Quantifying the impact of COVID-19 on chronic pain services in the Republic of Ireland

The Use of Telemedicine in an Interdisciplinary Pain Center in the Years 2020 and 2021 in Germany: Effects of the COVID-19 Pandemic

Introduction: COVID-19 changed the management of patients with chronic pain. The increased utilization of telemedicine was recommended as a solution. Telemedicine provides medical services by overcoming the geographical distance between practitioner and patient and makes it possible to continue treating the patients with a high level of safety for patients and staff. The aim of our study is to investigate the data on the use of telemedicine in an interdisciplinary pain center in the years 2020 and 2021. Methods: Every patient contact in 2020 and 2021 with the interdisciplinary pain center was registered. Dataset consists of 4,156 patient contacts (N = 1,996 in the year 2020; N = 2,160 in the year 2021). For each patient contact, we collected data on age, sex, place of residence, and the reason or type of the contact. In addition, the incidence rates were used as a data source for the COVID-19 development. Results: In 2020, there was a significant decrease in face-to-face contacts (85.0% to 59.4%) and a significant increase in telemedicine use (especially video calls 0.6% to 20.0%). The use of telemedicine had a temporary peak at the beginning of 2021 (first quarter of 2021: 41.2%). The trend generally reversed during 2021: face-to-face contacts increased again (25.5% to 58.9%) and telemedicine decreased (mainly video calls 41.2% to 25.9%). Conclusion: The results show that telemedicine was successfully implemented in an interdisciplinary pain center during 2020 and 2021. In addition to the software requirements and the data protection, the aspect of digital literacy appears to be relevant. There seems to be a need for an implementation plan in pain centers that includes guidelines for the use of telemedicine.

An evidence-based demand management strategy using a hub and spoke training model reduces waiting time for children's therapy services: An implementation trial

BACKGROUND

Waiting lists for community-based paediatric therapy services are common and lead to poorer health outcomes, anxiety and missed opportunities for treatment during crucial developmental stages. The Specific Timely Appointments for Triage (STAT) model has been shown to reduce waiting lists in a range of health settings.

AIMS

To determine whether providing training and support in the STAT model to champions within five community health centres using a remote 'hub and spoke' approach could reduce waiting time from referral to first appointment.

METHODS

Representatives from five community health centres providing paediatric therapy services (speech therapy, occupational therapy and other allied health services) participated in five online workshops over 6 months. They were guided sequentially through the steps of the STAT model: understanding supply and demand, reducing backlogs, preserving space for new patients based on demand and redesigning models of care to maintain flow. Waiting time was measured in three consecutive years (pre, during and post intervention) and compared using the Kruskal-Wallis test. Employee satisfaction and perception of the model were explored using surveys.

RESULTS

Data from 2564 children (mean age 3.2 years, 66% male) showed a 33% reduction in waiting time from the pre-intervention (median 57 days) to the post-intervention period (median 38 days, p < 0.01). The total number of children waiting was observed to reduce from 335 immediately prior to the intervention (mean per centre 67, SD 25.1) to 112 (mean 22, SD 13.6) after implementation (t[8] = 3.56, p < 0.01). There was no impact on employee satisfaction or other aspects of service delivery.

CONCLUSION

Waiting lists are a major challenge across the health system. STAT provides a practical, low-cost, data-driven approach to tackling waiting times. This study demonstrates its effectiveness in paediatric therapy services and provides evidence for a 'hub and spoke' approach to facilitate implementation that could be provided at scale.

Advanced clinical prioritisation in an Irish, tertiary, chronic pain management service: an audit of outcomes

Background

Advanced clinical prioritisation (ACP) pathways could potentially improve the interface between primary and secondary care, instigating appropriate treatment pathways with improved efficiencies. Telemedicine is a key component of ACP pathways.

Aims

Telephone consultations for new referrals (as part of a pilot ACP pathway for chronic pain) were trialled to try (a) improve efficiency of outpatient clinics, (b) expedite assessment/treatment, and (c) reduce the number of face-to-face attendances. An audit of this activity was undertaken.

Methods

The 100 longest waiting new referrals were identified. Over a 9-month period patients were contacted via telephone, undergoing an initial assessment. Treatment plans were initiated and outcomes (≥ 1) were documented.

Results

Average length of time on waiting list was 35.37 months. 40% patients were discharged with advice back to referrer, 8% were referred for diagnostics/imaging, 32% were offered pharmacological management, 30% were scheduled for interventional management, 9% were referred for further MDT assessment/treatment, 4% were referred directly for a pain management programme (PMP), 6% were referred for assessment by other specialist services, 9% were brought in for face-to-face consultation in our pain management OPD, 2% were uncontactable, and 1% had died before assessment could be made.

Conclusions

Telemedicine as part of ACP represents an opportunity to improve speed of access to care, reducing the number of patients and time spent on waiting lists. Future studies should be directed at assessing efficacy of treatment plans initiated in telemedicine clinics whilst also looking at cost effectiveness and patient satisfaction.

Behavior Modification Techniques on Patients with Chronic Pain in the Context of COVID-19 Telerehabilitation: An Umbrella Review

The aim of this systematic review (SR) of SRs was to assess the effectiveness of telerehabilitation based on behavior modification techniques (t-BMT) in patients with chronic musculoskeletal pain. We searched in PubMed, PEDro, Web of Science, CINAHL, PsycINFO, and Google Scholar (January 2022). The outcome measures were pain intensity, disability, psychological distress, pain-related fear of movement, disease impact, depressive symptoms, anxiety symptoms, and physical function. This review was previously registered on the international prospective register of systematic reviews PROSPERO (CRD42021262192). Methodological quality was analyzed using the AMSTAR and ROBIS scales, and the strength of evidence was established according to the Physical Activity Guidelines Advisory Committee grading criteria. Four SRs with and without meta-analyses covering 25 trials and involving 4593 patients were included. Of the three SRs that assessed pain intensity, two reported a significant decrease compared to usual care. Contradictory results were also found in the management of psychological distress, and of depressive and anxiety symptoms. However, two reviews found that t-BMT has significant effects on disability, and one review found that t-BMT seems to be effective for improving pain-related fear of movement and disease impact. Finally, one review found that t-BMT does not seem to be an effective modality to improve physical function. The quality of evidence was limited for all outcomes assessed. The results obtained showed that t-BMT was effective in improving disability, disease impact, and pain-related fear of movement, but it was not effective in improving physical function in patients with chronic pain. Mixed evidence was found for pain intensity, psychological distress, and depressive and anxiety symptoms, with a limited quality of evidence.