Group-based Integrative Pain Management: A multi-level approach to address intersectional stigma and social isolation in diverse primary care safety net patients with chronic pain

基于群体的综合疼痛管理：一种多层次的方法，用于解决患有慢性疼痛的不同初级保健安全网患者的交叉耻辱和社会隔离问题

• 批准号: 10539166
• 负责人: MARIA T CHAO
• 金额: $ 162.9万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-12 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10539166
• 关键词: Acupuncture Therapy; Address; Behavioral; COVID-19 pandemic; Caring; Clinic; Clinical; Data; Discrimination; Education; Empathy; Feeling; Guidelines; High Prevalence; Individual; Integrative Medicine; Intervention; Intervention Studies; Knowledge; Length; Link; Loneliness; Low Income Population; Low income; Mediating; Mediator of activation protein; Medical; Meditation; Mental Depression; Methods; Mind-Body Intervention; Modeling; Neighborhoods; Nonpharmacologic Therapy; Outcome; Pain; Pain Measurement; Pain intensity; Pain interference; Pain management; Pain quality; Participant; Patients; Personal Communication; Persons; Phase; Physical Function; Preparation; Primary Health Care; Procedures; Process; Protocols documentation; Provider; Public Health; Qualitative Methods; Quasi-experiment; Randomized; Reporting; Research; Research Personnel; Resource-limited setting; Resources; San Francisco; Self Efficacy; Social isolation; Social support; Standardization; Stigmatization; Structure; Testing; Time; Urban Health; Visit; Vulnerable Populations; Yoga; base; biopsychosocial; care seeking; chronic pain; chronic pain patient; clinical care; disadvantaged population; effective intervention; ethnic diversity; evidence base; experience; health equity; improved; individualized medicine; internalized stigma; intervention effect; member; multimodality; opioid mortality; opioid overuse; pain model; pain outcome; pain relief; post intervention; prescription opioid; primary care setting; primary outcome; programs; racial diversity; racism; recruit; safety net; secondary outcome; social; social factors; social health determinants; social stigma; socioeconomic disadvantage; socioeconomics; theories; treatment as usual

PROJECT ABSTRACT Background: The proposed study seeks to address chronic pain disparities in racially diverse, socioeconomically disadvantaged individuals by optimizing multimodal pain management provided in primary care safety net clinics. Multilevel barriers exist in primary care settings where socioeconomically disadvantaged patients are most often treated. Lack of access to multimodal and nonpharmacologic care at the organizational level, and provider bias and other forms of discrimination at the interpersonal level contribute to unequal assessment, treatment, and quality of pain care. Stigmatization cross-cuts all levels and is closely linked with social isolation common among individuals with chronic pain. Group-based models are a promising multilevel approach to increase access to non-pharmacologic therapies, address time constraints that contribute to disparities in pain care, improve interpersonal communication, and provide social support among safety net patients with chronic pain. Methods: This study uses mixed methods and a pragmatic 2x2 randomized factorial trial to test two group-based models: integrative group medical visits (IGMV) and group acupuncture. The study tests the hypotheses that compared with usual care, each study intervention improves pain interference and social isolation (primary outcomes), and that the two combined have synergistic effects mediated by increased social support and decreased impact of intersectional stigma among safety net patients with chronic pain. Study interventions include 12 weekly sessions based on existing protocols tested in primary care safety net settings. IGMV includes pain education, social and behavioral support, and mind-body approaches (meditation, yoga). Group acupuncture uses responsive manualization, allowing for a standardized yet individualized treatment. During the R61 phase, a panel of national experts and patient stakeholders will refine and optimize the structure, process, and content of IGMV aimed at reducing social isolation and intersectional stigma as part of pain management. Interventions will be piloted in 40 English or Spanish speaking patients with chronic pain at two primary care safety net clinics. Study procedures will be tested and adapted for a larger scale trial. In the R33 phase, 360 participants will be recruited from two safety net clinics and randomized to IGMV, group acupuncture, both, or neither. Aim 1 is to determine the effects of study interventions on pain-related outcomes (primary outcomes: pain interference and social isolation). Aim 2 tests social support and stigma as intervention mediators. Aim 3 examines patient experiences with pain management, patient-clinician relationships, and clinical care in primary care safety net settings using qualitative methods. Significance: Multilevel approaches are need to advance health equity in pain management. The proposed study will contribute to knowledge of group-based integrative pain management co-located in primary care to address disparities in pain care for socioeconomically vulnerable populations.

项目摘要 背景：这项拟议的研究旨在解决种族多样性中的慢性疼痛差异， 社会经济上处于不利地位的个人通过优化多模式疼痛管理提供的初级 护理安全网诊所。在社会经济条件不利的初级保健环境中存在多层次的障碍 患者最常接受治疗。缺乏获得多模式和非药物治疗的机会， 提供者的偏见和其他形式的人际歧视助长了不平等现象。 疼痛评估、治疗和护理质量。污名化问题贯穿所有层面，与下列因素密切相关： 慢性疼痛患者中常见的社交孤立。基于组的模型是一种很有前途的多层次 增加获得非药物治疗的机会的方法，解决有助于 差异的疼痛护理，改善人际沟通，并提供社会支持之间的安全网 慢性疼痛患者。方法：本研究采用混合方法和实用的2x2随机 析因试验测试两种基于组的模型：综合团体医疗就诊（IGMV）和团体针灸。 该研究测试了与常规护理相比，每种研究干预措施都能改善疼痛的假设 干扰和社会孤立（主要结果），两者结合具有协同效应 通过增加社会支持和减少安全网患者之间交叉污名的影响来介导 慢性疼痛。研究干预包括12个每周一次的会议，基于在初级 护理安全网设置。IGMV包括疼痛教育，社会和行为支持，以及身心 方法（冥想，瑜伽）。团体针灸使用响应手动化，允许标准化 还需要个体化治疗。在R61阶段，一个由国家专家和患者利益相关者组成的小组将 完善和优化IGMV的结构、流程和内容，以减少社会隔离， 作为疼痛管理的一部分。干预措施将以40种英语或西班牙语进行试点 在两个基层医疗安全网诊所为慢性疼痛患者发表演讲。将对研究程序进行检测， 适合更大规模的试验在R33阶段，将从两个安全网诊所招募360名参与者 并随机分为IGMV组、针刺组、两组或两组均不治疗。目的1是确定研究的效果 对疼痛相关结局的干预（主要结局：疼痛干预和社会隔离）。Aim 2测试 社会支持和耻辱作为干预调解人。目标3检查患者的疼痛体验 管理，患者-临床医生关系，并在初级保健安全网设置使用临床护理 定性方法。意义：需要多层次的方法来促进疼痛的健康公平 管理这项研究将有助于了解基于小组的综合疼痛管理 在初级保健中合用同一地点，以解决社会经济弱势群体在疼痛护理方面的差异。