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

Abstract

BackgroundOpioid overdose deaths occur in civilian and military populations and are the leading cause of accidental death in the USA.ObjectiveTo determine whether ECHO Pain telementoring regarding best practices in pain management and safe opioid prescribing yielded significant declines in opioid prescribing.DesignA 4-year observational cohort study at military medical treatment facilities worldwide.ParticipantsPatients 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.InterventionPCCs 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 MeasuresThis 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 ResultsPCCs 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.ConclusionsPatients 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.Electronic supplementary materialThe online version of this article (10.1007/s11606-018-4710-5) contains supplementary material, which is available to authorized users.

A Qualitative Evaluation of the Pain Management VA-ECHO Program Using the RE-AIM Framework: The Participant's Perspective

“…Many respondents reported that improved confidence enhanced their ability to talk to patients about their pain care. Respondents who were prescribers described increased comfort in reducing the use of opioids similar to other studies and as shown quantitatively (14)(15)(16)(17). Some reported improved job satisfaction.…”

Impact of Project ECHO Models of Medical Tele-Education: a Systematic Review

“…Conversely, referrals for behavioral health and physical therapy increased (p < 0.001). Two other studies, by Katzman and colleagues 61 and Frank and colleagues, 59 examined prescription and referral rates, respectively. Katzman and colleagues 61 inspected opioid prescription rates across 1382 clinics associated with the Army and Navy, 99 of which participated in an EELM.…”

“…Two other studies, by Katzman and colleagues 61 and Frank and colleagues, 59 examined prescription and referral rates, respectively. Katzman and colleagues 61 inspected opioid prescription rates across 1382 clinics associated with the Army and Navy, 99 of which participated in an EELM. Compared with patients of providers who did not participate in EELM (n = 1,187,945), those with providers who did participate (n = 52,941) observed a much greater decline in prescriptions: from 23 to 9% (p < 0.001).…”

Changes in Opioid Prescribing Behaviors among Family Physicians Who Participated in a Weekly Tele-Mentoring Program

“…Katzman et al studied 99 clinics who attended ECHO and compared them to 1283 clinics that did not participate in ECHO. The clinics that attended ECHO had a greater percent decline than the comparison clinics in the number of opioid users, annual opioid prescriptions per patient, average MED prescribed per patient per year, days of co-prescribed opioid and benzodiazepine per opioid user per year [8].…”

“…Tele-mentoring educational programs are a novel approach to bringing knowledge to remote and underserved settings. In recent years, these programs have expanded in Canada [7] and around the world [8]. Project Extension for Community Healthcare Outcomes (ECHO) is a tele-mentoring program that started with the need to provide care to hepatitis C patients in rural areas of New Mexico [9].…”