Chronic Pain Management in Veterans with Co-occurring Substance Use Disorders

患有同时发生的药物使用障碍的退伍军人的慢性疼痛管理

• 批准号: 9099544
• 负责人: Travis Ian Lovejoy
• 金额: --
• 依托单位: PORTLAND VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-11-01 至 2019-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9099544
• 关键词: AODD relapse; AODD relapse; Address; Address; Adult; Adult; Affect; Affect; Alcohol or Other Drugs use; Alcohol or Other Drugs use; Award; Award; Caring; Caring; Case-Control Studies; Case-Control Studies; Characteristics; Characteristics; Chronic; Chronic; Clinic; Clinic; Clinical; Clinical; Clinical Trials; Clinical Trials; Combined Modality Therapy; Combined Modality Therapy; Competence; Data; Data; Doctor of Philosophy; Doctor of Philosophy; Dropout; Dropout; Educational workshop; Educational workshop; Effectiveness; Effectiveness; Effectiveness of Interventions; Effectiveness of Interventions; Feasibility Studies; Feasibility Studies; Feedback; Feedback; Focus Groups; Focus Groups; Funding; Funding; Group Interviews; Group Interviews; Guidelines; Guidelines; Health; Health; Health Sciences; Health Sciences; Health Services; Health Services; Health Services Research; Health Services Research; Healthcare; Hybrids; Hybrids; Individual; Individual; Intervention; Intervention; Investigator-Initiated Research; Investigator-Initiated Research; K-Series Research Career Programs; K-Series Research Career Programs; Knowledge; Knowledge; Medical center; Medical center; Medicine; Medicine; Mentors; Mentors; Methods; Methods; Monitor; Monitor; Opioid; Oregon; Oregon; Outcome; Outcome; Outpatients; Outpatients; Pain; Pain; Pain management; Pain management; Patient Education; Patient Education; Patients; Patients; Pharmaceutical Preparations; Physical therapy; Physical therapy; Population; Population; Preventive Medicine; Preventive Medicine; Primary Health Care; Primary Health Care; Provider; Psychiatry; Psychiatry; Psychologist; Psychologist; Public Health; Public Health; Qualitative Evaluations; Qualitative Evaluations; Quality of life; Quality of life; Recommendation; Recommendation; Research; Research; Research Methodology; Research Methodology; Research Personnel; Research Personnel; Research Proposals; Research Proposals; Research Training; Research Training; Resources; Resources; Sampling; Sampling; Services; Services; Site; Site; Substance Use Disorder; Substance Use Disorder; Substance abuse problem; Substance abuse problem; Symptoms; Symptoms; Testing; Testing; Training; Training; Training Programs; Training Programs; Universities; Universities; Veterans; Veterans; base; base; care seeking; care seeking; career; career; case finding; case finding; chronic pain; chronic pain; clinical implementation; collaborative care; collaborative care; collaborative trial; disability; disability; effective intervention; effective intervention; effectiveness trial; effectiveness trial; evidence base; evidence base; experience; experience; health care settings; implementation research; implementation research; implementation science; implementation science; implementation trial; implementation trial; improved; improved; improved outcome; improved outcome; information gathering; innovation; innovation; medical specialties; medical specialties; mid-career faculty; mid-career faculty; non-cancer chronic pain; non-cancer pain; opioid therapy; pain reduction; patient population; pilot trial; pilot trial; preference; preference; prescription opioid; prescription opioid abuse; professor; professor; psychosocial; psychosocial; reduced substance abuse; reduced substance abuse; research and development; research and development; therapy design; therapy design; treatment as usual; treatment as usual; treatment program; treatment program

DESCRIPTION (provided by applicant): This application proposes a mentored training program to develop Travis Lovejoy, PhD, MPH into an independent VA Health Services Research & Development (HSR&D) investigator with expertise in the treatment and study of pain in specialty substance use disorder (SUD) treatment settings. Dr. Lovejoy is a Clinical Psychologist and junior Health Services Researcher at the Portland VA Medical Center and Assistant Professor of Psychiatry at Oregon Health & Science University (OHSU). Dr. Lovejoy's training objectives for the Career Development Award (CDA) include (a) establishing further content expertise in pain and substance use disorders, (b) developing proficiency in the use of VA administrative data to answer key research questions, and (c) enhancing competency in qualitative and mixed methods approaches as they apply to clinical trials and implementation science. His training plan consists of formal coursework, advanced training workshops, and mentor-guided study. Dr. Lovejoy is supported by an accomplished mentoring team of health services researchers that includes Steven Dobscha, MD, Director of the Center to Improve Veteran Involvement in Care (CIVIC), the newly funded VA HSR&D Center of Innovation at Portland VA Medical Center; Linda Ganzini, MD, MPH, Associate Director of CIVIC and Professor of Psychiatry and Medicine at OHSU; Benjamin Morasco, PhD, CIVIC Research Investigator and Associate Professor of Psychiatry at OHSU; Dennis McCarty, PhD, Professor and Vice Chair of Public Health and Preventive Medicine at OHSU; and Hildi Hagedorn, PhD, Core Research Investigator at the Minneapolis VA Medical Center and Implementation Research Coordinator for the SUD Quality Enhancement Research Initiative (SUD QUERI). The resources at OHSU and the Portland VA Medical Center support the transition of junior researchers from mentored study to research independence. These resources, combined with the expert guidance of the mentoring team, will provide the ideal opportunity for Dr. Lovejoy to develop into an independent VA HSR&D investigator. Dr. Lovejoy will complete three interrelated studies during the CDA. Study 1 will use VA administrative data to characterize pain treatment utilization in a national sample of Veterans following initiation of specialty SUD treatment and compare pain treatment utilization to that of Veterans with co-occurring chronic pain and SUDs who do not initiate specialty SUD care. Findings from this study will inform a VA HSR&D Investigator Initiated Research proposal for a mixed methods study that will evaluate practices of high-and low- performing VA SUD treatment programs in managing Veterans' chronic pain. Study 2 will qualitatively examine pain treatment experiences and preferences in Veterans with chronic pain currently receiving specialty SUD treatment at a single VA Medical Center. Additional qualitative focus groups and interviews with key VA Medical Center stakeholders will examine barriers and facilitators to implementation of a collaborative pain intervention into a specialty SUD treatment setting. Data from study 2 will inform tailoring of an evidence- based, primary care-delivered collaborative pain intervention for implementation in a specialty outpatient SUD treatment setting. Study 3 is a pilot non-controlled trial of the tailored collaborative pain intervention delivered in the specialty SUD treatment setting. Findings from this pilot trial will inform a second VA HSR&D Investigator Initiated Research proposal for a multi-site effectiveness trial of the collaborative pain intervention that concurrently evaluates intervention implementation. Successful completion of the proposed research and training will prepare Dr. Lovejoy to become an independent VA HSR&D investigator with expertise in pain and substance use, clinical trials, and mixed methods research.

描述(由申请人提供)： 本申请提出了一项有指导的培训计划，旨在将Travis LoveJoy博士、公共卫生硕士培养成一名独立的退伍军人健康服务研究与开发(HSR&D)研究员，在特殊物质使用障碍(SUD)治疗环境中的疼痛治疗和研究方面拥有专业知识。洛夫乔伊博士是波特兰退伍军人医学中心的临床心理学家和初级卫生服务研究员，也是俄勒冈健康与科学大学(OHSU)的精神病学助理教授。洛夫乔伊博士的职业发展奖(CDA)培训目标包括(A)在疼痛和药物使用障碍方面建立更多的内容专业知识，(B)熟练使用退伍军人管理局的管理数据来回答关键研究问题，以及(C)提高定性和混合方法方法应用于临床试验和实施科学的能力。他的培训计划包括正式课程、高级培训研讨会和导师指导的学习。洛夫乔伊博士得到了一支经验丰富的卫生服务研究人员指导团队的支持，团队成员包括波特兰退伍军人医疗中心新资助的退伍军人参与护理中心(CIICAL)主任Steven Dobscha医学博士、OHSU公民研究副主任、OHSU精神病学和医学教授Linda Ganzini医学博士、OHSU公民研究研究员兼精神病学副教授Benjamin Morasco博士、HSU公共卫生和预防医学教授兼副主席Dennis McCarty博士；Hildi Hagedorn博士，明尼阿波利斯退伍军人医学中心核心研究研究员，SUD质量增强研究倡议(SUD QUERI)实施研究协调员。OHSU和波特兰退伍军人医学中心的资源支持初级研究人员从指导性学习向研究独立性的转变。这些资源，再加上指导团队的专家指导，将为洛夫乔伊博士提供理想的机会，发展成为一名独立的退伍军人事务部HSR&D研究员。洛夫乔伊博士将在CDA期间完成三项相互关联的研究。研究1将使用退伍军人管理数据来表征全国退伍军人样本中疼痛治疗的使用情况 专门的SUD治疗，并将疼痛治疗的利用率与不启动专门的SUD护理的慢性疼痛和肥皂水共现的退伍军人进行比较。这项研究的结果将成为退伍军人HSR&D调查员发起的一项混合方法研究的研究建议，该研究将评估高绩效和低绩效的VA SUD治疗计划在管理退伍军人慢性疼痛方面的实践。研究2将定性地检查目前在退伍军人医疗中心接受专门的SUD治疗的慢性疼痛退伍军人的疼痛治疗经验和偏好。其他定性焦点小组和对退伍军人医学中心主要利益相关者的访谈将检查在专业SUD治疗环境中实施协作性疼痛干预的障碍和促进者。来自研究2的数据将为定制基于证据的、初级保健提供的协作性疼痛干预提供信息，以便在专门的门诊SUD治疗环境中实施。研究3是在专业SUD治疗环境中提供的量身定制的协作式疼痛干预的试点非对照试验。这项试点试验的结果将为退伍军人事务部HSR&D调查员发起的第二项研究提案提供信息，该研究提案旨在开展一项协作性疼痛干预的多地点有效性试验，同时评估干预实施情况。成功完成拟议的研究和培训将使洛夫乔伊博士做好准备，成为一名独立的退伍军人事务部HSR&D研究员，拥有疼痛和药物使用、临床试验和混合方法研究方面的专业知识。