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Building Pain Management Expertise in VA Primary Care

Chronic pain affects at least 100 million US adults and more than 50% of Veterans. VA's National Pain Management Strategy recommends an integrated, multimodal, and interdisciplinary approach to chronic pain, emphasizing non-opioid and non-pharmacologic modalities. As part of this strategy, the Stepped Care Model envisions routine screening, comprehensive assessment, and initial treatment in primary care followed by more specialized, more intensive pain care when appropriate. However, primary care providers (PCP) are often insufficiently trained in chronic pain management and coordination of multimodal, multidisciplinary pain care can be challenging. To address this need, VA has implemented the Pain Specialty Care Access Network-ECHO (SCAN-ECHO) program. In this model, a multidisciplinary group of pain specialists deliver pain education via video teleconferences to PCPs using a curriculum comprised of case-based presentations and didactics. In prior work, provider participation in Pain SCAN-ECHO was associated with increased Veteran initiation of physical medicine services and non-opioid medications (antidepressants and anticonvulsants) without an increase in opioid medication initiation.

The overall goal of the Multimodal Pain Project in the Triple Aim QUERI Program is to promote multimodal, multidisciplinary chronic pain care for Veterans by implementing targeted Pain SCAN-ECHO at eight VA healthcare facilities. This will be accomplished through the following specific aims.

• Develop measures of facility-level multimodal chronic pain care quality and identify early- and late-adopting VA sites (community-based outpatient clinics and medical centers) for multimodal chronic pain care quality, adjusting for patient complexity and site patient case-mix.
• Among early- and late-adopting sites, conduct semi-structured telephone interviews to assess perspectives of providers, hospital administrators, and VISN leadership on barriers and facilitators to multimodal chronic pain care.
• At eight late-adopting sites, enroll one or more PCPs in the Pain SCAN-ECHO program using a stepped wedge design, and evaluate the impact.

This project seeks to impact Veterans' health and the VA healthcare system by building pain management expertise in VA primary care to improve the quality, safety, and accessibility of chronic pain care for Veterans. Operational partners for this QUERI project include the National Pain Management Program, the Office of Specialty Care Services, and the Office of Rural Health.

For more information about the Multimodal Pain Project and Triple Aim QUERI, contact Joe Frank, MD, MPH at joseph.frank@va.gov .