ABSTRACT
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.
ABSTRACT
The purpose of the study was to understand the impact of involuntary remote working during the early phases of the COVID-19 pandemic on perceived stress and work-related burnout for workers with and without previous experience of remote work. The authors developed a questionnaire, open from March 23rd to May 19th, 2020, incorporating the Perceived Stress Scale, Copenhagen Burnout Inventory, demographic, and work-related questions. This sample consisted of 256 professionals who self-identified as working at home during the pandemic. Pandemic restrictions increased perceived stress for all participants, but age and gender had significant effects on stress and burnout. Burnout was most significant for respondents already working remotely before COVID-19. The most significant challenges reported were—communication, collaboration, and time management with colleagues via technology. Working from home may contribute to higher levels of perceived stress and work-related burnout, which questions moves by some employers to make working from home a permanent arrangement. © The Author(s) 2021.