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。这些变化很可能会带来 对于退伍军人获得慢性病（例如慢性病）定期护理的影响尤其深远 疼痛——特别是当退伍军人接受非药物治疗时，这通常需要定期、持续的治疗。 人来访。尽管为了应对大流行，退伍军人事务部的虚拟护理服务大幅增加，并且 不太可能减少，目前尚不清楚患有疼痛的退伍军人通过虚拟交付获得了哪些服务以及如何获得服务 退伍军人受到了这些转变的影响。该项目的目标是了解 VA 慢性变化 COVID-19 后的疼痛护理及其相关影响 - 并使用这些数据制定优化策略 在 COVID-19 后环境中提供 VA 疼痛服务。 意义：该项目解决了 HSR&D 关于阿片类药物安全和阿片类药物的定向征集的优先事项 使用混乱。具体来说，该项目响应优先领域 E，“审查 关于有效治疗慢性疼痛的 COVID-19 突发公共卫生事件，包括对获得药物的影响 护理、药物和治疗方式、患者功能和满意度。”尽管对护理产生明显影响 尽管由于 COVID-19 大流行而产生了交付，但人们对这些变化和中断如何影响知之甚少 受影响的退伍军人及其慢性疼痛护理，包括他们在疼痛发作后获得护理的能力 大流行。这些担忧反映在我们的试点数据中，这表明退伍军人已经感受到了影响 服务中断影响他们的疼痛管理。 创新和影响：COVID-19 大流行的影响尚未得到充分了解。该项目需要 采用混合方法来检查自大流行爆发以来慢性疼痛护理的变化， 在研究的每个阶段都有一个专家利益相关者小组，以确保结果和建议得到落实 迅速传播，以最大限度地发挥影响力。 具体目标： 目标 1（定量）：描述患有慢性低血压的退伍军人疼痛管理就诊的变化 COVID-19 大流行爆发后出现背痛 (cLBP)。目标 2（定性）：解释差异 目标 1 中确定的服务接受模式和感知影响。目标 3：在整个范围内分享研究结果 项目，包括目标 1 和 2 的最终综合结果，并制定短期和长期战略 在 COVID-19 后的环境中优化退伍军人的疼痛护理服务。 方法：本研究采用嵌入式混合方法设计。在目标 1 中，回顾性队列 将设立接受 cLBP 护理的退伍军人。收到指南推荐的、非药物的 疼痛管理服务，包括 COVID-19 发病后服务收据的变化，将 检查了。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 的分析已完成，目标 2 的定性抽样将开始。因此，与嵌入式一致 根据设计，大多数目标 1 和目标 2 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被更好地了解他们如何经历与流行病相关的 变化，包括对其当前实践/服务交付的任何影响，并确定所做的积极变化 自大流行以来，这可以作为其他设施的范例。在目标 3 中，我们将与利益相关者合作 由退伍军人管理局疼痛管理办公室领导的咨询小组制定全面的建议 指导 VA 制定政策，以优化 COVID-19 后环境中疼痛管理服务的提供。 后续步骤：按照 CIPHER 利益相关者小组（由 CIPHER 领导）的指示，调查结果将直接应用于 VA 护理 VA 国家疼痛管理办公室）。未来的研究将审查旨在 支持 VA 范围内的实施。