Published in:
Open Access 01-03-2019 | Original Research
Army and Navy ECHO Pain Telementoring Improves Clinician Opioid Prescribing for Military Patients: an Observational Cohort Study
Published in: Journal of General Internal Medicine | Issue 3/2019
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Background
Opioid overdose deaths occur in civilian and military populations
and are the leading cause of accidental death in the USA.
Objective
To determine whether ECHO Pain telementoring regarding best
practices in pain management and safe opioid prescribing yielded significant
declines in opioid prescribing.
Design
A 4-year observational cohort study at military medical treatment
facilities worldwide.
Participants
Patients included 54.6% females and 46.4% males whose primary care
clinicians (PCCs) opted to participate in ECHO Pain; the comparison group
included 39.9% females and 60.1% males whose PCCs opted not to participate in
ECHO Pain.
Intervention
PCCs attended 2-h weekly Chronic Pain and Opioid Management TeleECHO
Clinic (ECHO Pain), which included pain and addiction didactics, case-based
learning, and evidence-based recommendations. ECHO Pain sessions were offered
46 weeks per year. Attendance ranged from 1 to 3 sessions (47.7%), 4–19 (32.1%,
or > 20 (20.2%).
Main Measures
This study assessed whether clinician participation in Army and Navy
Chronic Pain and Opioid Management TeleECHO Clinic (ECHO Pain) resulted in
decreased prescription rates of opioid analgesics and co-prescribing of opioids
and benzodiazepines. Measures included opioid prescriptions, morphine milligram
equivalents (MME), and days of opioid and benzodiazepine co-prescribing per
patient per year.
Key Results
PCCs participating in ECHO Pain had greater percent declines than
the comparison group in (a) annual opioid prescriptions per patient (− 23% vs.
− 9%, P < 0.001), (b) average MME
prescribed per patient/year (−28% vs. −7%, p < .02), (c) days of co-prescribed opioid and benzodiazepine per
opioid user per year (−53% vs. −1%, p < .001), and (d) the number of opioid users (−20.2% vs. −8%,p < .001). Propensity scoring
transformation–adjusted results were consistent with the opioid prescribing and
MME results.
Conclusions
Patients treated by PCCs who opted to participate in ECHO Pain had
greater declines in opioid-related prescriptions than patients whose PCCs opted
not to participate.