHO, a telementoring program for primary care providers (PCPs) based on the ECHO project was launched in 2011 at seven national sites including VA Connecticut Healthcare System. SCAN ECHO Pain Management (PM) uses video-teleconferencing to provide PCPs with case-based specialist consultation and didactic education. Previous research has shown that PCPs who submitted consults to SCAN ECHO PM had better medication practices and used physical medicine services more frequently than those who did not. This study examines the effect of degree of attendance at SCAN ECHO sessions (i.e., “SCAN ECHO dose”: not quantified in previous studies) on pain care quality (PCQ) measures by evaluating 3 attendance groups: non-attendees (0 sessions, n=30), infrequent attendees (1 to 5 sessions, n=14), or frequent attendees (>5 sessions, n=11) of 20 sessions of Pain SCAN ECHO offered during 2012. All patients with pain intensity ratings of ≥4 seen by these PCP’s in six-month time windows prior to implementation (n=3258), and after implementation (Jan-June 2013, n=3660) were identified using administrative VHA data. PCQ measures were 1) referral to comprehensive pain care alternatives, including mental health services, physical and occupational therapy, chiropractic, health psychology, and specialty pain management, and 2) prescription of opioid and non-opioid medications for pain. Outcomes were evaluated using General Estimating Equations with patient as a random factor nested within provider. Frequent attendees were more likely to be from community-based outpatient centers rather than two large VA medical centers. Findings indicated that the proportion of patients who received specialty care and who received prescriptions for non-opioid medications increased significantly for frequent attendees, but not for infrequent and non-attendees. Results extend prior findings by documenting an effect of extent of participation in SCAN ECHO PM sessions and encourages efforts to promote sustained participation.