Telehealth and Rural-Urban Differences in Receipt of Pain Care in the Veterans Health Administration

Chen, Jessica A; DeFaccio, Rian J; Gelman, Hannah; Thomas, Eva R; Indresano, Jess A; Dawson, Timothy C; Glynn, Lisa H; Sandbrink, Friedhelm; Zeliadt, Steven B

doi:10.1093/pm/pnab194

Cited by 28Telemedicine and Telehealth ImplementationMusculoskeletal pain and rehabilitationOpioid Use Disorder Treatment

Telehealth and Rural-Urban Differences in Receipt of Pain Care in the Veterans Health Administration

Chen, Jessica A, DeFaccio, Rian J, Gelman, Hannah, Thomas, Eva R, Indresano, Jess A, Dawson, Timothy C, Glynn, Lisa H, Sandbrink, Friedhelm +1 more·2022·Pain Medicine

DOI 10.1093/pm/pnab194

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Abstract

Objective: Examine changes in specialty pain utilization in the Veterans Health Administration (VHA) after establishing a virtual interdisciplinary pain team (TelePain). Design: Retrospective cohort study. Setting: A single VHA healthcare system, 2015–2019. Subjects: 33,169 patients with chronic pain-related diagnoses. Methods: We measured specialty pain utilization (in-person and telehealth) among patients with moderate to severe chronic pain. We used generalized estimating equations to test the association of time (pre- or post-TelePain) and rurality on receipt of specialty pain care. Results: Among patients with moderate to severe chronic pain, the reach of specialty pain care increased from 11.1% to 16.2% in the pre- to post-TelePain periods (adjusted odds ratio [aOR]: 1.37, 95% confidence interval [CI]: 1.26–1.49). This was true of both urban patients (aOR: 1.62, 95% CI: 1.53–1.71) and rural patients (aOR: 1.16, 95% CI: 0.99–1.36), although the difference for rural patients was not statistically significant. Among rural patients who received specialty pain care, a high percentage of the visits were delivered by telehealth (nearly 12% in the post-TelePain period), much higher than among urban patients (3%). Conclusions: We observed increased use of specialty pain services among all patients with chronic pain. Although rural patients did not achieve the same degree of access and utilization overall as urban patients, their use of pain telehealth increased substantially and may have substituted for in-person visits. Targeted implementation efforts may be needed to further increase the reach of services to patients living in areas with limited specialty pain care options.

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The effectiveness of integrated interdisciplinary chronic pain programs on improving multi-dimensional pain outcomes is well-established in VA settings.
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From Benchmark findings from a veteran electronic patient-reported outcomes evaluation from a chronic pain management telehealth program (2024) · cites this paper as [34]

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Result

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Authors: Chen, J. A., DeFaccio, R. J., Gelman, H., Thomas, E. R., Indresano, J. A., Dawson, T. C., Glynn, L. H., Sandbrink, F., & Zeliadt, S. B.
Affiliations: University of Washington (US)
Health Services Research & Development (US)
VA Puget Sound Health Care System (US)
George Washington University (US)
Corresponding author: Chen, Jessica A
ORCID: Chen, Jessica A
Gelman, Hannah
Thomas, Eva R
Dawson, Timothy C
Glynn, Lisa H
Sandbrink, Friedhelm
Zeliadt, Steven B
Venue: Pain Medicine
Publisher: Oxford University Press (OUP)
Published: 2021-06-19
Volume: 23
Issue: 3
Pages: 466-474
ISSN: 1526-2375 (ISSN-L)
1526-4637
DOI: 10.1093/pm/pnab194
OpenAlex: W3169963966
Cited by: 28
References: 30
Citations by year: 2026: 2 · 2025: 6 · 2024: 13 · 2023: 2 · 2022: 4 · 2021: 1
FWCI: 4.35
Type: journal article
Language: en
Open access: closed
Licence: academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
Locations: Pain Medicine (publishedVersion, public-domain)
PubMed (publishedVersion)
Funders: VA Quality Enhancement Research Initiative
Expanding TelePain Across VISN20 (I50 HX002902)
VA Health Services Research & Development Career Development Award (IK2 HX002866)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
Keywords: telemedicine, chronic pain, urban-rural differences, Veterans Health Administration, access to pain care, veterans
MeSH terms: Humans, Retrospective Studies, United States, United States Department of Veterans Affairs, Telemedicine, Veterans Health, Chronic Pain

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Telehealth and Rural-Urban Differences in Receipt of Pain Care in the Veterans Health Administration

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