E-Consults Bridge to Interdisciplinary Team Care for Rural Appalachian Veterans With Chronic Pain and Opioid Use...

Co-occurring chronic pain and opioid use disorder (OUD) is often managed by primary care practitioners (PCPs) for rural veterans. Interdisciplinary teams (IDTs) and e-consults have shown promise at the US Department of Veterans Affairs for supporting PCPs. This quality improvement study sought to examine the impact of an e-consult service on pain care trajectories, determine the feasibility and reach of the RESTORE IDT appointment program, and determine the impact of RESTORE on engagement in evidence-based care.

A retrospective chart review was conducted at the Salem Veterans Affairs Healthcare System that primarily serves rural veterans in Central Appalachia. Veterans at risk for OUD with co-occurring chronic pain whose PCP placed an e-consult during a 1-year period were included. The following data were extracted from the electronic health record: demographics, referrals, treatment plans, and treatment engagement. Results were summarized using descriptive statistics. Of the 77 e-consults placed in 1 year, 75% were placed by PCPs, and 83% were requests for recommendations on medication adjustments. The reviewing pharmacist referred 19 veterans to RESTORE; of those, 17 (89%) agreed to be referred to a pain IDT specializing in nonpharmacologic pain management and 13 (68%) agreed to initiate buprenorphine.

This study demonstrated preliminary support for the feasibility of e-consults to increase engagement in evidence-based treatments. Additional research is needed.