Nonpharmacologic Pain Management in FQHC primary care clinics

项目总结 慢性疼痛是一个无处不在的问题，也是社会日益关注的问题，在很大程度上导致了持续的 阿片类药物泛滥。背痛是最常见的慢性疼痛诊断，也是最常见的 开了哪些阿片类药物。临床实践指南和阿片类药物处方建议使其 显然，对于背痛患者，非药物疼痛治疗比阿片类药物更可取。尽管 明确的证据表明，向背痛患者过度开阿片类药物的情况依然存在。初级保健提供者 服务农村和低收入社区面临着提供非药物疼痛护理的特殊挑战 而不是过度依赖阿片类药物。非药物护理的提供者通常不在这些 社区，即使存在，财政资源有限的患者也可能无法接触到。许多农村 低收入社区由联邦合格的健康中心(FQHC)提供服务。FQHC经常提供服务 处于阿片类药物危机最前沿的社区，但往往缺乏选择，无法提供 他们所服务的病人的非药物替代品。 该项目描述了一个为期1年的规划阶段，然后是一个为期4年的临床试验，将比较 不同非药物干预策略对背部背痛患者的干预效果 疼痛在犹他州各地的FQHC寻求治疗。评估的战略旨在克服 通过创新使用FQHC诊所为农村和低收入社区服务的障碍 远程医疗资源。这项随机临床试验将评估两种干预策略，一种同时提供两种干预策略 一个简单的疼痛远程治疗与基于电话的物理治疗，另一个使用自适应策略-提供 首先是简单的疼痛远程治疗，然后是那些对此没有反应的人进行基于电话的物理治疗 治疗。我们还将评估与在#年在FQHC诊所实施战略的努力有关的结果。 以便为未来的努力提供有价值的信息，以便将有效的战略扩展到其他低资源 医疗保健设置。我们的临床试验有4个具体目标：1)比较疼痛远程治疗的效果 接受或不接受电话理疗的FQHC慢性腰背痛患者的干预，2) 比较不同的两阶段治疗策略的有效性，其中基于电话的物理治疗 考虑一线或二线选项，3)检查目标1和2在预先指定的子项中的结果 基于基线特征的患者分组，以及4)检查疼痛的实施结果 远程结果包括可接受性、采用率、可行性和保真度。

PROJECT SUMMARY Chronic pain is a ubiquitous problem and growing concern for society, contributing substantially to the ongoing opioid epidemic. Back pain is the most common chronic pain diagnosis and the most common diagnosis for which opioids are prescribed. Clinical practice guidelines and opioid-prescribing recommendations make it clear that nonpharmacologic pain treatments are preferable to opioids for patients with back pain. Despite unequivocal evidence, over-prescribing of opioids to individuals with back pain persists. Primary care providers serving rural and low income communities face specific challenges to providing nonpharmacologic pain care instead of over-reliance on opioids. Providers of nonpharmacologic care are often absent from these communities and even if present may be inaccessible to patients with limited financial resources. Many rural and low income communities are served by federally-qualified health centers (FQHCs). FQHCs often serve communities at the forefront of the opioid crisis but too often lack options to provide accessible nonpharmacologic alternatives to the patients they serve. This Project describes a 1-year planning phase followed by a 4-year clinical trial that will compare the effectiveness of different strategies to provide efficacious nonpharmacologic interventions to patients with back pain seeking care in FQHCs throughout the state of Utah. The strategies evaluated are designed to overcome the barriers specific to rural and low income communities served by FQHC clinics through innovative use of telehealth resources. The randomized clinical trial will evaluate two interventions strategies, one providing both a brief pain teleconsult with phone-based physical therapy, the other uses an adaptive strategy – providing the brief pain teleconsult first, followed by phone-based physical therapy among those non-responsive to this treatment. We will also evaluate outcomes related to the efforts to implement strategies in FQHC clinics in order to provide valuable information for future efforts to scale effective strategies into other low resource health care settings. Our clinical trial has 4 Specific Aims: 1) compare the effectiveness of a pain teleconsult intervention with or without phone-based physical therapy for patients with chronic back pain in FQHCs, 2) compare the effectiveness of different 2-phase treatment strategies in which phone-based physical therapy is considered either a first-line or second-line option, 3) examine the results for Aims 1 & 2 in pre-specified sub- groups of patients based on baseline characteristics, and 4) examine implementation outcomes of the pain teleconsult including acceptability, adoption, feasibility and fidelity.