Speakers
Sebastian Tong, MD, MPH
Associate Professor, Department of Family Medicine
University of Washington
Kushang Patel, PhD, MPH
Research Professor, Department of Anesthesiology and Pain Medicine
University of Washington
Keywords
Rural; Chronic Pain; Nurse Care Management; Feasibility
Key Points
- Chronic pain affects roughly 20% of U.S. adults. In rural areas, that figure is closer to 30% – a disparity due, in part, to the concentration of older individuals and those with more physically demanding jobs. Rural residents often have less access to pain specialists and non-pharmacologic pain management approaches.
- Nurse care management (NCM) has been shown to be effective in treating other diseases that disproportionately affect rural residents. In the feasibility phase, the research team sought to test and adapt a virtual NCM model – including care meetings with nurses, cognitive behavioral therapy (CBT), Tele-Enhance® fitness, and a pain tracker – for chronic pain in rural primary care.
- The research team identified several adaptions to implement before scaling up to a 450-person randomized controlled trial. These include establishing a clinic learning collaborative; providing more take-home CBT and exercise options; implementing flexibility around who can serve as care manager; and providing asynchronous administrative support for care managers.
Discussion Themes
The research team focused on 2 systems during the feasibility phase given the research team’s limited bandwidth. In retrospect, Dr. Tong noted, continued engagement with the other health systems over the course of the feasibility phase may have helped maintain interest in the trial.
Different sites faced similar challenges; the learning collaborative will serve to harmonize implementation and provide a centralized space for troubleshooting.
While including non-RNs in care delivery makes the model more practical for rural clinics, the researchers acknowledged this creates a challenge for long-term sustainability, as insurance often only reimburses care managed by registered nurses.