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Editorial| Volume 22, ISSUE 4, P437-438, August 2021

Telehealth and Pain Management

      The COVID pandemic created a dramatic and sudden change in access to healthcare forcing greater emphasis on telehealth. According to
      • Demeke H.B.
      • Pao L.Z.
      • Clark H.
      • Romero L.
      • Neri A.
      • Shah R.
      • McDow K.B.
      • Tindall E.
      • Iqbal N.J.
      • Hatfield-Timajchy K.
      • Bolton J.
      • Le X.
      • Hair B.
      • Campbell S.
      • Bui C.
      • Sandhu P.
      • Nwaise I.
      • Armstrong P.A.
      • Rose M.A.
      Telehealth practice among health centers during the COVID-19 pandemic—United States, July 11–17, 2020.
      , approximately 30% of health-related pandemic visits in the United States were conducted using virtual visits between June and November 2020. Besides offering an effective and safe delivery model, telehealth reduces the need for personal protective equipment, avoids patient crowding, enables increased patient access to care, and improves interdisciplinary healthcare collaboration (
      • Demeke H.B.
      • Pao L.Z.
      • Clark H.
      • Romero L.
      • Neri A.
      • Shah R.
      • McDow K.B.
      • Tindall E.
      • Iqbal N.J.
      • Hatfield-Timajchy K.
      • Bolton J.
      • Le X.
      • Hair B.
      • Campbell S.
      • Bui C.
      • Sandhu P.
      • Nwaise I.
      • Armstrong P.A.
      • Rose M.A.
      Telehealth practice among health centers during the COVID-19 pandemic—United States, July 11–17, 2020.
      ;
      • Martin G.
      • Koizia L.
      • Kooner A.
      • Cafferkey J.
      • Ross C.
      • Purkayastha S.
      • ...
      • Collaborative P.
      Use of the HoloLens2 mixed reality headset for protecting health care workers during the COVID-19 pandemic: Prospective, observational evaluation.
      ). Projections suggest the use of telehealth is expected to continue well into the future with 20-25% of care expected to be delivered remotely (
      • Demeke H.B.
      • Pao L.Z.
      • Clark H.
      • Romero L.
      • Neri A.
      • Shah R.
      • McDow K.B.
      • Tindall E.
      • Iqbal N.J.
      • Hatfield-Timajchy K.
      • Bolton J.
      • Le X.
      • Hair B.
      • Campbell S.
      • Bui C.
      • Sandhu P.
      • Nwaise I.
      • Armstrong P.A.
      • Rose M.A.
      Telehealth practice among health centers during the COVID-19 pandemic—United States, July 11–17, 2020.
      ;
      • Kichloo A.
      • Albosta M.
      • Dettloff K.
      • Wani F.
      • El-Amir Z.
      • Singh J.
      • Aljadah M.
      • Chakinala R.C.
      • Kanugula A.K.
      • Solanki S.
      • Chugh S.
      Telemedicine, the current COVID-19 pandemic and the future: a narrative review and perspectives moving forward in the USA.
      ).
      With the recent expansion of telehealth, greater insights and data have emerged that highlight some of the major drivers affecting its future utilization including:
      • Cost savings
      Evidence suggests telehealth may result in considerable savings for both patients and providers. For patients, the cost savings includes reduced travel expenses, less waiting, and reduced loss of work time (
      • Demeke H.B.
      • Pao L.Z.
      • Clark H.
      • Romero L.
      • Neri A.
      • Shah R.
      • McDow K.B.
      • Tindall E.
      • Iqbal N.J.
      • Hatfield-Timajchy K.
      • Bolton J.
      • Le X.
      • Hair B.
      • Campbell S.
      • Bui C.
      • Sandhu P.
      • Nwaise I.
      • Armstrong P.A.
      • Rose M.A.
      Telehealth practice among health centers during the COVID-19 pandemic—United States, July 11–17, 2020.
      ). For providers there is a decrease in missed appointments, easier access to education for patients and family members, and greater availability of outside professional consultation from anywhere in the world.
      • Access to care
      Telehealth better serves more vulnerable populations such as the elderly, chronically ill, minorities and those with reduced mobility and limited transportation (
      • Totten AM
      • McDonagh MS
      • Wagner JH.
      The Evidence Base for Telehealth: Reassurance in the Face of Rapid Expansion During the COVID-19 Pandemic. White Paper Commentary. (Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University under Contract No. 290-2015-00009-I). AHRQ Publication No. 20-EHC015.
      ). Moreover, telehealth greatly expands the delivery of care outside the walls of hospitals and physician offices by providing greater access to resources (e.g., primary care professionals and specialists, counseling and support, education and training, physical and/or occupational therapy, screening for symptoms such as COVID and other conditions, etc.). Research further supports that telehealth facilitates continuity of care, reduces readmissions, improves patient self-management, improves timely follow-up, helps with managing chronic conditions, and facilitates achievement of targeted clinical outcomes (
      • Tauben D.J.
      • Langford D.J.
      • Sturgeon J.A.
      • Rundell S.D.
      • Towle C.
      • Bockman C.
      • Nicholas M.
      Optimizing telehealth pain care after COVID-19.
      ;
      • Totten AM
      • McDonagh MS
      • Wagner JH.
      The Evidence Base for Telehealth: Reassurance in the Face of Rapid Expansion During the COVID-19 Pandemic. White Paper Commentary. (Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University under Contract No. 290-2015-00009-I). AHRQ Publication No. 20-EHC015.
      ).

      Enhanced medication management

      With COVID, telepharmacy services were expanded, especially for patients and veterans in rural areas and in long-term care facilities (Perez, et al., 2020). Major advantages are greater access for pharmacist's hospital discharge management, better coverage during vacation and off hours, improved patient medication management, and higher patient adherence to prescribed medications (
      • Tauben D.J.
      • Langford D.J.
      • Sturgeon J.A.
      • Rundell S.D.
      • Towle C.
      • Bockman C.
      • Nicholas M.
      Optimizing telehealth pain care after COVID-19.
      ).

      Telehealth drawbacks

      • Lack of available, stable internet resources and secure communication technologies (
        • Zhai Y.
        A call for addressing barriers to telemedicine: Health disparities during the COVID-19 pandemic.
        ). Approximately 40% of rural Americans lack access to highspeed broadband compared to 4% of those living in urban areas,
      • Limited access to smart devices such as cell phones, iPads, and laptops (
        • Zhai Y.
        A call for addressing barriers to telemedicine: Health disparities during the COVID-19 pandemic.
        ).
      • Confusing billing and insurance coverage issues and reimbursements (
        • Sisk B.
        • Alexander J.
        • Bodnar C.
        • Curfman A.
        • Garber K.
        • McSwain S.D.
        • Perrin J.M.
        Pediatrician attitudes toward and experiences with telehealth use: Results from a national survey.
        ),
      • Limited consumer knowledge regarding personal communication technology or reluctance to use such technology (
        • Hawley C.E.
        • Genovese N.
        • Owsiany M.T.
        • Triantafylidis L.K.
        • Moo L.R.
        • Linsky A.M.
        • Sullivan J.L.
        • Paik J.M.
        Rapid integration of home telehealth visits amidst COVID-19: What do older adults need to succeed.
        ),
      • Individuals having hearing and visual impairments (
        • Zhai Y.
        A call for addressing barriers to telemedicine: Health disparities during the COVID-19 pandemic.
        ),
      • Healthcare providers’ lack of familiarity with telehealth, lack of knowledge on how to effectively use it, and an unwillingness to use telehealth as a way to provide healthcare services (
        • Zhai Y.
        A call for addressing barriers to telemedicine: Health disparities during the COVID-19 pandemic.
        ;
        • Perez J.
        • Niburski K.
        • Stoopler M.
        • Ingelmo P.
        Telehealth and chronic pain management from rapid adaptation to long-term implementation in pain medicine: A narrative review.
        ),

      Nursing's role in telehealth along with pain management implications

      Although the literature is still expanding, current evidence indicates nurses do well in managing their patients’ chronic pain, monitoring patient treatment outcomes, and teaching self-management strategies to manage pain. When using telehealth, nurses develop strategies to keep patients engaged and have a clear understanding of the planned path forward when using telehealth (
      • Tauben D.J.
      • Langford D.J.
      • Sturgeon J.A.
      • Rundell S.D.
      • Towle C.
      • Bockman C.
      • Nicholas M.
      Optimizing telehealth pain care after COVID-19.
      ).
      Telehealth enables consistent communications by nurses or care coordinators to assist patients and their families with problem solving and learning how to be compliant with pain management recommendations. A scoping literature review by
      • de Moraes É.B.
      • Santos Garcia J.B.
      • de Macedo Antunes J.
      • Daher D.V.
      • Seixas F.L.
      • Muniz Ferrari M.F.
      Chronic Pain Management during the Covid-19 Pandemic: A Scoping Review.
      reveals how the use of telehealth assists in the screening of patients with chronic pain who use opioids and are at greater risk for misuse in situations such as the pandemic. In addition, obtaining a clearer understanding of the major barriers and facilitators of telehealth by minorities in the United Stated is also important and the focus on my own current pilot research study (
      • Miller E.
      • Harris A.
      Factors affecting minorities use of telehealth during COVID-19.
      ). This study is framed within the Health Information Technology Acceptance Model (HITAM) which may provide additional insights into factors such as minority groups perceived usefulness, ease of use, and actual use of telehealth.
      What is the future of telehealth and to what degree will this model of care replace in-person visits, especially as we think about chronic pain management? The evidence supports that telehealth is here to stay. Yet, concerns will remain related to reimbursement, technology shortcomings, establishing best practices, privacy and safety issues, and overuse of telehealth when in-person visits are more appropriate.
      Areas where nurses excel and play a vital role in the advancement of telehealth include our ability to establish effective and caring working relationships with patients and their families, problem solving, and designing feasible, individualized plans of care with achievable outcomes in the short and long-term. Plus, nurses are highly skilled at monitoring outcome achievement as well as partnering with patients and other healthcare providers in modifying plans of care as needed. Nurses are also creative and adaptable in helping patients and family members master new technologies and assist them in developing realistic and sustainable self-management goals.
      In this issue, there is great applicability for the use of telehealth in expanding the reach of pain management. For example, in the home (
      • Rafii F.
      • Taleghani F.
      • Khaoni M.
      Barriers to effective pain management in the home setting: A qualitative study.
      ), for the management of chronic and/or musculoskeletal pain of adults and adolescents (Yanardg, et al., 2021;
      • Ozdemir S.
      • Gencbas D.
      • Tosun B.
      • Bebis H.
      • Sinan O.
      Musculoskeletal pain, related factors and posture profiles among adolescents: a cross sectional study.
      ) and implementing novel strategies to manage pain (
      • Cole L.
      The impact of guided imagery on pain and anxiety in hospitalized patients.
      ).
      Telehealth offers pain management nurses many opportunities to expand their practice settings, implement and evaluate best practices, and assist patients and families in new and effective ways. Let's work together to creatively implement new approaches to using telehealth that truly benefit our patients and then disseminate our success stories.

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        Chronic Pain Management during the Covid-19 Pandemic: A Scoping Review.
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