Delaware is using telemedicine to connect primary care doctors with some extra expertise — and support — as they help patients deal with pain.
The new videoconferencing program is part of the state’s fight against prescription drug abuse.
Some of the doctors at Westside Family Healthcare now have a standing, monthly face-to-face appointment with a team of pain management specialists from across the country.
“Our providers are able to discuss cases with them, and say, ‘Look, I have this patient with these particular issues, can you give me some feedback on how I might be able to treat them?'” said Tom Stephens, chief medical officer at Westside.
Helping patients can be tricky because there’s no definitive test for pain, Stephens said.
“So if someone has liver disease, there’s tests you can do. If they have pneumonia, you can get an X-ray. But for pain there’s no marker that says this person has pain, and their pain is this bad,” Stephens said.
Doctors and patients have to rely on good communication, their relationship and trust to get pain under control.
Stephens says sometimes that relationship is misused.
Karyl Rattay, director of the Division of Public Health, says prescription drug abuse is on the rise.
Rattay is a member of Delaware’s Prescription Drug Action Committee. The group includes health-care providers, law enforcement and substance abuse experts to address prescription drug abuse.
Eighty percent of the drug overdoses in the state involve one or more prescription drugs, and accidental drug poisoning deaths kill more Delawareans than car crashes.
The state committee has issued new recommendation; nationwide, there are several education efforts to deal with inappropriate prescribing of opioids.
“There are a lot of different kinds of approaches to dealing with pain,” Rattay said. “It has really become the norm for us here to use these opioids.”
OxyContin and Percoset are two pain relievers often diverted from appropriate use.
Primary care providers in the state report that about one-third of their appointments with adults involve concerns over chronic pain. And Delaware doctors are asking for more support, Rattay said.
“We don’t get a lot of training in medical school, or in our residencies, for controlling pain, and for how to best to prescribe opiates, how best to detect whether some one is diverting drugs, other whether someone is addicted to drugs,” Rattay said.
The telemedicine program, called Project ECHO or Extension for Community Healthcare Outcomes, was originally developed to connect rural doctors with faraway specialists.
Delaware has many specialists — but Rattay says they can’t keep up with the demand.