Journal Article

Telehealth for management of chronic non-cancer pain and opioid use disorder in safety net primary care

Knight, Kelly Ray, Enriquez, Celeste, Olsen, Pamela, Miaskowski, Christine, Cooke, Alexis, Castellanos, Stacy, Kushel, Margot

2023

Overview

Background The SARS-CoV-2 (COVID-19) pandemic increased use of telehealth for the management of opioid use disorder and chronic non-cancer pain in primary care safety net clinical systems. Significant barriers to telehealth exist, little is known about how these barriers impact urban safety net, primary care providers and their patients. The objective of this study was to qualitatively assess the benefits and challenges of telehealth for management of chronic non-cancer pain, opioid use disorder, and multi-morbidity in primary care, safety net clinical systems. Methods We interviewed patients with chronic non-cancer pain and history of substance use ( n  = 22) and their primary care clinicians ( n  = 7) in the San Francisco Bay Area, March-July 2020. We recorded, transcribed, coded, and content analyzed interviews. Results COVID-19 shelter-in-place orders contributed to increases in substance use and uncontrolled pain, and posed challenges for monitoring opioid safety and misuse through telehealth. None of the clinics used video visits due to low digital literacy/access. Benefits of telehealth included decreased patient burden and missed appointments and increased convenience and control of some chronic conditions (e.g., diabetes, hypertension). Telehealth challenges included loss of contact, greater miscommunication, and less comprehensive care interactions. Conclusions This study is one of the first to examine telehealth use in urban safety net primary care patients with co-occurring chronic non-cancer pain and substance use. Decisions to continue or expand telehealth should consider patient burden, communication and technology challenges, pain control, opioid misuse, and medical complexity.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Acupuncture / Analgesics, Opioid - therapeutic use / Cancer / Cancer pain / Cancer therapies / Chronic non-cancer pain / Chronic Pain - drug therapy / Coronaviruses / COVID-19 / COVID-19 - epidemiology / Data collection / Datasets / Diabetes / Drug therapy / Drug use / Ethnography / Health Administration / Health Informatics / Health services / Humans / Indigent care / Interviews / Medicine / Medicine & Public Health / Mental health / Narcotics / Nursing Research / Opioid-Related Disorders - drug therapy / Opioid-Related Disorders - therapy / Opioids / Pain management / Pandemics / Participation / Patients / Physical therapy / Primary care / Primary Health Care / Public Health / Qualitative / Qualitative research / Research Article / SARS-CoV-2 / Services / Severe acute respiratory syndrome coronavirus 2 / Substance abuse treatment / Substance use disorder / Telehealth / Telemedicine