In only a matter of months, COVID-19 has shaken up health care in the United States, albeit perhaps temporarily. Restrictions on telemedicine have been lifted. Some medication-assisted treatment prescribing rules have been waived. In some states, physician assistants (PAs) and nurse practitioners (NPs) can practice without oversight.
“It’s been a shift in operations, a challenging time,” said Jeremy Adler, DMSc, PA-C, a pain management PA, and the chief operations officer and partner at Pacific Pain Medicine, in Encinitas, Calif. “There’s been a lot of benefits and definitely some challenges.”
During a session titled “On the Front Lines: How Advanced Practice Providers Are Managing Pain Admidst COVID-19,” presented at the PAINWeek 2020 Live Virtual Conference, Adler, along with Theresa Mallick-Searle, MS, RN-BC, ANP-BC, spoke about the challenges with insight from their own recent experiences in managing telehealth visits, medication prescribing and interdisciplinary pain management during the pandemic.
As a variety of states have suspended or modified NP and PA regulations during the pandemic, providers should keep themselves up-to-date on the legislation or executive orders applicable to their locality, explained Adler, who is also a Pain Medicine News editorial advisory board member.
That’s true for federal standards, too. Prescribing requirements for Schedule II to IV drugs have been altered, and there are tools available to navigate the changes, such as the Drug Enforcement Administration’s prescribing decision charts. States have also made prescribing changes, with some now allowing Schedule III and IV drugs to have early refills, he said.
When prescribing or ordering refills, providers should keep in mind how long it may take for the medications to be delivered, Adler said. Patients may need to allow for shipping, local shortages, or other supply issues. If supply problems become prevalent, patients should be educated on opioid withdrawal strategies.
Nonpharmacologic pain management also can be offered during the pandemic through virtual means. Smartphone apps now offer guidance on meditation, physical therapy and exercise, and nutrition. With technology, patients should be advised to keep to a schedule and set achievable goals. Providers can act as a support system, problem-solving with the patient to reach their goals, setting function, and quality of life as priorities.
This support can be accomplished through telehealth. In some cases, patients may even be able to get a little more out of the virtual visit.
“We’ve expanded our technology so that we can have two or three different clinicians on a visit,” said Mallick-Searle, an adult NP in the Division of Pain Medicine at Stanford Health Care, in Redwood City, Calif. “That’s been really handy, particularly with the non-English speakers.”
Transitioning to telehealth has not always been easy, both Mallick-Searle and Adler agreed, but small changes have benefited their practices. Make sure the patient has a photo ID at the time of the video call, Mallick-Searle advised, and follow the professional standards that providers would have in an in-person visit, such as punctuality, professional dress and background, and eye contact.
Support staff was hired at Adler’s practice to help facilitate patients learning the new virtual systems. “I think that the barrier has been bringing patients along, trying to get them technologically sophisticated enough to do it,” Adler said. “But I’m happy to say that the majority of our patients have figured it out.”
Newly tech-savvy patients are finding other quality-of-life benefits, he noted.
“Some of the patients—especially some of our older patients who are not as familiar with technology—have found that through the instruction that they’ve learned from us, they’ve been able to apply it in their personal lives, and I’ve been able to use it to engage with their families and friends and stay connected.
“They have thanked us really for introducing [technology] not only for health care but it’s expanded beyond [health care].”