Scaling-Up Integrative Pain Management in Federally Qualified Health Centers

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PROJECT SUMMARY Background: Chronic pain impacts a fifth of American adults. Integrative pain management (IPM) interventions including mindfulness-based stress reduction, yoga, and other methods have demonstrated improvements in pain and function, and are now included in clinical guidelines for chronic pain conditions. Despite evidence of efficacy, IPM is not reaching low-income populations at greatest risk for chronic pain and related opioid overdose. Low-income communities rely on safety-net healthcare facilities to access care, of which Federally Qualified Health Centers (FQHCs) are the primary providers. The Integrative Medical Group Visit (IMGV) for chronic pain is one of a few promising IPM interventions developed specifically for safety-net settings. The challenge now is to examine effectiveness and implementation of IMGV in FQHC settings, to address chronic pain and risks associated with opioid use. Goals and Objectives: Dr. Roth’s long-term career goal is to become an independent investigator evaluating effectiveness and implementation of IPM interventions to reduce the burden of chronic pain, particularly in low-income communities. This K01 career development award will allow Dr. Roth to gain advanced skills in conducting trials that can identify successful implementation strategies for IPM interventions. Career Development Activities: The K01 application will provide structured didactic and hands-on training that will build on Dr. Roth’s training in community-based participatory research and foundational implementation science skills, through training in cluster-randomized trial designs, cost measurement and evaluation, and conducting a multi-site pilot study with FQHCs. The plan will engage Dr. Roth in robust training activities including mentorship, coursework, research projects, publishing and presenting, workshops and seminars, grant-writing, and responsible conduct of research. Mentors: Dr. Roth’s mentorship team consists of accomplished scientists from implementation science, clinical integrative health research, intervention epidemiology, health economics, and FQHCs. Environment: Dr. Roth will benefit from a comprehensive research training program and infrastructure based at the UNC School of Medicine’s Program on Integrative Medicine, the top-ranked UNC Gillings School of Public Health, and the North Carolina Translational and Clinical and Sciences Institute. The North Carolina Community Health Center Association will provide training in working with FQHCs. Research: Dr. Roth’s proposed K01 research project will address the limited access to IPM in FQHC settings serving low-income patients. Dr. Roth will first engage key stakeholders through implementation mapping to identify and refine implementation strategies (Aim 1). She will then pilot measures of effectiveness and implementation for IMGV in two FQHCs (one rural, one urban) in North Carolina (Aim 2). This award will prepare Dr. Roth to submit a future competitive grant application for a hybrid type 2 effectiveness-implementation trial of IMGV for chronic pain in FQHC settings.