Pre-implementation formative evaluation of cooperative pain education and self-management expanding treatment for real-world access: A pragmatic pain trial.
Pre-implementation formative evaluation of cooperative pain education and self-management expanding treatment for real-world access: A pragmatic pain trial.
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合作疼痛教育和自我管理扩展治疗以实现现实世界的实施前形成性评估：一项务实的疼痛试验。
DOI：
10.1111/papr.13195
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Heapy,AliciaA
中科院分区：
文献类型：
--
作者：
Mattocks,KristinM;LaChappelle,KathrynM;Krein,SarahL;DeBar,LynnL;Martino,Steve;Edmond,Sara;Ankawi,Brett;MacLean,RRoss;Higgins,DianaM;Murphy,JenniferL;Cooper,Emily;Heapy,AliciaA
慢性疼痛认知行为疗法(CBT-CP)是一种改善慢性疼痛患者功能和疼痛强度的循证治疗方法，具有广泛的有效性。然而，关于CBT-CP成功实施和应用的相关因素，特别是临床医生和系统水平的因素，研究相对较少。这项形成性评估从CBT-CP临床医生和参考初级保健临床医生的角度考察了CBT-CP成功实施和采用的障碍和促进者。方法在实施研究综合框架的指导下，在9个地理位置不同的退伍军人事务部站点进行了定性访谈，作为务实临床试验的一部分，比较了同步的、临床医生提供的CBT-CP和远程提供的、技术辅助的CBT-CP。结果2019年4月至2020年8月，来自9个退伍军人医学中心的26名临床医生(CBT-CP临床医生17名，初级保健临床医生9名)通过电话进行了个别定性访谈。在定性访谈中出现了四个主题：(1)跨地点转诊路径的复杂性和变异性，(2)临床医生对CBT-CP缺乏了解，(3)临床医生难以找到合适的CBT-CP候选人，(4)倾向于在家中完成干预。结论这项形成性评估确定了CBT-CP广泛实施的临床医生和系统障碍，并为后续两种形式CBT-CP的实施提供了改进。确定两种形式的CBT-CP在障碍和促进者方面的相对差异，可能会在评估治疗在现实世界环境中的效果的务实试验中更加清楚地出现，并可能为指导未来的全系统执行工作提供重要信息。
ObjectiveCognitive behavioral therapy for chronic pain (CBT‐CP) is an evidence‐based treatment for improving functioning and pain intensity for people with chronic pain with extensive evidence of effectiveness. However, there has been relatively little investigation of the factors associated with successful implementation and uptake of CBT‐CP, particularly clinician and system level factors. This formative evaluation examined barriers and facilitators to the successful implementation and uptake of CBT‐CP from the perspective of CBT‐CP clinicians and referring primary care clinicians.MethodsQualitative interviews guided by the Consolidated Framework for Implementation Research were conducted at nine geographically diverse Veterans Affairs sites as part of a pragmatic clinical trial comparing synchronous, clinician‐delivered CBT‐CP and remotely delivered, technology‐assisted CBT‐CP. Analysis was informed by a grounded theory approach.ResultsTwenty‐six clinicians (CBT‐CP clinicians = 17, primary care clinicians = 9) from nine VA medical centers participated in individual qualitative interviews conducted by telephone from April 2019 to August 2020. Four themes emerged in the qualitative interviews: (1) the complexity and variability of referral pathways across sites, (2) referring clinician's lack of knowledge about CBT‐CP, (3) referring clinician's difficulty identifying suitable candidates for CBT‐CP, and (4) preference for interventions that can be completed from home.ConclusionsThis formative evaluation identified clinician and system barriers to widespread implementation of CBT‐CP and allowed for refinement of the subsequent implementation of two forms of CBT‐CP in an ongoing pragmatic trial. Identification of relative difference in barriers and facilitators in the two forms of CBT‐CP may emerge more clearly in a pragmatic trial that evaluates how treatments perform in real‐world settings and may provide important information to guide future system‐wide implementation efforts.
非洲爪蟾 U2 基因启动子内的增强子样序列促进稳定转录复合物的形成
影响因子：
64.8
作者：
I. Mattaj;S. Lienhard;J. Jiricny;E. D. Robertis
通讯作者：
E. D. Robertis