Collaborative Care for Chronic Pain in Primary Care

初级保健中慢性疼痛的协作护理

• 批准号: 8775012
• 负责人: LYNN L. DeBAR
• 金额: $ 156.28万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-03-01 至 2018-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8775012
• 关键词: Activities of Daily Living; Address; Administrator; Adoption; Adult; Affect; American; Awareness; Behavior Therapy; Behavioral; Caring; Case Manager; Charge; Clinic; Clinical Data; Clinical Trials; Collaborations; Complex; Computerized Medical Record; Data; Developmental Diagnostic; Diagnostic; Effectiveness; Elements; Enrollment; Ensure; Environment; Evaluation; Face; Federally Qualified Health Center; Funding Mechanisms; Hawaii; Health Care Costs; Health Planning; Health Professional; Health Services; Health system; Individual; Information Technology; Intervention; Interview; Maintenance; Manuals; Measures; Medical; Medicine; Methods; Modality; Nature; Non-Malignant; Nurses; Opiates; Outcome; Pain; Pain Measurement; Pain management; Patient Care; Patients; Persistent pain; Pharmaceutical Preparations; Pharmacotherapy; Phase; Physical therapy; Positioning Attribute; Primary Health Care; Procedures; Process; Productivity; Provider; Psychiatric Social Work; Public Health; Randomized; Randomized Clinical Trials; Recording of previous events; Research; Research Infrastructure; Research Personnel; Resource Sharing; Resources; Role; Services; Specialist; Structure; Support System; Symptoms; System; Testing; Therapeutic; Time; Training; Treatment Cost; United States; Vulnerable Populations; Work; adverse outcome; base; care systems; chronic pain; clinical care; clinical practice; collaborative care; collaboratory; coping; cost; disability; economic impact; evidence base; experience; flexibility; functional improvement; medical specialties; member; multidisciplinary; phase 1 study; pragmatic trial; prevent; primary care setting; profession allied to medicine; programs; psychologic; satisfaction; staff intervention; success; treatment as usual; working group

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 interventionthe Pain Program for Active Coping and Training, or PPACTincludes 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 interventions 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.

慢性疼痛影响着美国至少1.16亿成年人，并导致巨大的痛苦代价 并且失去了生产力。虽然卫生系统提供专门的疼痛服务，但它处于初级保健环境中。 在那里，大多数患者寻求并接受疼痛护理。然而，初级保健提供者往往缺乏具体的 培训，更不用说提供有效的疼痛管理护理的时间了。为了解决这个问题，我们 提出一项混合方法、整群随机、实用的临床试验，以评估 将心理社会服务纳入三个凯撒永久地区的初级保健环境：佐治亚州、夏威夷、 还有西北部。我们的积极应对和训练疼痛计划(PPACT)包括 由负责让患者参与其治疗的多学科团队提供的各种治疗方式 自我照顾，并帮助他们越来越多地自我管理自己的情况。通过我们在合作实验室的参与 工作组，我们将加强我们的工作，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导向的形成性评估，以 确定UH3成功实施我们的务实临床试验的潜在促进者和障碍 阶段(第二阶段)；确保我们的IT基础设施和电子病历数据充足，以便在阶段全面实施 第二阶段；准备第二阶段干预材料，供广泛的卫生专业人员使用，如护士 案件经理和行为专家。在第二阶段，我们会根据 第一阶段在40家初级保健诊所进行整群随机临床试验。我们的主要目标是比较 通常关注我们干预对一些措施的影响，包括患者疼痛症状， 功能能力，对医疗服务的满意度，以及接受阿片类药物治疗。我们还将表演一场 对我们的干预措施进行成本和经济影响分析，以最大限度地发挥其广泛采用的潜力。阶段 二将包括对干预措施的覆盖范围、有效性、采用、实施和维护的评估 在参与的诊所中，还将包括创建和传播一份实施指南。 这一涉及慢性疼痛多因素性质的交叉项目将提供重要数据 在之前已经在多个真实世界环境中测试的干预上。通过测试PPACT 在不同的Kaiser Permanente地区进行干预，并在我们的 定性的面试过程，我们将创造一个具有很强变革潜力的高度概括性的资源 治疗和管理慢性疼痛的范例。