Nonpharmacologic Pain Management in FQHC primary care clinics

项目摘要 慢性疼痛是一个普遍存在的问题，并日益受到社会的关注，这对正在进行的 阿片类药物流行病背痛是最常见的慢性疼痛诊断和最常见的诊断为 哪些阿片类药物是处方药临床实践指南和阿片类药物处方建议使其 显然，对于背痛患者，非药物性疼痛治疗优于阿片类药物。尽管 明确的证据表明，对背痛患者过度使用阿片类药物的情况仍然存在。初级保健提供者 服务农村和低收入社区面临着提供非药物疼痛护理的特殊挑战 而不是过度依赖阿片类药物非药物治疗的提供者往往缺席这些 社区，即使存在，也可能是经济资源有限的患者无法进入的。许多农村 和低收入社区由联邦合格的卫生中心（CIMCs）提供服务。HHCs通常用于 社区处于阿片类药物危机的最前沿，但往往缺乏提供可获得的选择 非药物替代品，他们所服务的病人。 该项目描述了一个为期1年的规划阶段，然后是一个为期4年的临床试验，该试验将比较 不同策略对背部疾病患者提供有效非药物干预的有效性 在整个犹他州，评估的战略旨在克服 农村和低收入社区特有的障碍， 远程保健资源。随机临床试验将评估两种干预策略，一种提供两种 一个简短的疼痛远程咨询与基于电话的物理治疗，另一个使用自适应策略-提供 首先进行简短的疼痛远程咨询，然后在对这种治疗无反应的人中进行基于电话的物理治疗。 治疗我们还将评估与在2010年在联合国艾滋病毒/艾滋病联合方案诊所实施战略的努力有关的结果。 以便为今后努力将有效战略扩展到其他低资源领域提供有价值的信息， 卫生保健机构。我们的临床试验有4个具体目的：1）比较疼痛远程会诊的有效性 对慢性背痛患者进行基于电话或不基于电话的物理治疗的干预，2） 比较不同的2阶段治疗策略的有效性，其中基于电话的物理治疗是 3）在预先规定的子项目中检查目标1和2的结果， 基于基线特征的患者组，以及4）检查疼痛的实施结果 包括可接受性、采用性、可行性和忠实性。

PROJECT SUMMARY Chronic pain is a ubiquitous problem and growing concern for society, contributing substantially to the ongoing opioid epidemic. Back pain is the most common chronic pain diagnosis and the most common diagnosis for which opioids are prescribed. Clinical practice guidelines and opioid-prescribing recommendations make it clear that nonpharmacologic pain treatments are preferable to opioids for patients with back pain. Despite unequivocal evidence, over-prescribing of opioids to individuals with back pain persists. Primary care providers serving rural and low income communities face specific challenges to providing nonpharmacologic pain care instead of over-reliance on opioids. Providers of nonpharmacologic care are often absent from these communities and even if present may be inaccessible to patients with limited financial resources. Many rural and low income communities are served by federally-qualified health centers (FQHCs). FQHCs often serve communities at the forefront of the opioid crisis but too often lack options to provide accessible nonpharmacologic alternatives to the patients they serve. This Project describes a 1-year planning phase followed by a 4-year clinical trial that will compare the effectiveness of different strategies to provide efficacious nonpharmacologic interventions to patients with back pain seeking care in FQHCs throughout the state of Utah. The strategies evaluated are designed to overcome the barriers specific to rural and low income communities served by FQHC clinics through innovative use of telehealth resources. The randomized clinical trial will evaluate two interventions strategies, one providing both a brief pain teleconsult with phone-based physical therapy, the other uses an adaptive strategy – providing the brief pain teleconsult first, followed by phone-based physical therapy among those non-responsive to this treatment. We will also evaluate outcomes related to the efforts to implement strategies in FQHC clinics in order to provide valuable information for future efforts to scale effective strategies into other low resource health care settings. Our clinical trial has 4 Specific Aims: 1) compare the effectiveness of a pain teleconsult intervention with or without phone-based physical therapy for patients with chronic back pain in FQHCs, 2) compare the effectiveness of different 2-phase treatment strategies in which phone-based physical therapy is considered either a first-line or second-line option, 3) examine the results for Aims 1 & 2 in pre-specified sub- groups of patients based on baseline characteristics, and 4) examine implementation outcomes of the pain teleconsult including acceptability, adoption, feasibility and fidelity.