My mom was a pill-popper.
Technically, it was only partially her fault. She had serious back problems, and back in the late ‘70’s early ‘80’s, doctors were a bit prescription happy. So, my mom got hooked on opioids. Those little pills would turn my normally joyful Pentecostal preacher mother into a raging, abusive crazy person. She would wake me up in the middle of the night, hitting me and screaming until I’d get up and help her find the pills that my dad would hide from her.
She even had several doctors that she could rotate through in order to get her drugs. She never really recovered.
My family’s story isn’t all that uncommon- opioid addiction is a massive problem in the US. But since 2010, the Louis Stokes Cleveland VA Medical Center has reduced prescriptions for the drugs by 25%. Compare that to the local area’s 10% or even the national 12% reduction, and you know the Cleveland VAMC is onto something.
That “something” has a long name to it: the VA Specialty Care Access Network – Extension for Community Health Care Outcomes, or SCAN-ECHO.
SCAN-ECHO uses teleconferencing technology to link a pain management specialist team, located at Cleveland’s VA hospital, with primary care providers at VA outpatient clinics throughout northeast Ohio. It’s different from telemedicine because patients aren’t involved with the calls. Each week, 90-minute training sessions let the pain specialist share information with primary care providers using a lecture format as well as real-time consultations on actual patient cases.
Prescribing opioids varies across physicians, sometimes by as much as three times in the same hospital. The New England Journal of Medicine released a study earlier this year that shows the spread of opioid prescriptions at 7.3% for general visits vs. 24.1% of emergency department visits. Now, the SCAN-ECHO team provides guidance on appropriate opioid prescribing for patients who are suitable candidates for these medications.
The Cleveland SCAN-ECHO team has a one-year training program for primary care providers that teaches how to care for their patients with various common pain management processes. These processes include tapering a patient off the drugs slowly and transitioning them to non-opioid medications. It also helps providers identify noninvasive and invasive interventions that give pain relief. This also develops a working relationship between these providers and the pain management specialists.
At the height of our countries prescription opioid epidemic in 2012, the Louis Stokes Cleveland VA Medical Center ranked best out of all VA hospitals for giving out the fewest opioid prescriptions per patient. The results of Cleveland VAMC’s approach to pain proves that it’s possible to improve physician’s opioid prescribing patterns, and in doing so, battle America’s opioid problem.