Pilot of Peers Enhancing Engagement for Pain Services

同行加强疼痛服务参与试点

• 批准号: 10700218
• 负责人: Sara Edmond
• 金额: --
• 依托单位: VA CONNECTICUT HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-02-01 至 2025-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10700218
• 关键词: Active Listening; Address; Behavioral; Caring; Centers for Disease Control and Prevention (U.S.); Certification; Chronic; Chronic Disease; Clinic; Clinical; Clinical Trials; Data; Development; Distress; Effectiveness; Elements; Employee; Enrollment; Goals; Guidelines; Healthcare; Individual; Intervention; Manuals; Medicine; Mental Health; Methodology; Opioid; Outcome; Outcome Measure; Pain; Pain management; Patients; Persistent pain; Personal Satisfaction; Pharmaceutical Preparations; Physical activity; Primary Care; Prospective Studies; Protocols documentation; Public Health; Quality of life; Randomized, Controlled Trials; Recommendation; Research; Research Personnel; Resources; Role; Self Management; Services; Specialist; Substance Use Disorder; Testing; Time; Training; Veterans; Veterans Health Administration; Walking; Work; acceptability and feasibility; addiction; arm; chronic pain; chronic pain management; chronic pain patient; cost; daily functioning; diabetes self-management; disability; experience; functional improvement; improved; innovation; intervention mapping; intervention refinement; medical appointment; meetings; motivational enhancement therapy; multidisciplinary; multimodality; non-cancer chronic pain; non-opioid analgesic; opioid misuse; opioid overdose; opioid therapy; pain reduction; pain self-management; pain-related disability; patient engagement; patient navigator; pedometer; peer; peer support; physical conditioning; pilot test; pilot trial; randomized trial; rehabilitation research; research and development; skills; team-based care; therapy development; whole health

Background: Chronic pain, and particularly high-impact chronic pain (that is, pain last three months or longer that impacts daily functioning in one or more domains) is a leading cause of disability, often associated with declining functioning, lost days of work, and worsened quality of life. The Veterans Health Administration (VHA) identified both improved pain management and reduced opioid-related harms as national priorities, with an emphasis on improving function and pain-related disability. Peer specialists may be an untapped and valuable resource to support Veterans with chronic pain and enhance the effectiveness of pain treatment. Peer specialists are individuals with lived experience who work with Veterans to encourage patient activation and help patients manage chronic conditions. Peer specialists work in a variety of clinical settings, most commonly mental health clinics, and are well-suited to help patients who are harder to engage in services or those needing more support to promote self-management strategies. Peer support is particularly effective for patients with more severe illnesses or higher levels of distress, and thus may be helpful for Veterans with high-impact chronic pain. Significance: Chronic pain is one of the most common and costly problems among Veterans using VHA healthcare. VHA guidelines for pain management and opioid therapy encourage non-pharmacological pain management strategies (NPMs) and non-opioid medications for chronic pain management. However, NPMs that emphasize improved pain-related function are often underutilized. Addressing pain management and opioid misuse are VHA priorities and this research directly aligns with VHA Rehabilitation Research & Development (RR&D) priorities, including promotion of non-pharmacological activity-based interventions for chronic pain, impacting outcomes such as pain; it also aligns with RR&D’s broader goal of maximizing Veteran’s function and quality of life. Innovation & Impact: The role of peer specialists in VHA is rapidly expanding beyond traditional mental health settings, leading to an urgent need for additional research to understand how best to use peer specialists’ unique skills to enhance care for Veterans in a wider range of settings. No studies to date have evaluated the use of peer specialists to support improvements in pain-related function among Veterans with chronic pain. The current proposal is innovative because it proposes, for the first time, using peer specialists to focus on pain management. If proven effective, this project could pave the way for widespread implementation of peer specialists into new settings where they can support pain management. Specific Aims: The specific aims of this project are to (1) Use intervention mapping (IM) to refine our intervention, Peers Enhancing Engagement for Pain Services (PEEPS) and (2) Pilot test the feasibility and acceptability of PEEPS and collect function-focused outcome measures for use in a rigorous prospective study. Methodology: After refining the intervention protocol using intervention mapping, we propose a single arm pilot trial where we will enroll 24 Veterans with high-impact chronic pain to participate in PEEPS, collecting data at baseline and three-months post baseline. Our primary focus will be feasibility and acceptability; we will also collect data on pain-related function, activity (steps walked, using pedometers), and well-being/quality of life. Next Steps/Implementation: These data will inform the development of a larger proposal testing PEEPS in a multicenter randomized controlled trial.

背景：慢性疼痛，特别是影响较大的慢性疼痛(即疼痛持续三个月或更长时间 影响一个或多个领域的日常功能)是导致残疾的主要原因，通常与 功能下降，失去工作天数，生活质量下降。退伍军人健康管理局(VHA) 将改善疼痛管理和减少阿片类药物相关危害确定为国家优先事项，并制定了 强调改善功能和疼痛相关的残疾。同行专家可能是一个未被开发和有价值的 支持患有慢性疼痛的退伍军人，提高疼痛治疗的有效性。同级 专家是有生活经验的人，他们与退伍军人一起工作，鼓励患者激活和 帮助患者管理慢性病。同行专家在各种临床环境中工作，最常见的是 心理健康诊所，非常适合帮助那些难以从事服务的患者或 需要更多的支持来推动自我管理战略。同伴支持对病人特别有效 有更严重的疾病或更高水平的痛苦，因此可能对具有高影响力的退伍军人有帮助 慢性疼痛。 意义：在使用VHA的退伍军人中，慢性疼痛是最常见和代价高昂的问题之一 医疗保健。VHA疼痛管理和阿片类药物治疗指南鼓励非药理性疼痛 慢性疼痛管理策略(NPM)和非阿片类药物。然而，NPM 那些强调改善疼痛相关功能的人往往没有得到充分利用。解决疼痛管理和 阿片类药物滥用是VHA的优先事项，这项研究直接与VHA康复研究和 发展(RR&D)优先事项，包括促进以非药理活动为基础的干预 慢性疼痛，影响结果，如疼痛；它也与RR&D最大化的更广泛目标一致 退伍军人的功能和生活质量。 创新和影响：VHA中同行专家的作用正在迅速扩大，超越了传统的心理健康 环境，导致迫切需要更多的研究，以了解如何最好地使用同行专家的 在更广泛的环境中加强对退伍军人的护理的独特技能。到目前为止，还没有研究评估过 使用同行专家来支持患有慢性疼痛的退伍军人疼痛相关功能的改善。 目前的建议是创新的，因为它首次提出使用同行专家来专注于 疼痛管理。如果被证明是有效的，该项目将为PEER的广泛实施铺平道路 专家进入新的环境，在那里他们可以支持疼痛管理。 具体目标：本项目的具体目标是：(1)使用干预映射(IM)来完善我们的 干预、同行加强疼痛服务参与度(PEEPS)和(2)试点测试可行性和 PEEPS的可接受性和收集以功能为重点的结果测量用于严格的前瞻性研究 学习。 方法：在使用介入标测细化干预方案后，我们提出了单个ARM 试点试验，我们将招募24名患有高度慢性疼痛的退伍军人参加PEEPS，收集 基线时和基线后三个月的数据。我们的主要关注点是可行性和可接受性；我们将 还收集与疼痛相关的功能、活动(步行步数、使用计步器)和幸福感/质量的数据 生活。 下一步/实施：这些数据将为开发更大的提案提供信息，以在 多中心随机对照试验。