Telecollaborative pain care for rural Veterans: The role of nurse care managers within interdisciplinary teams

Abstract: Background: Non-pharmacologic interventions are a first-line treatment for chronic pain. Yet, availability of these treatments may be reduced for those living in rural areas. Compounding poor access to services, patients in rural areas may also need to navigate multiple systems of care. Purpose: The Tele-Collaborative Outreach to Rural Patients with Chronic Pain (CORPs) trial is a four-year multi-site pragmatic effectiveness randomized controlled trial being conducted in VA healthcare settings. The purpose of the study is to examine the effectiveness of a remotely delivered collaborative care intervention for improving pain interference among Veterans with high impact chronic pain living in rural areas. The uniqueness of this study is the nurse-led collaborative care intervention. Design: Participants (n=608) will be randomized to either the CORPs intervention or to minimally enhanced usual care (MEUC). Participants randomized to the intervention will complete a biopsychosocial intake appointment, five follow-up visits with a Nurse Care Manager (NCM) receiving personalized care recommendations, and education in both one-on-one and a 6-session group education class. Consistent with collaborative care models, the NCM will be supported by a consulting clinician. Participants randomized to the comparator will receive a brief one-time education session with the NCM to review available pain services. All participants will complete quarterly research assessments for one year. The primary study outcome is pain interference. Results: The design of the CORPs intervention and MEUC comparator was informed by semi-structured interviews with patient engagement groups comprising Veterans enrolled in VA care (n=35), VA clinicians and administrators (n=24), and non-VA clinicians and administrators (n=7). The activities constructed as part of the nurse-led collaborative care team reflect the defining elements of the intervention: patient education and care coordination and navigation. This presentation will provide a detailed explanation of the NCM role and the tele-collaborative care model, including how it can be tailored to systems of care outside of the VA. Conclusion: This pragmatic trial will test the real-world effectiveness of a remotely delivered nurse-led collaborative care intervention for chronic pain. The trial findings can provide guidance on nursing activities that facilitate integrative care and use of non-pharmacologic treatments for chronic pain.

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