The use of telemedicine for perioperative pain management during the COVID-19 pandemic

Abstract

Introduction Using a human factors engineering approach, the Johns Hopkins Personalized Pain Program adopted telemedicine for perioperative pain management in response to the COVID-19 pandemic. This study examines the impact of telemedicine adoption on the quality and outcomes of perioperative pain management. Methods A mixed-methods study with a convergent parallel design was conducted. From June 2017 to December 2021, 902 patients participated in the Personalized Pain Program. Quantitative data on daily opioid consumption, pain severity and interference, physical and mental health status, and patient satisfaction and engagement were continuously collected with all patients using chart review and patient surveys. Beginning 23 March 2020, the Personalized Pain Program transitioned to telemedicine. A pre–post quasi-experimental design was used to examine the impact of telemedicine. In addition, qualitative interviews were conducted with 3 clinicians and 17 patients to explore their experience with telemedicine visits. Results The monthly number of new patients seen in the Personalized Pain Program did not significantly change before and after telemedicine adoption. Compared to patients having in-person visits before the pandemic, patients having telemedicine visits during the pandemic achieved comparable improvements in daily opioid consumption, pain severity and interference, and physical health status. While telemedicine helped overcome many challenges faced by the patients, the limitations of telemedicine were also discussed. Conclusion The COVID-19 pandemic stimulated the use of telemedicine. To facilitate telemedicine adoption beyond the pandemic, future research is needed to examine best practices for telemedicine adoption and provide additional evidence on the effectiveness of telemedicine.

Patient Experiences and Clinical Outcomes in a Multidisciplinary Perioperative Transitional Pain Service

“…We have previously demonstrated that transitional perioperative pain services have the potential to facilitate opioid reductions during treatment [34][35][36]57]. To our knowledge, this is the first study to report sustained reductions in opioid use, in terms of the number of participants who discontinued opioids and mean opioid doses, nearly three years after initiating treatment in a transitional perioperative pain service.…”

“…These interviews were conducted with participants who were initially seen prior to the COVID-19 pandemic. The PPP transitioned to telemedicine services in March 2020 [78]; ongoing studies are evaluating how this transition has impacted clinical outcomes [57] and patients' experiences in the PPP.…”

The Personalized Pain Program: A New Transitional Perioperative Pain Care Delivery Model to Improve Surgical Recovery and Address the Opioid Crisis

“…We have previously demonstrated that PPP patients who were using opioids preoperatively achieve significant postoperative reductions (from 81 to 29 mg, P < .001) in daily opioid use. 8 Furthermore, via self-reported outcome measures, patients report significant reductions in pain severity and pain interference, as well as improved physical functioning. 8 Approximately 60% of patients discontinue opioids by PPP discharge, and those who successfully complete the program remain abstinent or on low doses (<30 mg) of morphine equivalent doses up to 2 years after PPP discharge (unpublished data).…”