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 脊柱疼痛是非西班牙裔白人（NHWs）最常见和致残的健康状况之一 种族/少数民族。虽然西班牙裔经常报告比NHWs更严重的肌肉骨骼疼痛， 他们不太可能咨询医疗保健专业人员进行疼痛管理，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。本提案的总体目标是调整和 在沿着医疗保健的多个影响层面上测试基于证据的、文化上知情的做法 继续改善获得和参与作为非药物治疗的身体康复 脊柱疼痛的西班牙裔人的选择。Aim 1提出了一种混合方法来适应和手动化 多层次干预，以解决导致医生就诊率种族差异的可变因素 在联邦合格的健康中心，脊柱疼痛的转诊和患者对物理治疗的依从性 （UHC）服务于美国-墨西哥边境附近的多样化低收入社区。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， 物理治疗），使用一个群集随机阶梯楔形临床试验中，在CIMHC设置。相比 标准治疗，我们假设STEPPT将显着减少医生比率种族差异， 转诊和患者对脊柱疼痛物理治疗转诊的依从性。成功完成 拟议的目标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 进行文化上合适的疼痛治疗。这种方法可以作为一个模式，为cnhc和其他 医疗保健系统，以减轻对各种健康状况的专业服务的差异， 对少数民族和种族造成了不成比例的影响。

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.