Integrating Nonpharmacologic Strategies for Pain with Inclusion, Respect, and Equity (INSPIRE): Tailored digital tools, telehealth coaching, and primary care coordination

将非药物治疗疼痛策略与包容、尊重和公平相结合 (INSPIRE)：定制数字工具、远程医疗指导和初级保健协调

• 批准号: 10536567
• 负责人: JASON M SATTERFIELD
• 金额: $ 161.42万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-15 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10536567
• 关键词: Address; Affect; African American; Anxiety; Awareness; Black race; Caring; Chinese; Clinical; Cognitive Therapy; Collection; Common Data Element; Communities; Data Collection; Decision Making; Development; Documentation; Education; Educational Intervention; Electronic Health Record; Evidence based intervention; Focus Groups; Future; Health Care Costs; Health Personnel; Health Services Accessibility; Healthcare; Hybrids; Improve Access; Individual; Intake; Integrative Therapy; Intervention; Interview; Knowledge; Language; Latinx; Limited English Proficiency; Linguistics; Low Income Population; Measures; Mediator of activation protein; Medical; Mental Depression; Methods; Minority; Modeling; Morbidity - disease rate; Motivation; Multilingualism; Opioid; Outcome; Pain; Pain intensity; Pain interference; Participant; Pathway interactions; Patient Isolators; Patient Outcomes Assessments; Patient Recruitments; Patients; Persons; Phase; Physical therapy; Pilot Projects; Primary Health Care; Process; Protocols documentation; Provider; Quality of Care; Quality of life; Records; Reporting; Risk; Self Efficacy; Social Network; Social isolation; Stigmatization; Substance Use Disorder; Support Groups; Surveys; System; Testing; Time; Trust; Validation; Visit; Visualization; acceptability and feasibility; arm; base; behavioral health; care coordination; chronic pain; chronic pain management; chronic pain patient; clinically relevant; community engagement; comorbidity; compliance behavior; dashboard; design; digital; digital health; dissemination strategy; ethnic minority; evidence base; flexibility; health care disparity; health disparity; health disparity populations; health literacy; high standard; human centered design; implementation evaluation; implementation outcomes; implementation strategy; improved; informant; literacy; medical specialties; mindfulness; mindfulness meditation; mobile application; opioid use disorder; overdose death; pain outcome; pain reduction; pain symptom; participant retention; pilot test; prescription opioid; primary outcome; process evaluation; programs; provider networks; psychiatric comorbidity; psychologic; racial minority; randomized trial; satisfaction; secondary outcome; smartphone Application; social; social stigma; standard of care; substance use; success; telehealth; theories; tool; treatment as usual; treatment effect; treatment program; tutoring

PROJECT SUMMARY/ABSTRACT Chronic pain (CP) is one of the most common and debilitating medical conditions resulting in substantial morbidity, lower quality of life and tremendous health care costs. With ongoing and tragic consequences, opioids were overprescribed creating a surge in opioid use disorders and overdose deaths. Although non- pharmacologic interventions have a strong evidence base, these interventions are rarely available and expensive. The common co-morbidities of psychiatric and substance use disorders trigger further stigma and lower quality care. Subjective reports of pain symptoms and the cultural meanings ascribed to them create a situation ripe for health care disparities driven by multilevel biases on individual, provider, and systemic levels. These biases are manifested in stigmatizing language and the denial of interventions to reduce pain and alleviate suffering. Multiple studies have shown that racial and ethnic minorities with CP are especially mistreated. It is essential to accelerate the creation of hybrid CP management programs that improve access to treatments while simultaneously addressing the stigma, bias, and mistrust that further harm and isolate patients with CP. The INSPIRE CP intervention creates a hybrid blend of tailored cognitive-behavioral therapy, physical therapy, mindfulness, and pain education delivered via a trilingual mobile app and supported by a telehealth pain coach providing essential care coordination with PCPs within the EHR. PROs for pain, depression, anxiety, substance use, and a range of social risks and needs will be regularly collected, summarized in the coaching dashboard, and shared with PCPs. The intervention builds on an existing, in person pain program for marginalized patients but significantly improves reach, expands cultural and linguistic adaptations, and directly addresses multilevel bias and stigma through intensive community engagement, individual and group support, and the provision of “tech tutoring” to improve digital health literacy. The two year R61 development phase includes 3 specific aims with matched milestones: 1) creation of the digital tool and coaching protocol using intensive community engagement, 2) iterative development of educational and implementation strategies for health care staff and providers, and 3) a 3 month pilot test to further assess acceptability and feasibility. The three year R33 validation phase includes 3 additional specific aims 1) perform a pragmatic RCT with n=586 patients comparing INSPIRE to enhanced usual care, 2) analyze secondary outcomes and the treatment effects model, and 3) a mixed method evaluation of implementation outcomes using Normalization Process Theory to better design strategies for future scale.

项目摘要/摘要 慢性疼痛(CP)是最常见和最令人衰弱的疾病之一，导致大量 高发病率、较低的生活质量和巨大的医疗费用。带来持续和悲惨的后果， 阿片类药物处方过多，导致阿片类药物使用障碍和过量死亡激增。虽然不是 药物干预有很强的证据基础，这些干预措施很少有，而且 很贵的。精神疾病和药物使用障碍的常见共病引发了进一步的耻辱和 较低质量的医疗服务。 对疼痛症状的主观报道以及赋予这些症状的文化意义创造了一个适合 由个人、提供者和系统层面上的多层次偏见驱动的医疗保健差异。这些偏见 表现为污名化的语言和拒绝采取干预措施来减轻痛苦和减轻痛苦。 多项研究表明，患有CP的种族和少数民族尤其受到虐待。这是至关重要的 加快创建混合型CP管理计划，以改善获得治疗的机会，同时 同时解决进一步伤害和隔离CP患者的耻辱、偏见和不信任。 INSPIRE CP干预创造了量身定制的认知-行为疗法、物理疗法 治疗、正念和疼痛教育通过三种语言的移动应用程序提供，并由远程健康支持 疼痛教练为EHR内的PCP提供基本护理协调。疼痛、抑郁的专家， 焦虑，药物使用，以及一系列的社会风险和需求将定期收集，汇总在 指导仪表板，并与PCP共享。该干预建立在现有的面对面疼痛计划的基础上 边缘化的患者，但显著改善了覆盖范围，扩大了文化和语言适应，并直接 通过密集的社区参与、个人和群体支持，解决多层次的偏见和耻辱， 并提供“科技辅导”，提升数位健康素养。 两年的R61开发阶段包括3个具体目标和匹配的里程碑：1)创建 使用密集社区参与的数字工具和指导协议，2)迭代开发 针对卫生保健人员和提供者的教育和实施战略，以及3)为期3个月的试点测试，以 进一步评估可接受性和可行性。三年R33验证阶段包括3个额外的特定 目标1)对586名患者进行一项务实的随机对照试验，将INSPIRE与增强型常规护理进行比较，2)分析 次级结果和治疗效果模型，以及3)执行情况的混合方法评估 结果使用标准化过程理论来更好地设计未来规模的策略。