Health Justice CT

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Closing the gap in chronic pain management through the promise of technology

Community Spotlight is a blog series of Connecticut-based health equity profiles of community partners and organizations.

“We don’t carry that,” was a phrase typically heard by black and Hispanic patients when trying to obtain prescribed opioids from neighborhood pharmacies; it was also the controversial title of a Journal of New England Journal of Medicine study, looking at the ability of minority patients to obtain these medications.

Not only is the supply of pain medication is limited to racial minorities, these patients also suffer needlessly because they are victims of deficiencies in pain management care. A recent PAIN® study found that black patients were less likely to be referred to a pain specialist than white patients, and were more likely to be sent to substance abuse assessment.  Black patients were also likely to be tested more often for abuse than white patients.

This is a large part of the reason why black patients tend to have less successful pain management outcomes than white patients.  And only when providers acknowledge this disparities and barriers, can they begin to improve pain management for minority patients.

Project EchoThe Community Health Center (CHC) in Middletown is tackling this specific disparity issue through their telemedicine initiative modeled after Project Echo – “Extension for Community Healthcare Outcomes,” which links healthcare specialists with primary care doctors by teleconference.

Project Echo was started by Dr. Sanjeev Arora, a professor from the University of New Mexico, who was frustrated with the lack of specialty care for patients living in rural New Mexico. While Connecticut is not as geographically isolated as rural New Mexico,  many underserved patients face similar challenges accessing specialty care, even when they live in a city where there is a major hospital.

In January 2012, CHC began their Project Echo program by providing Hepatitis C and HIV clinics, and has since expanded to include chronic pain and buprenorphine clinics. A few weeks ago, I had the pleasure of attending CHC’s weekly pain management videoconferencing meetings.

I noticed that the patients presented at these videoconferencing meetings were the more extreme cases. These patients often have comorbid physical and mental health problems that make treating their pain even more difficult. Having a multidisciplinary team of pain specialists that include rheumatologists, clinical psychologists, and acupuncturists, offers the patient the best treatment plan possible.

I also noticed that Project Echo seems to have other benefits aside from the obvious. One of the doctors in the session noted that she found compiling her patient’s case to present helped her get a better picture of her patient, thus making treatment more straightforward. Other doctors also noted that being able to tell their patients that they had discussed their cases with a panel of specialist gave added weight to the doctors’ recommendations. A few said they felt their patients seemed more compliant with their treatment because of this.

Project Echo is an incredible collaboration of healthcare providers, brought together by state of the art technology.  The result is a more efficient workforce that can do much more for the underserved.

Phillip Montgom

Phillip Montgomery is a HJCT program intern and rising junior at John Hopkins University. Connect with Phillip on Twitter.

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