Evaluating Feasibility and Acceptability of a Telehealth Integrative Pain Management Program Among Primary Care Safety-Net Patients.

Background: The COVID-19 pandemic exacerbated pain care inequities for low-income people. The Telehealth Integrative Pain Management Program (t-IPMP) was developed to provide pain management services for patients in public health clinics of the San Francisco Health Network (SFHN). Adapted from an existing program, t-IPMP delivered multimodal pain treatment via telehealth groups when in-person healthcare was restricted.

Objective: This mixed-methods study evaluates the feasibility and acceptability of t-IPMP.

Methods: We conducted a single-arm evaluation of three cohorts of t-IPMP, comprising 12 two-hour weekly online sessions on pain education, mindfulness, therapeutic movement, and self-acupressure. Participants were adults with chronic pain referred by SFHN primary care providers. We conducted baseline surveys, three-month surveys, and qualitative interviews (n = 15); participant observation of three sessions per cohort; and 3 focus groups (n = 20). Mixed-methods analysis included descriptive statistics, pre/post comparisons using t-tests, and codebook thematic analysis.

Results: The t-IPMP received 107 referrals from 52 providers at 11 clinics, and 35% of referrals enrolled. Participants (n = 37) attended an average of 6 sessions. Participants who completed surveys (n = 15) were majority cisgender women (67%) with below-average wealth (87%) from diverse racial and ethnic identities. Qualitative data highlighted that t-IPMP created a supportive environment which fostered social connection and reduced social isolation. Social support encouraged use of new mind-body practices for pain. Telehealth was well received, though some participants preferred in-person interaction. From baseline to three-month follow up, average scores increased on measures of physical function (mean = 1.9, 95% CI 0.2-3.6); global quality of life (mean = 3.8, 95% CI 1.6-6.0); and pain self-efficacy (mean = 5.3, 95% CI 0.9-9.7).

Conclusion: Integrative, multimodal pain management delivered through telehealth groups is feasible among primary care safety net patients, however, may not be optimal for all. Findings indicate that offering options for participating either online or in-person may best address patient needs and preferences.