Collaborative Care for Chronic Pain in Primary Care

描述(申请人提供)：慢性疼痛在美国至少影响1.16亿成年人，并造成巨大的痛苦和生产力损失。虽然卫生系统提供专门的疼痛服务，但大多数患者寻求和接受疼痛护理的是初级保健环境。然而，初级保健提供者往往缺乏提供有效疼痛管理护理的具体培训，更不用说时间了。为了解决这个问题，我们提出了一项混合方法、整群随机的实用临床试验，该试验将评估在三个Kaiser Permanente地区：佐治亚州、夏威夷和西北地区将心理社会服务整合到初级保健环境中的情况。我们的干预措施-主动应对和培训疼痛计划(PPACT)-包括由一个多学科团队提供的各种治疗方式，负责让患者参与自己的护理，并帮助他们越来越多地自我管理自己的病情。通过参与合作实验室工作组，我们将加强我们的工作，并在整个两阶段项目中共享资源。在拟议研究的UH2阶段(第一阶段)，我们将进行以访谈为主导的形成性评估，以找出在UH3阶段(第二阶段)成功实施我们的务实临床试验的潜在促进者和障碍；确保我们的IT基础设施和EMR数据足够在第二阶段全面实施；以及准备第二阶段的干预材料，供广泛的健康专业人员，如护士病例经理和行为专家使用。在第二阶段，我们会根据第一阶段所进行的有系统规划，在40间基层医疗诊所进行整群随机临床试验。我们的主要目标是将常规护理与我们干预措施在一些指标上的效果进行比较，包括患者的疼痛症状、功能能力、对医疗服务的满意度以及接受 鸦片类药物。我们还将对我们的干预措施进行成本和经济影响分析，以最大限度地扩大其广泛采用的潜力。第二阶段将包括对参与的诊所的干预范围、有效性、采用、实施和维护进行评估，并将包括创建和传播实施指南。这一交叉项目解决了慢性疼痛的多因素性质，将提供 关于先前在多个真实世界环境中测试过的干预的重要数据。通过在不同的Kaiser Permanente地区测试PPACT干预措施，并在我们的定性访谈过程中纳入联邦合格的医疗中心，我们将创建一个具有强大潜力的高度泛化的资源，以改变慢性疼痛的治疗和管理模式。 与公共卫生相关：慢性疼痛在美国是一个普遍且代价高昂的问题，近年来，用于治疗疼痛的阿片类药物的使用大幅增加。这项研究在初级保健环境中进行，将结合许多治疗方法，包括物理治疗和心理干预。将支持患者在管理疼痛方面发挥更积极的作用，初级保健提供者将在治疗慢性疼痛患者方面获得更多支持和指导。

DESCRIPTION (provided by applicant): Chronic pain affects at least 116 million adults in the United States and exacts a tremendous cost in suffering and lost productivity. While health systems offer specialized pain services, it is in the primary care setting where most patients seek and receive care for pain. However, primary care providers often lack the specific training, not to mention the time, to deliver effective pain-management care. To address this problem, we propose a mixed-methods, cluster-randomized pragmatic clinical trial that will evaluate the integration of psychosocial services into the primary care environment in three Kaiser Permanente regions: Georgia, Hawaii, and the Northwest. Our intervention-the Pain Program for Active Coping and Training, or PPACT-includes a variety of therapeutic modalities delivered by a multidisciplinary team charged with engaging patients in their own care and helping them increasingly self-manage their condition. Through our participation in Collaboratory Work Groups, we will strengthen our work and share resources throughout the two-phase project. In the UH2 phase of the proposed study (Phase I), we will conduct an interview-driven formative evaluation to identify potential facilitators and barriers to successful implementation of our pragmatic clinical trial in the UH3 phase (Phase II); ensure the adequacy of our IT infrastructure and EMR data for full implementation in Phase II; and prepare Phase II intervention materials for use by a broad range of health professionals, such as nurse case managers and behavioral specialists. In Phase II, we will build upon the systematic planning conducted in Phase I to conduct a cluster-randomized clinical trial in 40 primary care clinics. Our primary aim is to compare usual care to the effects of our intervention on a number of measures, including patients' pain symptoms, functional ability, satisfaction with health care services, and receipt of opiate medication. We will also perform a cost and economic-impact analysis of our intervention to maximize its potential for widespread adoption. Phase II will include evaluations of the intervention's reach, effectiveness, adoption, implementation, and maintenance in the participating clinics, and will include the creation and dissemination of an implementation guide. This cross-cutting project, which addresses the multifactorial nature of chronic pain, will provide important data on an intervention that has previously been tested in multiple real-world settings. By testing the PPACT intervention in diverse Kaiser Permanente regions and including federally qualified health centers in our qualitative interviewing process, we will create a highly generalizable resource with strong potential to change the paradigm for the treatment and management of chronic pain. PUBLIC HEALTH RELEVANCE: Chronic pain is a widespread and costly problem in the United States, and the use of opiate drugs to treat pain has increased dramatically in recent years. This study, conducted in primary care settings, will combine a number of treatment approaches, including physical therapy and psychological interventions. Patients will be supported to take a more active role in managing their pain, and primary care providers will receive additional support and guidance in treating patients with chronic pain.