Pain Management in the Clinic & Community

诊所的疼痛管理

• 批准号: 8831633
• 负责人: Kelly Ray Knight
• 金额: $ 29.48万
• 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 2017-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8831633
• 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 misuse; 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方法来检查影响初级保健提供者和患者在临床环境和患者家庭社区中的疼痛管理实践的因素。慢性非癌性疼痛 (CNCP) 影响着 25% 的美国成年人，是导致美国残疾和医疗费用过高的主要原因。在安全网卫生系统中获得初级保健服务的低收入患者比参保患者更有可能被诊断为 CNCP。有药物滥用史的 CNCP 患者使用处方阿片类止痛药的频率最高，但获得疼痛和心理健康专家护理的机会最少。美国医学研究所和美国疼痛协会得出的结论是，缺乏科学研究来指导初级保健提供者 (PCP) 的疼痛管理实践，特别是对于阿片类药物滥用以及与意外过量相关的发病率和死亡率高风险的物质使用患者。阿瑟·克莱曼 (Arthur Kleinman) 的疼痛管理人类学研究模型表明，西方临床健康实践涵盖个体、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且广泛不同的社会环境中：在生物医学和家庭环境中讨论疼痛并对其做出反应的诊所和患者每天应对疼痛的家庭环境。通过调整 Kleinman 的模型，以具有物质使用史及其 PCP 史的 CNCP 患者为目标，拟议的定性研究将提供所需的背景观察数据，为这一高风险、研究不足的患者群体的 CNCP 疼痛管理提供信息。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）的患者的疼痛管理实践。目标 2：探索临床环境中患者的疼痛管理实践。目标 3：探索患者在家庭环境中的疼痛管理实践。该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家庭环境中进行。对于目标 1，我们将进行 (a) 对 20 位 PCP 进行定性访谈，以及 (b) 对 20 位 PCP 与其 60 名 CNCP 患者之间的疼痛管理相互作用进行临床观察。对于目标 2，我们将 (a) 对 60 名 CNCP 患者进行定性访谈，并 (b) 从患者角度分析患者与提供者的临床互动数据。对于目标 3，我们将从 60 名参与患者中理论上选择的 20 名样本进行基于社区的参与观察。定性数据将使用扎根理论方法进行转录、编码和分析。由医学人类学家/药物使用研究员（早期首席研究员）、医生/卫生服务研究员（联合研究员）和护士/临床疼痛政策专家（联合研究员）组成的多学科研究团队将综合数据，旨在提高我们对 CNCP 管理的理解，为未来的研究和临床实践提供信息。