Table 1 Results of the needs assessments conducted for implementation mapping step 1 across groups (CHC, community health center; EHR, electronic health record)
Group | Assessment method | Facilitators | Barriers |
|---|---|---|---|
CHC leadership and providers | Sociotechnical group interviews with CHC organizations conducted remotely | Supportive of providing nonpharmacological pain management options Recognition of the impact of the opioid epidemic within community being served Availability of service in English or Spanish to accommodate patients Ability to receive feedback on persons referred from the BeatPain team | Time constraints and competing demands during patient care Limited understanding of clinic staff about EHR capabilities and how to send e-referrals Staffing shortages, COVID restrictions, and turnover make consistent work flows challenging Lack of a systematic process for managing patients with chronic LBP |
Patients | Individual zoom interviews with CHC patients with chronic back pain | All patients had smart phones and Internet access Patients trusted CHC clinics and providers Most patients did not perceive language or culture as barriers to care provided by CHCs | Concerns about treatment access due to costs Most had not heard of telehealth physical therapy and were not certain it would help Preference for passive pain care (rest, medication, etc.) |
Physical therapists | Group discussions with physical therapists | Strong commitment to reducing pain management disparities and provide an accessible, nonpharmacologic pain management option Prior experience providing care in low-income and Spanish-speaking communities Availability of team members with Spanish language skills and cultural background | Limited experience or training to provide treatments using telehealth Inexperienced providing care using audio-only telehealth delivery with no video access Concerns about the ability to engage and motivate patients and provide effective exercise instruction via telehealth |