Partner engagement for planning and development of non-pharmacological care pathways in the AIM-Back trial.
Partner engagement for planning and development of non-pharmacological care pathways in the AIM-Back trial.
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DOI：
10.1177/17407745231178789
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发表时间：
2023-10
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中科院分区：
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嵌入式实用临床试验越来越多地被推荐用于非药物疼痛护理研究，因为它们侧重于检查现实世界环境中的干预效果。与患者、卫生保健提供者和其他合作伙伴的接触至关重要，但关于如何利用接触有意义地为在与疼痛有关的实用临床试验中测试的干预措施的设计提供信息的指导有限。本文旨在描述合作伙伴输入对设计两种干预措施（护理路径）的过程和影响，目前正在VA医疗保健系统的嵌入式实用试验中进行测试。采用序贯队列设计进行干预发展。2017年11月至2018年6月，共有25名参与者开展了参与活动。参与者包括来自多个群体的代表：临床医生、行政领导、患者和护理人员。合作伙伴的反馈导致了每个护理途径的一些变化，以改善患者体验和可用性。顺序护理途径的主要变化包括从基于电话的递送过渡到灵活的远程医疗模式，增加疼痛调节活动的特异性，减少物理治疗就诊。疼痛导航员路径的主要变化包括从传统的阶梯式护理模式转变为在反馈回路中提供护理的模式，增加疼痛导航员提供者类型的灵活性，以及增加患者出院标准的特异性。以患者体验为中心成为所有合作伙伴群体的一个关键考虑因素。在嵌入式实用试验中实施新的干预措施之前，考虑多样化的投入是很重要的。合作伙伴的参与可以提高患者和提供者对新的护理途径的接受程度，并加强卫生系统对有效干预措施的吸收。
Embedded pragmatic clinical trials are increasingly recommended for non-pharmacological pain care research due to their focus on examining intervention effectiveness within real-world settings. Engagement with patients, health care providers and other partners is essential, yet there is limited guidance for how to use engagement to meaningfully inform the design of interventions to be tested in pain-related pragmatic clinical trials. This manuscript aims to describe the process and impacts of partner input on the design of two interventions (care pathways) for low back pain currently being tested in an embedded pragmatic trial in the VA healthcare system. Sequential cohort design for intervention development was followed. Engagement activities were conducted with 25 participants between November 2017 and June 2018. Participants included representatives from multiple groups: clinicians, administrative leadership, patients, and caregivers. Partner feedback led to several changes in each of the care pathways to improve patient experience and usability. Major changes to the sequenced care pathway included transitioning from telephone-based delivery to a flexible telehealth model, increased specificity about pain modulation activities, and reduction of physical therapy visits. Major changes to the pain navigator pathway included transitioning from a traditional stepped care model to one that offers care in a feedback loop, increased flexibility regarding pain navigator provider type, and increased specificity for patient discharge criteria. Centering patient experience emerged as a key consideration from all partner groups. Diverse input is important to consider before implementing new interventions in embedded pragmatic trials. Partner engagement can increase acceptability of new care pathways to patients and providers and enhance uptake of effective interventions by health systems.
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影响因子：
2.1
作者：
Esmail, Laura;Moore, Emily;Rein, Alison
通讯作者：
Rein, Alison
影响因子：
--
作者：
Dy, Tiffany;Hamilton, Winifred J;Kramer, C Bradley;Apter, Andrea;Krishnan, Jerry A;Stout, James W;Teach, Stephen J;Federman, Alex;Elder, John;Bryant-Stephens, Tyra;Bruhl, Rebecca J;Jackson, Shawni;Sumino, Kaharu
通讯作者：
Sumino, Kaharu
影响因子：
3.1
作者：
Seal, Karen H.;Becker, William C.;McCamish, Nicole
通讯作者：
McCamish, Nicole
影响因子：
7.2
作者：
Gale, Randall C.;Wu, Justina;Midboe, Amanda M.
通讯作者：
Midboe, Amanda M.
影响因子：
2.9
作者：
Duncan，Edward;O'Cathain，Alicia;Hoddinott，Pat
通讯作者：
Hoddinott，Pat