Online Migration of Services Catalyzed by the COVID-19 Pandemic in a Community Based Pain Clinic: A Mixed Method Study of the Perspective from Providers, Patients and Staff (Preprint)

Abstract

During the COVID-19 pandemic, patients living with chronic pain (CP) have experienced more frequent pain flare-ups with reduced access to routine pain management services. Many healthcare centers pivoted their operations to an online approach.

This study aimed to evaluate the transition from in-person to online services in a community-based pain clinic for patients with CP from the perspective of providers, patients, and implementers.

The study followed a cross-sectional, concurrent mixed methods approach. The study primarily used quantitative methods, while qualitative data was used to contextualize patient and provider experiences. The study period was January 1st, 2019, to December 31st, 2021. Data regarding change in appointment volumes was derived from the Electronic Medical Record and analyzed using SPSS. There were two respondent groups – First, providers who consisted of doctors, allied health professionals, facilitators, management and support staff. The second group consisted of patients. These patients were randomly selected from among those who had a minimum of one encounter of care in 2021. Email questionnaires were sent to both groups. 44 providers and 1721 patients answered the questionnaire.

84,853 Encounters of Care (EOC) were analyzed. Some services experienced a 300% increase; others, formally on-site, experienced a decline of -70%. 86% of providers felt comfortable delivering care virtually and aim to continue even when it is not mandatory. Subjects using virtual care lived within an average 64.3 km distance from the facility. 75% of patients were satisfied with the delivery of virtual care for their chronic pain. Patients and facilitators both expressed that virtual mode reduces barriers and hence improves access.

Migration from in-person to online services created many challenges for the team ranging from technological limitations, patient comfort with online platforms, and increased demands on the staff for patient support and billing. Telemedicine demonstrated to be a powerful tool to increase care access for patients with CP. More research is required to understand the efficacy of the interventions using standardized metrics.