How Does a Telemedicine Pain Program Work in Rural American with Multi-Vulnerable Patient Populations?

Dax Trujillo, MD

July 20, 2022

In April 2017 Summit Healthcare started a multi-disciplinary program to treat patients with chronic and acute pain in the White Mountains of Arizona. Our patient service area is HRSA-designated as having a shortage of providers and medically underserved. The area is the size of Rhode Island and includes Native American reservations and other vulnerable populations. Many of our patients live in a high poverty area which makes access to care challenging.

In order to provide multi-disciplinary services that include interventional procedures, monitored medication management and cognitive behavior therapy, we needed to create a hybrid program. Our program incorporates in-person, video/audio and telephone visits. By using three different modes of care delivery we were able to reach and follow more patients with better outcomes. Since April 1, 2017 we have had over 900 patients participate in our telemedicine pain program. The visits include virtual appointments for medical management, behavioral therapy, and general wellness checks after an in-person visit; virtual check-ins for procedure or testing follow-ups and eVisits via email communication to answer questions and/or review prescription issues or re-ordering.

Due to the rurality of the service area we estimate that patients were saved from having to travel 66,144 miles to a physician’s office. This was a significant relief to patients with limited means to transportation, knowing that their weekly, monthly in-patient visits were reduced to quarterly in-patient visits. Patient satisfaction has been high due to the reduction of travel time and costs. Simultaneously, the patient perceived they were being more closely monitored and their pain issues addressed in a timely manner.

Another benefit is that more than one professional can join a telemedicine visit with the patient which allows a more holistic and comprehensive visit for better value based care of the patient. By providing virtual visits as part of the entire treatment program, we have saved thousands of dollars in chronic pain treatment costs. Through evidence-based research we know that patients are achieving better healthcare outcomes in this hybrid program by incorporating telemedicine technology.

Our program has had overall success with addressing pain but there are some risks involved that must be addressed within your institution to provide a platform that is HIPPA compliant and protects critical sensitive health information. Providing a secure platform must be a top priority when delivering pain treatment virtually due to the sensitive nature of the disease/treatments with this patient population.

While most patients do well with the hybrid program we do have patients for whom it is not appropriate. Due to our location, a subset of patients do not have access to broadband internet service so we cannot perform visits via video or sometimes audio. Other patients have expressed a preference for in-person visits while another group prefers all visits to be virtual. Patients needing neuraxial interventions or surgeries will need to be seen in-person. Each patient has their own unique circumstances so having a hybrid pain treatment program with various care delivery options allows us to reach more patients previously not being treated for their chronic pain issues.

In the future we will purchase a remote patient monitoring platform/equipment that can be used with our chronic pain patients to better track their vitals, physical and mental health. This will also allow us to manage medications and behavioral issues related to pain and opioid addiction, both of which are prevalent in our service area. Our hospital system is also developing a hospital at home program which will incorporate the telemedicine pain program for patients with co-morbidities. The future of healthcare access is using hybrid delivery of care systems that include telemedicine, to improve accessibility and outcomes for chronic pain patients.

For original article: https://southwesttrc.org/blog/2022/how-does-telemedicine-pain-program-work-rural-american-multi-vulnerable-patient