Telehealth acceptability and opioid prescribing patterns of providers of painful chronic diseases during the COVID-19 pandemic: A survey of sickle cell providers

Authors

DOI:

https://doi.org/10.5055/jom.2021.0683

Keywords:

sickle cell disease, opioid prescribing, telemedicine, telehealth, COVD-19 pandemic, chronic pain

Abstract

Objective: The coronavirus disease 2019 (COVID-19) has led to a rapid transition to telehealth services. It is unclear how subspecialists managing painful chronic diseases—such as sickle cell disease (SCD), an inherited hemoglobinopathy with significant disparities in access and outcomes—have viewed the transition to telehealth or altered their pain management practices. This study elicits the views of sickle cell providers regarding their transition to telehealth and their opioid prescribing patterns during the COVID-19 pandemic.

Design: An anonymous online survey was sent to eligible sickle cell providers.

Setting: Comprehensive sickle cell centers and/or clinics across the United States.

Participants: Physicians and advanced practice providers providing care to SCD patients.

Main outcome measures: Respondents answered questions regarding their (1) views of telehealth compared to in-person encounters and (2) opioid prescribing practices during the early months of the pandemic.

Results: Of the 130 eligible participants, 53 respondents from 35 different sickle cell centers completed at least 90 percent of the survey. Respondents reported a significant increase in telehealth encounters for routine and acute appointments (mean difference and standard deviation: 57.6 ± 31.9 percent, p < 0.001 and 24.4 ± 34.1 percent, p < 0.001, respectively) since COVID-19. The overwhelming majority of respondents reported no changes in their opioid prescribing patterns since COVID-19, despite increased telehealth use. Only a minority coprescribed naloxone as a risk mitigation strategy.

Conclusion: The rapid uptake of telehealth has not suppressed ambulatory providers’ prescribing of opioids for SCD. Studies assessing the impact of the COVID-19 pandemic and telehealth on opioid prescribing practices in other painful chronic diseases are needed to ensure health equity for vulnerable pain patients.

Author Biographies

Martha O. Kenney, MD

Division of Pediatric Anesthesiology, Department of Anesthesiology, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina

Benjamin Becerra, DrPH; MBA, MPH, MS

Department of Information & Decision Sciences, Center for Health Equity, California State University, San Bernardino, California

Sean Alexander Beatty, BA

Blood Research Center, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina

Wally R. Smith, MD

Division of General Internal Medicine, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia

References

Wang D, Hu B, Hu C, et al.: Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020; 323(11): 1061-1069.

Kato GJ, Piel FB, Reid CD, et al.: Sickle cell disease. Nat Rev Dis Primers. 2018; 4: 18010.

Lee L, Smith-Whitley K, Banks S, et al.: Reducing health care disparities in sickle cell disease: A review. Public Health Rep. 2019; 134(6): 599-607.

Ruta NS, Ballas SK: The opioid drug epidemic and sickle cell disease: Guilt by association. Pain Med. 2016; 17(10): 1793-1798.

Power-Hays A, McGann PT: When actions speak louder than words—Racism and sickle cell disease. N Engl J Med. 2020; 383(20): 1902-1903.

Shapiro BS, Benjamin LJ, Payne R, et al.: Sickle cell-related pain: Perceptions of medical practitioners. J Pain Symptom Manage. 1997; 14(3): 168-174.

Labbé E, Herbert D, Haynes J: Physicians’ attitude and practices in sickle cell disease pain management. J Palliat Care. 2005; 21(4): 246-251.

Rudd RA, Seth P, David F, et al.: Increases in drug and opioid-involved overdose deaths—United States, 2010-2015. MMWR Morb Mortal Wkly Rep. 2016; 65(50-51): 1445-1452.

Dowell D, Haegerich TM, Chou R: CDC guideline for prescribing opioids for chronic pain—United States, 2016. MMWR Recomm Rep. 2016; 65(1): 1-49.

Buchanan ID, Woodward M, Reed GW: Opioid selection during sickle cell pain crisis and its impact on the development of acute chest syndrome. Pediatr Blood Cancer. 2005; 45(5): 716-724.

Brandow AM, Carroll CP, Creary S, et al.: American society of hematology 2020 guidelines for sickle cell disease: Management of acute and chronic pain. Blood Adv. 2020; 4(12): 2656-2701.

Ballas SK, Kanter J, Agodoa I, et al.: Opioid utilization patterns in United States individuals with sickle cell disease. Am J Hematol. 2018; 93(10): E345-E347.

Demeke HB, Pao LZ, Clark H, et al.: Telehealth practice among health centers during the COVID-19 pandemic—United States, July 11-17, 2020. MMWR Morb Mortal Wkly Rep. 2020; 69(50): 1902-1905.

Drug Enforcement Administration/Diversion Control Division: How to prescribe controlled substances to patients during the COVID-19 public health emergency. 2020. Available at https://www.deadiversion.usdoj.gov/GDP/(DEA-DC-023)(DEA075)Decision_Tree_(Final)_33120_2007.pdf. Accessed March 10, 2021.

Cohen SP, Baber ZB, Buvanendran A, et al.: Pain management best practices from multispecialty organizations during the COVID-19 pandemic and public health crises. Pain Med. 2020; 21(7): 1331-1346.

Joyce AA, Conger A, McCormick ZL, et al.: Changes in interventional pain physician decision-making, practice patterns, and mental health during the early phase of the SARS-CoV-2 global pandemic. Pain Med. 2020; 21(12): 3585-3595.

Day AL, Curtis JR: Opioid use in rheumatoid arthritis: Trends, efficacy, safety, and best practices. Curr Opin Rheumatol. 2019; 31(3): 264-270.

Niccum B, Moninuola O, Miller K, et al.: Opioid use among patients with inflammatory bowel disease: A systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2021; 19: 895-907.e4.

Madden N, Emeruwa UN, Friedman AM, et al.: Telehealth uptake into prenatal care and provider attitudes during the COVID-19 pandemic in New York city: A quantitative and qualitative analysis. Am J Perinatol. 2020; 37(10): 1005-1014.

Whiteman LN, Haywood C Jr, Lanzkron S, et al.: Primary care providers’ comfort levels in caring for patients with sickle cell disease. South Med J. 2015; 108(9): 531-536.

Harris PA, Taylor R, Thielke R, et al.: Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009; 42(2): 377-381.

Benjamini Y, Hochberg Y: On the adaptive control of the false discovery rate in multiple testing with independent statistics. J Educ Behav Stat. 2000; 25(1): 60-83.

Kauf TL, Coates TD, Huazhi L, et al.: The cost of health care for children and adults with sickle cell disease. Am J Hematol. 2009; 84(6): 323-327.

Grosse SD, Schechter MS, Kulkarni R, et al.: Models of comprehensive multidisciplinary care for individuals in the United States with genetic disorders. Pediatrics. 2009; 123(1): 407-412.

Lopez L 3rd, Hart LH 3rd, Katz MH: Racial and ethnic health disparities related to COVID-19. JAMA. 2021; 325(8): 719-729.

Smith WR, Penberthy LT, Bovbjerg VE, et al.: Daily assessment of pain in adults with sickle cell disease. Ann Intern Med. 2008; 148(2): 94-101.

Nguyen GC, LaVeist TA, Harris ML, et al.: Racial disparities in utilization of specialist care and medications in inflammatory bowel disease. Am J Gastroenterol. 2010; 105(10): 2202-2208.

Barton JL, Trupin L, Schillinger D, et al.: Racial and ethnic disparities in disease activity and function among persons with rheumatoid arthritis from university-affiliated clinics. Arthritis Care Res. 2011; 63(9): 1238-1246.

Painter EM, Ussery EN, Patel A, et al.: Demographic characteristics of persons vaccinated during the first month of the COVID-19 vaccination program—United States, December 14, 2020-January 14, 2021. MMWR Morb Mortal Wkly Rep. 2021; 70(5): 174-177.

Cunningham CT, Quan H, Hemmelgarn B, et al.: Exploring physician specialist response rates to web-based surveys. BMC Med Res Methodol. 2015; 15: 32.

Published

11/01/2021

How to Cite

Kenney, MD, M. O., B. Becerra, DrPH; MBA, MPH, MS, S. A. Beatty, BA, and W. R. Smith, MD. “Telehealth Acceptability and Opioid Prescribing Patterns of Providers of Painful Chronic Diseases During the COVID-19 Pandemic: A Survey of Sickle Cell Providers”. Journal of Opioid Management, vol. 17, no. 6, Nov. 2021, pp. 489-97, doi:10.5055/jom.2021.0683.