by Jim Lichauer
PharmD, BCPS, FASHP, Performance Improvement Program Director
07/17/20

While providers have rightly been focused on the COVID-19 pandemic that is surging in our country, it’s also important not to lose sight of another significant public health issue that continues to take lives: opioid abuse.  In 2018, 41 Americans died each day from overdoses involving prescription drugs. With over 50 million U.S. adults experiencing chronic pain daily, the need for patient care hasn’t disappeared, but it may have grown more complicated due to the pandemic.   

A recent survey from the U.S. Pain Foundation found that almost 70% of chronic pain patients surveyed considered themselves in the COVID-19 high risk category. The majority (77.4% of respondents) indicated they face barriers to medical care, most commonly cited as issues receiving treatments that require direct, person-to-person interaction. The majority also responded that the COVID-19 crisis led to increased stress (86.1%) and increased pain (63.8%). The crisis is not only limiting access to their physician, it is limiting or temporarily eliminating access to integrative modalities such as massage, chiropractic care, yoga, tai chi, fitness centers and chronic medications.

Under these unprecedented circumstances, health care organizations with a comprehensive pain management program are better able to treat patients with chronic pain. They can transition to or increase virtual health visits and triage urgent, semi-urgent and non-urgent cases or elective procedures more easily than those organizations without a formal infrastructure. This capability is sure to lead to greater patient satisfaction when compared to no patient-doctor interaction at all.

How and why to re-examine your chronic pain management program

As providers put safety measures in place to help patients become more comfortable returning to their doctors, it’s a good time to evaluate the need to implement or expand your chronic pain management program. Start first by assessing your market’s landscape to understand what services are currently offered and what gaps exist for chronic pain management. The development of a comprehensive pain program is complex as there are multiple factors that will impact a program’s success, including the key elements of strategy, people, services and process. Each factor can provide structure for a start-up program and additional components as the program advances and matures.     

One critical process element is referrals. While patients with chronic pain can generally access the health care system through a variety of entry points, a centralized referral center and virtual triage process, such as through the phone or internet, has shown to be more beneficial, which is especially important during a pandemic.

A centralized patient triage process provides for efficient care delivery and patient satisfaction compared to physician referrals that can impede access when patients are erroneously referred to the wrong type of specialist and lengthen the amount of time before receiving care. A pain management coordinator can provide the initial evaluation and degree of urgency, identifying the most appropriate provider for the initial visit and matching unmet needs appropriately. This can reduce unnecessary consults, increasing provider access and improving patient satisfaction.

People and services are connected. With each added interdisciplinary team member, the program’s breadth and expertise improves and so do the number of treatments available to the patients. Each organization will need to determine what services are appropriate and economically feasible for their system.

Complementary and alternative medicine (CAM) therapies, such as acupuncture, movement therapies, massage and manipulation, are effective chronic pain treatment modalities. Access to and reimbursement for those services are routine barriers. Changes to reimbursement have been slow, however in 2020 Medicare started covering some costs for acupuncture for chronic low back pain. Integrating CAM into a traditional medicine clinic can improve access to treatment and coordination of care. 

Measure the success of your program

Much like the framework and development of the program, success of a chronic pain management program is evaluated by assessing metrics in multiple domain areas. Obviously, the financial impact is a very important factor, but other important areas include operational, clinical, patient experience, workforce and market. Establishing a balanced, systemic and progressive evaluation will be critical to measuring and recognizing success throughout the maturation of the program.  

Vizient partnered with several member hospital subject matter experts to develop a guide for establishing a comprehensive pain management program. The guide presents key elements and attributes of a program as it progresses from a basic to mature level. As organizations pause and reflect on their existing strategic plans and the disruption caused by the COVID-19 pandemic, it will be important for them to evaluate all services for potential re-engineering to better meet patients’ needs.

The opioid crisis is not over.  Chronic pain management strategies and patient assistance must not be lost during this pandemic. To continue the reduction of opioid utilization, we must continue to improve access to and the quality of chronic pain management therapies. 

About the author. As performance improvement program director for pharmacy, Jim Lichauer is primarily responsible for developing and leading collaborative programs focused on medication safety and adverse drug events