COVID-19 Impact on Pain management: Highlighting, Explaining, and Realigning services (CIPHER)

COVID-19 对疼痛管理的影响：突出显示、解释和重新调整服务 (CIPHER)

• 批准号: 10595645
• 负责人: Marianne Matthias
• 金额: --
• 依托单位: RLR VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10595645
• 关键词: Address; Administrator; Affect; Appointment; Area; COVID-19; COVID-19 impact; COVID-19 pandemic; COVID-19 pandemic effects; Caring; Characteristics; Chronic Care; Chronic low back pain; Data; Data Collection; Diagnosis; Ensure; Environment; Equity; Event; Funding; Future; Goals; Guidelines; Health Services Accessibility; Healthcare; Height; Interruption; Interview; Light; Low Back Pain; Methodology; Methods; Modality; Office Management; Opioid; Opioid Analgesics; Outcome; Pain; Pain management; Participant; Patients; Pattern; Persons; Pharmaceutical Preparations; Phase; Physical therapy; Policies; Publishing; Race; Recommendation; Reporting; Research; Retrospective cohort; Safety; Sampling; Services; Site; Surveys; Telephone; Testing; Time; Veterans; Visit; Work; care delivery; chiropracty; chronic pain; chronic pain management; chronic painful condition; data warehouse; design; disability; effective therapy; evidence base; experience; health care delivery; implementation strategy; innovation; interest; multimodality; opioid epidemic; opioid use disorder; pandemic disease; post-COVID-19; prescription opioid; public health emergency; response; satisfaction; service delivery; telehealth; virtual delivery; virtual healthcare; virtual visit

Background: The COVID-19 pandemic severely disrupted healthcare. These changes are likely to have especially profound implications for Veterans obtaining regular care for chronic conditions, such as chronic pain—particularly when Veterans are obtaining nonpharmacologic treatments, which often require regular, in- person visits. Although virtual care delivery in VA increased dramatically in response to the pandemic and is unlikely to diminish, it is unclear what services Veterans with pain have received via virtual delivery and how Veterans have been affected by these shifts. The goal of this project is to understand changes in VA chronic pain care after COVID-19 and their associated impacts—and use these data to develop strategies to optimize delivery of VA pain services in a post-COVID-19 environment. Significance: This project addresses priorities in HSR&D's Targeted Solicitation on Opioid Safety and Opioid Use Disorder. Specifically, this project is responsive to priority area E, “examination of the impact of the COVID-19 public health emergency on the effective treatment of chronic pain, including effects on access to care, medication and treatment modalities, patient function and satisfaction.” Despite the clear impact on care delivery exerted by the COVID-19 pandemic, little is known about how these changes and disruptions have affected Veterans and their chronic pain care, including their ability to access care after the onset of the pandemic. These concerns are reflected in our pilot data, which indicate that Veterans have felt the impact of service disruptions on their pain management. Innovation and Impact: The effects of the COVID-19 pandemic are not yet well-understood. This project takes a mixed-methods approach to examine changes in chronic pain care since the onset of the pandemic, working with an expert stakeholder panel at each stage of the research to ensure results and recommendations are disseminated rapidly to maximize impact. Specific Aims: Aim 1 (quantitative): Describe changes in pain management visits for Veterans with chronic low- back pain (cLBP) following the onset of the COVID-19 pandemic. Aim 2 (qualitative): Explain differential patterns of receipt of services identified in Aim 1 and perceived impacts. Aim 3: Share findings throughout the project, including final, integrated findings from Aims 1 and 2, and develop short- and long-term strategies to optimize delivery of pain care for Veterans in a post-COVID-19 environment. Methodology: This study uses an embedded mixed-methods design. In Aim 1 a retrospective cohort of Veterans receiving care for cLBP will be established. Receipt of guideline-recommended, nonpharmacological pain management services, including changes in service receipt following the onset of COVID-19, will be examined. Veteran and facility factors associated with differential changes will be tested. Once the first phase of Aim 1 analyses is complete, qualitative sampling for Aim 2 will begin. Thus, consistent with an embedded design, most Aim 1 and Aim 2 activities will take place concurrently. Qualitative interviews with clinicians, administrators, and Veterans will be conducted to better understand how they experienced pandemic-related changes, including any effects on their current practice/service delivery, and to identify positive changes made since the pandemic that could serve as examples for other facilities. In Aim 3 we will work with our stakeholder advisory panel, led by the VA Office of Pain Management, to develop comprehensive recommendations to guide VA on policies to optimize delivery of pain management services in a post-COVID-19 environment. Next Steps: Findings will be directly applied to VA care, as directed by the CIPHER stakeholder panel (led by the VA National Pain Management Office). Future research will examine implementation strategies aimed at supporting VA-wide implementation.

背景：COVID-19大流行严重扰乱了医疗保健。这些变化很可能 特别是对退伍军人获得定期护理的慢性疾病，如慢性 疼痛，特别是当退伍军人正在获得非药物治疗，这往往需要定期， 人访问。尽管VA的虚拟护理服务在应对大流行时急剧增加， 不太可能减少，目前还不清楚有痛苦的退伍军人通过虚拟交付获得了什么服务，以及如何获得 退伍军人受到这些变化的影响。本项目的目标是了解VA慢性 COVID-19后的疼痛护理及其相关影响，并使用这些数据制定策略， 在后COVID-19环境中提供VA疼痛服务。 意义：该项目解决了HSR&D关于阿片类药物安全性和阿片类药物的有针对性征集的优先事项 使用Disorder。具体而言，该项目是对优先领域E“审查 2019冠状病毒病突发公共卫生事件对慢性疼痛有效治疗的影响，包括对获得 护理、药物和治疗方式、患者功能和满意度。”尽管对医疗保健有明显的影响， 由于COVID-19大流行所带来的影响，人们对这些变化和中断如何影响 受影响的退伍军人及其慢性疼痛护理，包括他们在发病后获得护理的能力。 流行病这些担忧反映在我们的试点数据中，这些数据表明退伍军人已经感受到了 服务中断对他们的痛苦管理。 创新及影响：COVID-19疫情的影响尚未得到充分了解。本项目以 一种混合方法的方法来检查慢性疼痛护理的变化，因为大流行病的开始，工作 在研究的每个阶段都有一个专家利益相关者小组，以确保结果和建议 迅速传播，以最大限度地发挥影响。 具体目标：目标1（定量）：描述慢性低血糖退伍军人疼痛管理访视的变化。 2019冠状病毒病大流行后的背痛（cLBP）。目标2（定性）：解释差异 目标1中确定的服务接受模式和预期影响。目标3：在整个会议期间分享调查结果 项目，包括目标1和2的最后综合结论，并制定短期和长期战略， 在后COVID-19环境中优化退伍军人的疼痛护理。 方法：本研究采用嵌入式混合方法设计。在Aim 1中， 将建立接受cLBP护理的退伍军人。接受指南推荐的非药物治疗 疼痛管理服务，包括COVID-19爆发后服务收据的变化，将 考察将测试与差异变化相关的退伍军人和设施因素。一旦第一阶段 目标1分析完成后，目标2的定性取样将开始。因此，与嵌入式 在设计过程中，目标1和目标2的大多数活动将同时进行。与临床医生的定性访谈， 管理人员和退伍军人将进行，以更好地了解他们如何经历与流行病有关的 变化，包括对其当前做法/服务提供的任何影响，并确定所做的积极变化 自大流行以来，这可以为其他设施提供榜样。在目标3中，我们将与利益相关者合作 由VA疼痛管理办公室领导的咨询小组，制定全面的建议， 指导退伍军人事务部在COVID-19后环境中优化疼痛管理服务交付的政策。 下一步：调查结果将直接应用于VA护理，由CIPHER利益相关者小组（由 国家疼痛管理办公室（National Pain Management Office）今后的研究将审查旨在 支持全VA的实施。