Delivery of pain education through picture-telephone videoconferencing for veterans with chronic, non-cancer pain

Abstract

Purpose Almost a quarter of Veterans nationwide live in rural communities, which may negatively impact their health-related quality of life compared to their counterparts in urban areas. The incidence of chronic pain is higher in rural areas because the population is often older, obese, and impoverished. Social factors also play a role, such as limited access of pain specialists, transportation issues, unstable housing, poor education, and unemployment. The high rates of chronic pain amongst rural Veterans coupled with the barriers found in these areas complicate the delivery of pain self-management interventions. Thus, clinical care at a distance is progressing as a model and is being used more frequently to treat disease in rural areas. Dial-up phones and videocassette recording devices are both examples of technologies that have become obsolete, but new, amazing devices and applications are coming on the market every day that allow services to be provided at a distance. Technology-assisted treatments, or "telehealth," may provide a comparable alternative to face-to-face interventions. The Pain Education School program has been shown to positively impact Veterans stage of change, their experience of pain, and their mood. The purpose of the current feature is to propose the feasibility and potential efficacy of using picturetelephone (PICTEL) videoconferencing technology to disseminate a pain education program to rural Veterans with chronic, non-cancer pain. Method The current study used a retrospective outcome design with a sample of 463 Veterans aged 18-88 years old with mixed idiopathic, chronic, non-cancer pain conditions who participated in the Pain Education School program either face-toface (N=350; 76%) or via PICTEL (N=113; 24%) at a Midwestern VA Medical Center between January 8, 2010-November 4, 2011. Veterans were referred to the Pain Education School program by their primary care provider. The investigators would receive the consult through the computerized patient record system and determine the closest location to the Veteran. The Veteran was then sent a letter two weeks before the scheduled appointment about the location, time, and place of their appointment. The participant then attends their first one-hour class session after the introduction class. The participant is scheduled and encouraged to attend 11 subsequent weeks of one-hour classes led by guest speakers from 23 different disciplines within the VA. The program provides a menu of treatment modalities-the presenters rotated on a schedule, not the Veterans. Presenters from each discipline shared information about chronic, non-cancer pain from their perspective, available treatments within their service, and how to access their respective clinics. As a part of quality management, measures were completed by participants of the face-to-face and PICTEL interventions at the introduction and conclusion of the program. The assessments included a battery of measures, including the Readiness Questionnaire, the Patient Pain Questionnaire, and the Patient Health Questionnaire. Results Preliminary findings from the current study propose there was no significant difference between the face-to-face and PICTEL interventions on any of the outcome measures aforementioned, including the stage of readiness to adopt a selfmanagement approach, F (1,429)=0.01, p=0.92; knowledge level about pain, F (1,429)=0.56, p=0.46; experience of pain, F (1,429)=0.03, p=0.87; and the frequency of depression, F (1,429)=0.99, p=0.32. However, the preliminary findings from the current study support past research which has found a significant difference between the pre- and post-measures of the participants' stage of readiness to adopt a selfmanagement approach, F (1,429)=29.81, p=0.00; their experience of pain, F (1,429)=17.49, p=0.00; and the frequency of their depressed mood, F (1,429)=11.19, p=0.01, regardless of how the intervention was delivered. These results suggest the Pain Education School telehealth program had a moderate effect in increasing participants' readiness to adopt a selfmanagement approach. In addition, the current findings suggest the telehealth program had a small to moderate effect in decreasing the negative experience of pain. Finally, the results suggest the telehealth program had a small to moderate effect in decreasing depressive symptoms. The preliminary findings mirrored those of previous non-cancer pain research in which Veterans participating in a pain education program did not evidence increased pain knowledge. A prior research study found that the addition of audience response systems to the pain education program at a VA demonstrated significantly greater increases in pain knowledge compared to those locations without the technology by facilitating active learning. The current presentation will also detail logistics and considerations, the PICTEL technology used, technology troubleshooting, best practices and etiquette, and how to capture workload. Several lessons were learned through this process, including the importance of making partnerships, having support from administration, marketing, and obtaining knowledge about the healthcare system in order to have a successful telehealth program. Conclusions The current program may prove to be an avenue by which rural Veterans can bypass identified barriers and realize selfmanagement goals. There are merits to the videoconferencing format, but a lot of the recent studies on mobile health and internet-based training programs may better address transportation and time-related barriers. Despite these advancements, there continues to be issues related to trust, quality, security, privacy, and reimbursement with these newer formats. Therefore, videoconferencing may serve as the best option for telehealth care in the current healthcare system. Before such programming can be widely disseminated, more largescale, multisite, and scientifically-rigorous evaluations are needed.