The Military Health System (MHS) https://health.mil is continuing to address the national challenges in dealing with pain management and prescription medications by working on the implementation of a comprehensive pain management policy within the Department of Defense.
Today, improved coordination and collaboration exists across the Military Departments, Defense Health Agency (DHA) and the Uniformed Services’ University of the Health Sciences (USUHS).
Some of the MHS pain strategy and initiatives include:
- Implementing the Stepped Care Model of Pain Management to ensure that the appropriate level of pain care is available and delivered to patients throughout the continuum of acute and chronic pain
- Increasing the use of pain telehealth integration into MHS primary care by both direct care visits and provider webinar case-based education
- Expanding pilot in-home telehealth visits to transitioning and rural service members and beneficiaries
MHS has also taken several actions to determine effectiveness and the overuse of prescription pain medications. One measure involves the development and deployment of the Pain Assessment Screening Tool and Outcomes Registry (PASTOR).
PASTOR, a 20-30 minute patient survey produces a comprehensive three page clinician report on a specific patient’s chronic pain. The Defense Health Agency (DHA) enabled PASTOR to be used at all Military Treatment Facilities (MTF) with priority for PASTOR training and implementation to be available through MTF’s with designated pain management specialty clinics. As of August 2021, staff at 20 MTF pain management specialty clinics use PASTOR with DHA continuing to train providers on using PASTOR at the 11 remaining MTFs.
Military providers also use MOTION, which is a musculoskeletal research initiative to gain consent to use patient survey data and then link detailed surgical reporting with patient outcomes. MOTION has evolved into an enterprise patient outcomes and data collection solution for all MHS musculoskeletal communities.
MOTION and PASTOR clinics collect Patient-Reported Outcomes Measurement Information System (PROMIS), and Defense and Veterans Pain Rating Scale Outcomes to enable longitudinal assessment of patients as they move among primary, secondary, and tertiary care. As of August 2021, patient have completed over 194,000 MOTION surveys.
The Military has established Patient-Centered Medical Homes (PCMH) with support from full time integrated behavioral health consultants and Primary Care Pain Champions (PCPC).
The consultants working in PCMHs support patients and their primary care managers in implementing pain management care, particularly through education and encouraging on-pharmacological approaches to pain control and symptom management to limit opioid use.
In conjunction with MHS’ expansion of the PCMH model, pain programs along with the Defense and Veterans Center for Integrative Pain Management (DVCIPM), it is now possible to provide the necessary clinical, education, and training support for pain management in primary care.