Madigan Army Medical Center, Joint Base Lewis-McChord, Tacoma, WA 98431, USA.
College of Nursing, University of Illinois Chicago, IL 60612, USA.
Mil Med. 2023 May 16;188(5-6):1192-1198. doi: 10.1093/milmed/usac005.
Telementoring is an evidence-based approach to meet the educational needs of primary care providers (PCPs) and to improve the quality of chronic pain care. This mixed methods study evaluated the effectiveness of pain management telementoring in improving provider knowledge, attitudes, and perceived competence.
The study was conducted at Madigan Army Medical Center. Using a non-randomized quasi-experimental approach, 25 providers were assigned to intervention arm and control arm (14 intervention and 13 control). Providers in the intervention group attended telementoring sessions. Videoconference technology was used to deliver weekly 90-minute TelePain sessions to the PCPs in the intervention group. The first 25-30 minutes of each session consisted of a didactic presentation led by a panel of interdisciplinary pain management clinicians. During the remaining 60 minutes, all PCPs in the intervention group presented clinical histories and asked specific management questions regarding patients of their choosing. An interdisciplinary panel of pain management clinicians provided telementoring consultations. The panel included experts from pain medicine, primary care, psychology or psychiatry, chiropractic, clinical pharmacy, and nursing. Changes in provider knowledge, attitudes, and perceived competence were evaluated using the Knowledge and Attitudes Survey Regarding Pain, KnowPain-12, and the Perceived Competence Scale (n = 23; 12 intervention and 11 control). Qualitative interviews were conducted among a subset of providers (n = 12; 8 intervention and 4 control), and provider narratives were analyzed using content analysis.
Increased provider knowledge (Z = 2.0, P = .046 [KnowPain-12]) and perceived competence (Z = 2.1, P = .033) were observed among intervention group providers. Provider narratives supported more implementation of non-pharmacological pain management strategies, use of strategies to engage patients in reducing reliance on opioids, and perception of TelePain as a helpful resource especially in the context of inadequate preparation in chronic pain management during professional training.
Telementoring may hold significant potential to support providers in their efforts to decrease use of prescription opioids. Overall, this study provides further support for the value of telementoring in improving comprehensive chronic pain management in military settings.
远程指导是一种基于证据的方法，旨在满足初级保健提供者（PCP）的教育需求，并提高慢性疼痛管理的质量。这项混合方法研究评估了疼痛管理远程指导在提高提供者知识、态度和感知能力方面的有效性。
该研究在马迪根陆军医疗中心进行。使用非随机准实验方法，将 25 名提供者分配到干预组和对照组（14 名干预组和 13 名对照组）。干预组的提供者参加远程指导课程。视频会议技术用于向干预组的 PCP 提供每周 90 分钟的 TelePain 课程。每个课程的前 25-30 分钟由一组跨学科疼痛管理临床医生进行的专题介绍组成。在剩余的 60 分钟内，干预组的所有 PCP 都介绍了病史，并就他们选择的患者提出了具体的管理问题。一个跨学科的疼痛管理临床医生小组提供远程指导咨询。该小组包括疼痛医学、初级保健、心理学或精神病学、脊骨神经医学、临床药学和护理方面的专家。使用疼痛知识和态度调查（Knowledge and Attitudes Survey Regarding Pain，KnowPain-12）和感知能力量表（Perceived Competence Scale）评估提供者知识、态度和感知能力的变化（n=23；12 名干预组和 11 名对照组）。对一组提供者（n=12；8 名干预组和 4 名对照组）进行了定性访谈，并使用内容分析法分析提供者的叙述。
干预组提供者的知识（Z=2.0，P=0.046 [KnowPain-12]）和感知能力（Z=2.1，P=0.033）均有所提高。提供者的叙述支持更多地实施非药物性疼痛管理策略，使用策略来促使患者减少对阿片类药物的依赖，以及将 TelePain 视为一种有益的资源，特别是在专业培训中慢性疼痛管理准备不足的情况下。
远程指导可能具有很大的潜力，能够支持提供者努力减少处方阿片类药物的使用。总的来说，这项研究进一步支持了远程指导在改善军事环境中全面慢性疼痛管理方面的价值。
