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Nonpharmacologic Pain Management in FQHC primary care clinics

FQHC 初级保健诊所的非药物疼痛管理

基本信息

批准号：
10683326
负责人：
Julie M Fritz
金额：
$ 141.74万
依托单位：
UNIVERSITY OF UTAH
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-09-25 至 2025-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10683326
关键词：
Acceleration Address Adopted Adoption Area Back Pain Behavioral Belief COVID-19 pandemic Caring Characteristics Chronic Clinic Clinical Practice Guideline Clinical Trials Cognitive Communities Data Data Analyses Data Collection Diagnosis Education Electronics Exercise Face Federally Qualified Health Center Future Gender Goals Health Health Resources Health system Healthcare Systems Heart Individual Intervention Low income Manuals Methods Neighborhood Health Center Opioid Outcome Outcome Study Pain Pain interference Pain management Patient Care Patients Persons Phase Phenotype Physical therapy Play Poverty Prevalence Primary Care Procedures Protocols documentation Provider Recommendation Research Resources Risk Factors Role Rural Rural Community Self Management Services Site Societies Specific qualifier value Telephone Testing Training Utah Veterans Work care seeking chronic back pain chronic pain chronic pain patient community organizations compare effectiveness design disparity reduction effectiveness evaluation effectiveness outcome evidence base evidence based guidelines federal poverty level frontier health care availability health care settings hybrid type 1 design implementation evaluation implementation outcomes improved innovation opioid abuse opioid epidemic opioid misuse opioid use opioid user pain outcome pain reduction patient subsets poor communities prescription opioid prevent primary care clinic primary care provider primary health center primary outcome programs randomized, clinical trials rurality safety net secondary outcome teleconsultation telehealth treatment strategy

项目摘要

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.

项目概要慢性疼痛是一个普遍存在的问题，越来越受到社会的关注，在很大程度上导致了持续的疼痛鸦片类药物泛滥。背痛是最常见的慢性疼痛诊断，也是最常见的诊断开出哪些阿片类药物。临床实践指南和阿片类药物处方建议使其明确对于背痛患者，非药物疼痛治疗优于阿片类药物。尽管明确的证据表明，对背痛患者过度服用阿片类药物的现象仍然存在。初级保健提供者为农村和低收入社区提供服务在提供非药物疼痛护理方面面临着特定的挑战而不是过度依赖阿片类药物。这些服务中往往缺少非药物护理的提供者社区，即使存在，对于财力有限的患者来说也可能无法获得。很多农村低收入社区由联邦合格的健康中心 (FQHC) 提供服务。 FQHC 经常服务处于阿片类药物危机最前沿的社区，但往往缺乏提供无障碍服务的选择他们所服务的患者的非药物替代方案。该项目描述了一个为期 1 年的规划阶段，随后是一个为期 4 年的临床试验，该试验将比较为背部疼痛患者提供有效非药物干预的不同策略的有效性在整个犹他州的 FQHC 中寻求疼痛治疗。评估的策略旨在克服通过创新使用 FQHC 诊所服务的农村和低收入社区特有的障碍远程医疗资源。随机临床试验将评估两种干预策略，一种提供两种干预策略一种是通过基于电话的物理治疗进行简短的疼痛远程咨询，另一种则采用适应性策略——提供首先进行简短的疼痛远程咨询，然后对对此无反应的人进行基于电话的物理治疗治疗。我们还将评估与 FQHC 诊所实施战略相关的成果以便为今后将有效战略推广到其他资源匮乏的领域的努力提供有价值的信息医疗保健环境。我们的临床试验有 4 个具体目标：1) 比较疼痛远程咨询的有效性对 FQHC 中的慢性背痛患者进行有或没有基于电话的物理治疗的干预，2) 比较不同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) 检查预先指定的子项目中目标 1 和 2 的结果根据基线特征对患者进行分组，4) 检查疼痛的实施结果远程咨询包括可接受性、采用性、可行性和保真度。