Equity Using Interventions for Pain and Depression (EQUIPD)

项目摘要 非药物止痛疗法(NPT)得到了证据的支持，并被广泛推荐用于治疗 指导方针。然而，这些方法仍然没有得到充分利用。即使在访问增加的同时，几个与患者相关的 障碍依然存在，包括缺乏关于《不扩散核武器条约》的可获得性和有效性的知识，患者服务质量差 沟通，以及参与和遵守方面的挑战--尤其重要，因为非营利组织通常 与服药相比，需要更多的承诺、时间和精力。这些障碍可能特别 对患有抑郁症的患者来说很明显，因为抑郁症状会干扰疼痛 管理，以及黑人患者，他们在疼痛治疗方面继续经历差异，包括 与白人患者相比，提供的治疗选择更少。该提案的总体目标是改进、测试和 准备实施一种新的方法，以克服与患者有关的使用NPT的障碍，该方法旨在 黑人患者同时患有疼痛和抑郁。EQUIPD(使用疼痛和干预措施的公平 抑郁症)使用1)以NPT为重点的决策辅助工具来增加使用，以及2)使用教练来帮助患者 参与度和治疗依从性。借鉴种族多层次机制的启发式模型 疼痛结果的不公平，EQUIPD从关注个人开始，同时为以后的工作奠定基础 通过随后的全系统干预在结构一级(即诊所/保健系统)进行干预 实施。在第一阶段，我们将建立一个患者参与小组，吸引初级保健提供者的 关于决策辅助的观点，并进行双臂试点随机对照试验(RCT) 进行干预，以测试和改进程序。在第二阶段，我们将进行全功率(N=250)RCT和 评价全系统执行工作的促进者和障碍。EQUIPD的主要结果是疼痛 干预(在6个月时)；次要结果包括抑郁、使用NPT、焦虑、疼痛灾难、 和耐心的参与。为了促进实施规划，我们将有目的地进行访谈 抽样的干预患者子集，并与临床医生、管理人员和其他诊所工作人员一起优化 干预和阐明全系统执行的关键因素。EQUIPD同时寻址 通过合作，疼痛治疗中普遍存在的差异以及与共病疼痛和抑郁相关的挑战 帮助和支持微型化患者找到安全、有效的治疗慢性疼痛的最佳匹配方法 他们的价值观、喜好和生活方式。此外，EQUIPD通过以下方式帮助推进国家痛苦战略 推广多种模式的疼痛护理方法，以满足个别患者的需求。

Project Summary Nonpharmacological pain treatments (NPTs) are supported by evidence and widely recommended in treatment guidelines. However, these approaches remain underused. Even as access increases, several patient-related barriers remain, including lack of knowledge about NPT availability and effectiveness, poor patient-provider communication, and challenges to engagement and adherence –particularly important as NPTs typically require more commitment, time, and effort than taking medications. These barriers may be especially pronounced for patients with comorbid depression, since depressive symptoms can interfere with pain management, and for Black patients, who continue to experience disparities in pain treatment, including being offered fewer treatment options than White patients. The overall goal of this proposal is to refine, test, and prepare to implement a novel approach to overcoming patient-related barriers to NPT use that is tailored to Black patients with comorbid pain and depression. EQUIPD (Equity Using Interventions for Pain and Depression) uses 1) a decision aid focused on NPTs to increase use, and 2) a coach to foster patient engagement and treatment adherence. Drawing on a heuristic model of multi-level mechanisms of racial injustice in pain outcomes, EQUIPD begins by focusing on the individual, while laying the groundwork for later intervention at the structural level (i.e., clinic/healthcare system) through subsequent system-wide implementation. In Phase 1, we will establish a patient engagement panel, elicit primary care providers’ perspectives on the decision aid, and conduct a 2-arm pilot randomized controlled trial (RCT) of the intervention to test and refine procedures. In Phase 2 we will conduct a fully powered (N=250) RCT and evaluate facilitators and barriers to system-wide implementation. The primary outcome of EQUIPD is pain interference (at 6 months); secondary outcomes include depression, NPT use, anxiety, pain catastrophizing, and patient engagement. To facilitate implementation planning, we will conduct interviews with a purposefully sampled subset of intervention patients and with clinicians, administrators, and other clinic staff to optimize the intervention and elucidate critical factors for system-wide implementation. EQUIPD simultaneously addresses disparities pervasive in pain treatment and challenges related to comorbid pain and depression, by partnering with and empowering minoritized patients to find safe, effective approaches to chronic pain that best match their values, preferences, and lifestyles. Moreover, EQUIPD helps to advance the National Pain Strategy by promoting multi-modal approaches to pain care that is tailored to individual patients’ needs.