Salud de tu Espalda Primary Care to Physical Therapy (STEPPT): Mitigating ethnic disparities in access and engagement in spine pain rehabilitation

项目摘要 脊椎疼痛是非西班牙裔白人(NHW)最常见和最令人丧失能力的健康状况之一 和种族/少数民族。尽管拉美裔美国人报告的肌肉骨骼疼痛通常比卫生保健工作者更严重， 他们不太可能向医疗保健专业人员咨询疼痛管理，而医疗保健提供者 不太可能评估和治疗西班牙裔患者的疼痛。这项提案的总体目标是适应和 在医疗保健的多个影响级别测试基于证据的文化信息实践 作为一种非药物治疗，改善获得和参与身体康复的机会 有脊椎疼痛的西班牙裔美国人的选择。目标1提出了一种混合方法方法，以适应和手动执行 多层次干预以解决导致就诊率种族差异的可改变因素 联邦合格健康中心脊柱疼痛的转诊和患者对物理治疗的依从性 (FQHC)为美国-墨西哥边境附近的各种低收入社区提供服务。然后，目标2将评估 手动干预的有效性，称为STEPPT(Salud de tu espalda：初级保健至 物理疗法)，在FQHC环境中使用整群随机阶梯楔形临床试验。与.相比 标准护理，我们假设STEPPT将显著降低就诊率的种族差异 脊柱疼痛的转诊和患者对物理治疗的依从性。圆满完成 提议的AIMS将为服务不足的西班牙裔社区提供可扩展、可持续和有效的选择 因为他们从事文化上合适的疼痛护理。这种方法可以作为FQHC和其他 医疗保健系统，以缓解针对各种健康状况的专科服务的差异 对少数民族和种族少数群体的影响不成比例。

Project Summary Spine pain is among the most common and disabling health conditions for both non-Hispanic whites (NHWs) and racial/ethnic minorities. Although Hispanics often report more severe musculoskeletal pain than NHWs, they are less likely to consult a healthcare professional for pain management, and health care providers are less likely to assess and treat pain in Hispanic patients. The overall objective of this proposal is to adapt and test evidence-based, culturally informed practices at multiple levels of influence along the healthcare continuum to improve access to and engagement in physical rehabilitation as a non-pharmacological treatment option for Hispanics with spine pain. Aim 1 proposes a mixed-methods approach to adapt and manualize a multilevel intervention to address modifiable factors contributing to ethnic disparities in rates of physician referral and patient adherence to physical therapy referral for spine pain in a Federally Qualified Health Center (FQHC) serving diverse, low-income communities near the US-Mexico border. Aim 2 will then assess effectiveness of the manualized intervention, referred to as STEPPT (Salud de tu Espalda: Primary Care to Physical Therapy), using a cluster-randomized stepped-wedge clinical trial in the FQHC setting. Compared to standard care, we hypothesize that STEPPT will significantly reduce ethnic disparities in rates of physician referral and patient adherence to physical therapy referral for spine pain. Successful completion of the proposed aims will provide underserved Hispanic communities with scalable, sustainable, and effective options for engaging in culturally appropriate pain care. This approach can serve as a model for FQHCs and other healthcare systems to mitigate disparities in specialty services for a variety of health conditions that disproportionately impact ethnic and racial minorities.