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: 9757713
• 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/9757713
• 关键词: AODD relapse; Address; Adult; Affect; Alcohol or Other Drugs use; Award; Caring; Case-Control Studies; Characteristics; Chronic; Clinic; Clinical; Clinical Trials; Combined Modality Therapy; Competence; Data; Doctor of Philosophy; Dropout; Educational workshop; Effectiveness; Effectiveness of Interventions; Feasibility Studies; Feedback; Focus Groups; Funding; Group Interviews; Guidelines; Health; Health Sciences; Health Services; Health Services Research; Hybrids; Individual; Intervention; Investigator-Initiated Research; K-Series Research Career Programs; Knowledge; Medical center; Medicine; Mentors; Methods; Monitor; Oregon; Outcome; Outpatients; Pain; Pain management; Patient Education; Patients; Physical therapy; Population; Preventive Medicine; Primary Health Care; Provider; Psychiatry; Psychologist; Public Health; Qualitative Evaluations; Quality of life; Recommendation; Research; Research Methodology; Research Personnel; Research Proposals; Research Training; Resources; Sampling; Services; Site; Substance Use Disorder; Substance abuse problem; Symptoms; Testing; Training; Training Programs; Universities; Veterans; base; care seeking; career; case finding; chronic pain; clinical implementation; collaborative care; collaborative trial; disability; effective intervention; effectiveness trial; evidence base; experience; health care settings; implementation research; implementation science; implementation trial; improved; improved outcome; innovation; medical specialties; mid-career faculty; non-cancer chronic pain; opioid therapy; pain reduction; patient population; pilot trial; preference; prescription opioid; prescription opioid abuse; professor; psychosocial; reduced substance abuse; research and development; therapy design; treatment as usual; 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）： 本申请提出了一项指导培训计划，旨在将Travis洛夫乔伊博士、公共卫生硕士培养为独立的VA健康服务研究与发展（HSR&D）调查员，该调查员在特殊物质使用障碍（SUD）治疗环境中具有治疗和研究疼痛的专业知识。洛夫乔伊博士是波特兰VA医疗中心的临床心理学家和初级卫生服务研究员，也是俄勒冈州健康与科学大学（OHSU）的精神病学助理教授。洛夫乔伊博士的职业发展奖（CDA）的培训目标包括：（a）建立疼痛和物质使用障碍的进一步内容专业知识，（B）开发使用VA管理数据回答关键研究问题的熟练程度，以及（c）提高定性和混合方法方法的能力，因为它们适用于临床试验和实施科学。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。洛夫乔伊是由一个成功的指导团队的卫生服务研究人员，其中包括史蒂芬Dobscha，医学博士，中心主任，以提高退伍军人参与护理（CIVIC），新资助的VA HSR&D创新中心在波特兰VA医疗中心;琳达Ganzini，医学博士，公共卫生硕士，CIVIC副主任和OHSU精神病学和医学教授; Benjamin Morasco博士，OHSU CIVIC研究员和精神病学副教授; Dennis McCarty博士，OHSU公共卫生和预防医学教授兼副主席;和希尔迪哈格多恩博士，明尼阿波利斯VA医学中心的核心研究员和SUD质量增强研究计划的实施研究协调员（SUD QUERI）。OHSU和波特兰VA医学中心的资源支持初级研究人员从指导学习到研究独立的过渡。这些资源，再加上导师团队的专家指导，将为洛夫乔伊博士提供理想的机会，使其成为一名独立的VA HSR&D调查员。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VA管理数据来描述在开始治疗后， 专业SUD治疗，并将疼痛治疗利用率与患有并发慢性疼痛和未启动专业SUD护理的SUD的退伍军人的疼痛治疗利用率进行比较。这项研究的结果将为VA HSR&D研究者发起的混合方法研究提案提供信息，该研究将评估高性能和低性能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将定性检查疼痛治疗经验和偏好的退伍军人与慢性疼痛目前接受专业SUD治疗在一个单一的VA医疗中心。额外的定性焦点小组和采访的关键VA医疗中心的利益相关者将检查的障碍和促进者实施协作疼痛干预到专业SUD治疗设置。研究2的数据将为定制基于证据的、初级保健提供的协作疼痛干预措施提供信息，以在专科门诊SUD治疗环境中实施。研究3是在专科SUD治疗环境中提供的定制协作疼痛干预的试点非对照试验。这项试点试验的结果将为第二个VA HSR&D研究者发起的研究提案提供信息，该研究提案将用于协同疼痛干预的多中心有效性试验，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成为一名独立的VA HSR&D研究员，在疼痛和物质使用，临床试验和混合方法研究方面具有专业知识。