Telehealth program to manage pain and reduce opioid use in Veterans after surgery

Reducing Chronic Opioid Use Among Veterans Undergoing Community Care Surgery Using a Transitional Pain Service

This study is testing a telehealth program to help Veterans manage pain and lower their use of opioids after orthopedic surgery.

Quick facts

• Phase: Not applicable
• Study type: Interventional
• Enrollment: 400 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: VA Office of Research and Development (Federal)
• Locations: 1 site (Salt Lake City, Utah)
• Trial ID: NCT06223503 on ClinicalTrials.gov

What this trial studies

This study evaluates the effectiveness of a telehealth Transitional Pain Service (TPS) for Veterans undergoing orthopedic surgery through the Community Care Program. It aims to reduce chronic opioid use by providing comprehensive nurse care coordination before, during, and after surgery. Veterans will be randomized to receive either the TPS intervention or standard care, with their pain management and opioid use monitored throughout the process. The study seeks to establish whether this innovative approach can improve outcomes for at-risk surgical patients.

Who should consider this trial

Good fit: Ideal candidates are Veterans referred for orthopedic surgery through the Community Care Program who are not on chronic opioids at the time of surgery.

Not a fit: Patients scheduled for other types of surgeries or those already on chronic opioid therapy prior to surgery may not benefit from this study.

Why it matters

Potential benefit: If successful, this program could significantly reduce chronic opioid use and improve recovery outcomes for Veterans after surgery.

How similar studies have performed: Previous studies have shown that multidisciplinary approaches like TPS can effectively reduce chronic opioid use, suggesting potential success for this telehealth adaptation.

Eligibility criteria

Inclusion Criteria:

Aims 1 \& 3:

* The investigators will include Veterans who are referred to the Veteran Community Care Program (VCCP) for an orthopedic surgery procedure from any VA medical center throughout VISN-19.
* Additionally, these Veterans must be 18+ years of age who are not on chronic opioids at the time of surgery, and who have a VA primary care provider (PCP).

Aim 2:

* Veterans who received TPS (Aim 1) and referring VA Primary Care Providers.

Exclusion Criteria:

Aim 1:

* The investigators will exclude Veterans who are scheduled for other types of surgical procedures, are on chronic opioid therapy before surgery, are on hospice or end-of-life care, are cognitively impaired, or unable to complete the follow-up visits for any other reason.

Aim 2:

* The investigators will exclude Veterans not randomized to the TPS Telehealth intervention of Aim 1.

  * Primary Care Providers will be excluded if they do not primarily work at the VA.

Aim 3:

* The investigators will exclude Veterans who were not randomized to the TPS Telehealth intervention.
* Veterans who experienced a major complication during the perioperative period or experienced an extended length of stay (LOS) based on exceeding the upper interquartile range of median LOS.
* Exclusion criteria for this aim also include patients on hospice care, individuals discharged to a care facility, and those with scheduled readmissions for follow up procedure(s) within 90-days.

Where this trial is running

Salt Lake City, Utah

• VA Salt Lake City Health Care System, Salt Lake City, UT — Salt Lake City, Utah, United States (Recruiting)

Study contacts

• Principal investigator: Benjamin S Brooke, MD PhD — VA Salt Lake City Health Care System, Salt Lake City, UT
• Study coordinator: Benjamin S Brooke, MD PhD

Conditions Chronic Opioid Use; Post-operative pain; Opioid use disorder; Opioid misuse; MISSION Act; Community Care; Transitional Care Coordination