Pain Management in the Clinic & Community

诊所的疼痛管理

• 批准号: 8668916
• 负责人: Kelly Ray Knight
• 金额: $ 29.93万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-06-01 至 2016-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8668916
• 关键词: Adult; Affect; Alcohol or Other Drugs use; American; Analgesics; Area; Attention; Belief; Cancer Pain Management; Caring; Cessation of life; Chronic; Clinic; Clinical; Clinical Nursing; Code; Communities; County; Data; Diabetes Mellitus; Diagnosis; Dimensions; Ethnography; Frequencies; Goals; Health; Health Care Costs; Health Services; Health Services Accessibility; Health system; Healthcare; Heart Diseases; Home environment; Individual; Institute of Medicine (U.S.); Interdisciplinary Study; Interview; Knowledge; Life; Low income; Malignant Neoplasms; Medical; Mental Health; Methodology; Modeling; Morbidity - disease rate; Opioid; Outcome; Overdose; Pain; Pain Clinics; Pain Research; Pain management; Participant; Patients; Perception; Pharmaceutical Preparations; Physicians; Policies; Primary Health Care; Principal Investigator; Provider; Public Health; Qualitative Methods; Race; Recording of previous events; Research; Research Personnel; Risk; Sampling; San Francisco; Services; Social Environment; Societies; Specialist; Staging; Study models; Uncertainty; Uninsured; United States; base; clinical practice; coping; disability; experience; high risk; improved; innovation; mortality; non-cancer pain; opioid misuse; prescription opioid; public health relevance; research study; safety net; social; theories

DESCRIPTION (provided by applicant): The proposed study will use qualitative methods to examine the factors impacting primary care providers' and patients' pain management practices in clinical settings and patients' home communities. Chronic non-cancer pain (CNCP), which affects 25% of American adults, is a leading cause of disability and exorbitant health care costs in the United States. Low income patients, who access primary care services in safety net health systems, are more likely to be diagnosed with CNCP than their insured counterparts. CNCP patients with histories of substance use are the highest frequency users of prescribed opioid pain medications with the least access to pain and mental health specialist care. The Institute of Medicine and the American Pain Society have concluded that a dearth of scientific research exists to guide primary care providers' (PCPs') pain management practices, particularly with substance-using patients at high risk for opioid misuse and morbidity and mortality associated with accidental overdose. Arthur Kleinman's model for the anthropological study of pain management suggests that Western clinical health practices encompass individual, interactive and socio- structural dimensions which all influence health outcomes. Pain management practices take place in specific and widely divergent social contexts: the clinic where pain is discussed and responded to biomedically and home environments where patients cope with pain on an everyday basis. By adapting Kleinman's model to target CNCP patients with histories of substance use and their PCPs, the proposed qualitative study will provide needed contextual, observational data to inform CNCP pain management for this high-risk, under- researched patient group. The Specific Aims are: Aim 1: To explore primary care providers' pain management practices in safety net clinical settings with patients who have a history (past or current) of substance use. Aim 2: To explore patients' pain management practices in clinical settings. Aim 3: To explore patients' pain management practices in their home environments. The study will take place in six safety net clinics and patients' home environments in three diverse San Francisco Bay Area Counties. For Aim 1 we will conduct (a) qualitative interviews with 20 PCPs and (b) clinical observation of pain management interactions between the 20 PCPs and 60 of their CNCP patients. For Aim 2, we will conduct (a) qualitative interviews with the 60 CNCP patients and (b) analyze the patient-provider clinical interaction data from the patient perspective. For Aim 3, we will conduct community-based participant observation with a theoretically-selected sample of 20 of the 60 participating patients. Qualitative data will be transcribed, coded and analyzed using grounded theory methodologies. The multidisciplinary research team, consisting of a medical anthropologist/substance use researcher (Early Stage Principal Investigator), a physician/health services researcher (Co-investigator), and a nurse/clinical pain policy expert (Co-investigator), will synthesize the data with the goal of improving our understanding of CNCP management to inform future research and clinical practice.

描述(由申请人提供)：拟议的研究将使用定性的方法来检查在临床环境和患者的家庭社区中影响初级保健提供者和患者的疼痛管理实践的因素。慢性非癌症疼痛(CNCP)影响着25%的美国成年人，是美国残疾和高昂的医疗费用的主要原因。低收入患者在安全网卫生系统中获得初级保健服务，比他们的保险同龄人更有可能被诊断为CNCP。有药物使用史的CNCP患者使用处方阿片类止痛药的频率最高，获得疼痛和心理健康专家护理的机会最少。医学研究所和美国疼痛学会得出结论，缺乏科学研究来指导初级保健提供者(PCP)的疼痛管理实践，特别是在阿片类药物滥用以及与意外过量有关的发病率和死亡率高风险的药物使用患者中。Arthur Kleinman的疼痛管理人类学研究模型表明，西方临床健康实践包括个人、互动和社会结构维度，这些维度都会影响健康结果。疼痛管理实践发生在特定和广泛不同的社会背景中：从生物医学角度讨论疼痛并对其做出反应的诊所，以及患者每天应对疼痛的家庭环境。通过采用Kleinman的模型来针对有药物使用史和他们的PCP的CNCP患者，拟议的定性研究将提供必要的上下文、观察性数据，为这一高风险、研究不足的患者群体提供CNCP疼痛管理信息。具体目标是：目标1：探索初级保健提供者在安全网临床环境中对有药物使用史(过去或当前)的患者的疼痛管理做法。目的2：探讨临床环境下患者的疼痛管理实践。目的3：探讨患者在家庭环境中的疼痛管理实践。这项研究将在旧金山湾区三个不同县的六个安全网诊所和患者的家庭环境中进行。对于目标1，我们将进行(A)对20名PCP的定性访谈和(B)对这20名PCP与其60名CNCP患者之间的疼痛管理互动的临床观察。对于目标2，我们将(A)对60名CNCP患者进行定性访谈，(B)从患者的角度分析患者与提供者之间的临床交互数据。对于目标3，我们将以社区为基础的参与者观察，从理论上选择60名参与患者中的20名进行观察。定性数据将使用扎根的理论方法进行转录、编码和分析。多学科研究团队由一名医学人类学家/物质使用研究员(早期首席调查员)、一名医生/卫生服务研究员(联合调查员)和一名护士/临床疼痛政策专家(联合调查员)组成，他们将综合数据，目的是提高我们对CNCP管理的理解，为未来的研究和临床实践提供信息。