VIDEO-TELECARE COLLABORATIVE PAIN MANAGEMENT DURING COVID-19

BACKGROUND: COVID-19 presents a barrier to high-quality treatment for patients with chronic pain receiving long-term opioid therapy (LTOT) as guideline-recommended approaches may be challenging to deliver. We implemented a novel virtual care model, Video-Telecare Collaborative Pain Management (VCPM) harnessing innovative clinical approaches: opioid reassessment and tapering, buprenorphine switch and maintenance, and behavioral pain self-management. The primary aim of this study was to assess the feasibility and acceptability of VCPM. METHODS: VCPM is a multi-component intervention led by clinical pharmacy practitioners (CPPs) supported by a collaborating physician and approved as a quality improvement project by the two participating VA IRBs. Participants were VA patients on LTOT for chronic pain at ≥50 mg morphine equivalent daily dose identified using a VA dashboard. We mailed eligible patients letters describing the program, then called to invite them to schedule a virtual appointment with a CPP. Following a standardized intake, an individualized plan was presented to patients. Interested patients continued virtual follow-up for up to 90 days via video or phone, based on patient preference. We assessed feasibility and acceptability based on 1) enrollment rate, defined as completion of baseline visit;2) retention rate, as indicated by engagement in longitudinal care;3) willingness to trial buprenorphine when recommended;and 4) treatment satisfaction measured at three months post intake. We assessed pain and other measures at 3-month follow up. RESULTS: Of 133 patients contacted, 44 completed an initial CPP visit (33%) and 19 engaged in longitudinal care with VCPM (14%). Of those who engaged in VPCM, 11 trialed buprenorphine (58%), 7 reduced their opioid dose (37%), and 1 was lost to follow up. 32/44 patients (73%) completed the 3-month survey. Patients endorsed high satisfaction with both video (M = 4.3/5) and phone visits (M = 4.0/5). Patients who engaged viewed VCPM as successful (M = 7.0/10) and would recommend (M = 7.6/10). Patients who attended multiple VCPM visits (n = 16), compared to one visit, generally reported lower pain intensity (6.1/10 vs. 7.1), pain interference with enjoyment of life (6.0/10 vs 8.3) and general activities (5.9/10 vs 7.3), reported higher quality of patient-provider interaction (70.2/75 vs 64.1), and were more likely to report that their pain severity had improved compared to 3 months ago (44% vs 19%). CONCLUSIONS: Results partially supported feasibility and acceptability of VCPM. Enrollment rates were low, perhaps due to recruitment strategies;we are exploring peer outreach. Enrolled patients were satisfied and showed potential improvements in pain-related functioning. Refining recruitment approaches and larger effectiveness trials are underway.

Whole Health Options in Pain Education (wHOPE): A Multi-Site Pragmatic Trial of a VA Whole Health Team Approach to Pain Management in Veterans

Methods: Target enrollment in the wHOPE (Whole Health Options in Pain Education) trial is 750 veterans with moderate to severe chronic pain from five geographically diverse VA facilities across the U.S. We are creating an inclusive and generalizable sample through few exclusion criteria, over-sampling and stratified randomization, prioritizing women veterans and those prescribed opioids, while closely monitoring racial and ethnic diversity. The primary aim of the trial is to determine whether a Whole Health Team (WHT) (interdisciplinary Whole Health/integrative pain team) is superior to Primary Care Group Education (PC-GE, abbreviated group Cognitive Behavioral Therapy for Chronic Pain), and whether both are superior to Usual Primary Care (UPC) in decreasing pain interference and secondarily, in improving quality of life and use of non-pharmacological modalities to manage chronic pain. An implementation evaluation and budget impact analysis will provide information about feasibility, maintenance, and sustainability. Descriptive statistics characterized wHOPE study participants including COVID-19-related impacts. Results: To date, of 248 randomized participants, mean age is 60.2 (SD+/-12.3) years;39% women;23% Black or African American and 9.2% Hispanic/Latinx;27% were prescribed opioids. Roughly half endorsed moderate to severe depression, moderate PTSD symptoms, and 58% reported sleep difficulties. Roughly 20% engaged in hazardous drinking and 10% problem drug use. At baseline, veterans reported high rates of non-pharmacological and CIH pain management, e.g., mindfulness (42%);spinal manipulation (32%). As a result of COVID, wHOPE participants reported worsening: mental and emotional health (73%);access to healthcare (59%);pain intensity (48%) and use of tobacco (44%) and cannabis products (36%). Background: To conduct a pragmatic trial to establish evidence for the VA Whole Health model for chronic pain care. Conclusion: This ongoing multi-site pragmatic trial in a diverse group of veterans with chronic pain and high rates of comorbidity indicates high baseline use of CIH and substantial negative COVID-related impacts.

Surviving remotely: How job control and loneliness during a forced shift to remote work impacted employee work behaviors and well-being

This paper investigates the impact of job control and work-related loneliness on employee work behaviors and well-being during the massive and abrupt move to remote work amid the COVID-19 pandemic. We draw on job-demands control and social baseline theory to link employee perceived job control and work-related loneliness to emotional exhaustion and work-life balance and posit direct and indirect effects on employee minor counterproductive work behaviors, depression, and insomnia. Using a two-wave data collection with a sample of U.S. working adults to test our predictions, we find that high job control was beneficially related to emotional exhaustion and work-life balance, while high work-related loneliness showed detrimental relationships with our variables of interest. Moreover, we find that the beneficial impact of high perceived job control was conditional on individual segmentation preferences such that the effects were stronger when segmentation preference was low. Our research extends the literature on remote work, job control, and workplace loneliness. It also provides insights for human resource professionals to manage widespread remote work that is likely to persist long after the COVID-19 pandemic.