Equity Using Interventions for Pain and Depression (EQUIPD)

公平使用疼痛和抑郁干预措施 (EQUIPD)

• 批准号: 10595133
• 负责人: Marianne Matthias
• 金额: $ 155.76万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-21 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10595133
• 关键词: Address; Adherence; Administrator; Anxiety; Appointment; Caring; Clinic; Clinic Visits; Clinical Trials; Consultations; Control Groups; Data; Data Collection; Decision Aid; Development; Effectiveness; Fostering; Goals; Health; Health system; Healthcare; Healthcare Systems; Individual; Intervention; Intervention Trial; Interview; Knowledge; Learning; Life Style; Manuals; Mental Depression; Outcome; Pain; Pain interference; Pain management; Patients; Pharmaceutical Preparations; Phase; Primary Health Care; Procedures; Protocols documentation; Provider; Randomized; Randomized Controlled Trials; Reach Effectiveness Adoption Implementation and Maintenance; Research; Resources; Sampling; Structure; System; Testing; Time; Waiting Lists; Work; arm; black patient; care providers; chronic depression; chronic pain; chronic pain patient; comorbid depression; comorbidity; comparison intervention; depressive symptoms; effectiveness implementation study; effectiveness study; effectiveness testing; empowered; evidence base; experience; follow-up; future implementation; heuristics; implementation barriers; implementation facilitation; improved; individual patient; intervention delivery; multilevel analysis; multimodality; novel; novel strategies; pain catastrophizing; pain outcome; patient engagement; patient-clinician communication; patient-level barriers; pilot test; preference; primary outcome; racial disparity; recruit; safety net; secondary outcome; socioeconomic disadvantage; treatment adherence; treatment comparison; treatment guidelines

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.

项目摘要 非药物疼痛治疗（NPT）得到证据的支持，并在治疗中得到广泛建议 指南。但是，这些方法仍然没有用。即使访问增加，几个与患者有关的 仍然存在障碍，包括缺乏关于不可nat核可用性和有效性的知识，患者提供的差 沟通以及对参与和依从性的挑战 - 尤其重要，因为NPT通常 比服用药物需要更多的承诺，时间和精力。这些障碍可能尤其是 对于合并抑郁症患者而言，由于抑郁症状会干扰疼痛 管理人员以及继续经历疼痛治疗分配的黑人患者，包括 与白人患者相比，提供的治疗选择少。该建议的总体目标是完善，测试和 准备实施一种新颖的方法来克服与患者相关的NPT使用的障碍，该方法是量身定制的 合并疼痛和抑郁的黑人患者。设备（使用干预措施进行疼痛和 抑郁症使用1）侧重于NPT的决策辅助 参与和治疗依从性。利用种族多层次机制的启发式模型 不公正的疼痛结果，设备始于专注于个人，同时为以后的基础奠定了基础 通过随后的系统范围 执行。在第1阶段，我们将建立一个患者参与面板，引起初级保健提供者 对决策援助的观点，并进行2臂飞行员随机对照试验（RCT） 干预测试和完善程序。在第2阶段，我们将进行全功率（n = 250）RCT，并且 评估促进者和全系统实施的障碍。设备的主要结果是支付的 干扰（6个月）；次要结果包括抑郁症，NPT使用，焦虑，疼痛灾难性， 和患者参与。对于最喜欢的实施计划，我们将有目的地进行采访 对干预患者以及与临床医生，管理员和其他诊所的人员进行了取样，以优化 干预和阐明全系统实施的关键因素。设备简单地讲话 通过合作，在疼痛治疗和与合并症疼痛和抑郁有关的挑战中普遍存在的差异 伴随并授权少数患者找到安全，有效的慢性疼痛方法 他们的价值观，偏好和生活方式。此外，设备有助于通过 促进针对个别患者的需求量身定制的多模式方法来进行疼痛护理。