Supporting Better Access to Chronic Pain Specialists: The Champlain BASE ^™ eConsult Service

Abstract

Introduction: Excessive wait times for chronic pain are associated with significant reductions in quality of life and worse health outcomes. The Champlain BASE ™ (Building Access to Specialists through eConsultation) eConsult service can improve access to specialist care for patients with chronic pain by facilitating electronic communication between primary care providers (PCPs) and specialists. We explored the content of eConsult cases sent to chronic pain specialists to identify the major themes emerging from exchanges between PCPs and specialists regarding patients with chronic pain.Methods: We conducted a thematic analysis of eConsult cases submitted to chronic pain specialists between April 1, 2011 and October 31, 2014, using a constant comparison approach.Results: PCPs submitted 128 cases to chronic pain specialists during the study period. The study team coded 48 cases before data saturation was reached. PCPs sought advice for treating patients with chronic pain arising from a range of medical problems, and who frequently struggled with issues of mental health, substance dependence, and social complexity. Specialists responded with advice on pain management and treatment, directed PCPs to published guidelines and community resources, and validated the PCPs' frustration or concerns. Specialists provided instruction on safe opioid prescribing and how to identify and manage potential cases of substance dependence.

Barriers and facilitators for implementation of electronic consultations (eConsult) to enhance access to specialist care: a scoping review

“…The apparent benefits of using eConsult may not be realised if it creates an additional burden on clinicians. However, several studies showed specialists’ self-reported time spent responding to e-consult requests was less than 10 min on average, much less than a face-to-face consult which e-consult often replaces the need for 38 39 42 93–96. For PCPs, the time commitment is less clear; one study reported that a consultation takes an average of 10 min to be completed by both PCPs and specialists 97.…”

<p>Factors associated with waiting times for persons with rheumatic conditions in multidisciplinary pain treatment facilities</p>

“…Another potential avenue for improvement is to increase access to multidisciplinary teams able to manage chronic pain conditions within rheumatology departments or at the primary care level, which could be better suited for patients with rheumatic conditions who may not need highly specialized pain interventions 28. Supporting primary care physicians and rheumatologists by providing prompt recommendations and advice from chronic pain specialists is another strategy to consider 29. The use of technology and social media (eg, online support groups, pain management videos and blogs)30 as well as self-management interventions31 have also raised interest as innovative ways to reduce patients’ burden while waiting for MPTF.…”

Virtual Access to Subspecialty Care

“… 78 Integrated care models with primary care using pain management services via telehealth have been described but not studied. 79 , 80 , 81 In one study, military PCPs were given access to video consults with pain management specialists as well as an online pain management curriculum. Patients were asked to assess their pain at various intervals up until 8 weeks after their visit with a PCP.…”

“…The most common patient diagnoses included chronic pain patients with mental health diagnoses, substance dependence, and social complexity. 80 …”