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Collaborative Care for Chronic Pain in Primary Care

初级保健中慢性疼痛的协作护理

基本信息

批准号：
9047338
负责人：
LYNN L. DeBAR
金额：
$ 188.63万
依托单位：
KAISER FOUNDATION RESEARCH INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-03-01 至 2018-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9047338
关键词：
Activities of Daily Living Address Administrator Adoption Adult Affect American Awareness Behavior Therapy Behavioral Caring Case Manager Charge Clinic Clinical Data Collaborations Complex Computerized Medical Record Data Developmental Diagnostic Diagnostic Effectiveness Elements Enrollment Ensure Environment Evaluation Face Federally Qualified Health Center Funding Mechanisms Hawaii Health Care Costs Health Planning Health Professional Health system Individual Information Technology Intervention Interview Maintenance Manuals Measures Medical Medicine Methods Modality Nature Non-Malignant Nurses Opiates Outcome Pain Pain Measurement Pain management Patient Care Patients Persistent pain Pharmaceutical Preparations Pharmacotherapy Phase Physical therapy Positioning Attribute Pragmatic clinical trial Primary Health Care Procedures Process Productivity Provider Psychiatric Social Work Public Health Randomized Randomized Clinical Trials Recording of previous events Research Research Infrastructure Research Personnel Resource Sharing Resources Role Services Specialist Structure Support System System Testing Therapeutic Time Training Treatment Cost United States Vulnerable Populations Work adverse outcome base care recipients care systems chronic pain clinical care clinical practice collaborative care collaboratory coping cost disability economic impact evidence base experience flexibility formative assessment functional improvement health care service medical specialties member multidisciplinary pain symptom phase 1 study pragmatic trial prevent primary care setting profession allied to medicine programs psychologic satisfaction staff intervention success treatment as usual working group

项目摘要

Chronic pain affects at least 116 million adults in the United States and exacts a tremendous cost in suffering and lost productivity. While health systems offer specialized pain services, it is in the primary care setting where most patients seek and receive care for pain. However, primary care providers often lack the specific training, not to mention the time, to deliver effective pain-management care. To address this problem, we propose a mixed-methods, cluster-randomized pragmatic clinical trial that will evaluate the integration of psychosocial services into the primary care environment in three Kaiser Permanente regions: Georgia, Hawaii, and the Northwest. Our interventionthe Pain Program for Active Coping and Training, or PPACTincludes a variety of therapeutic modalities delivered by a multidisciplinary team charged with engaging patients in their own care and helping them increasingly self-manage their condition. Through our participation in Collaboratory Work Groups, we will strengthen our work and share resources throughout the two-phase project. In the UH2 phase of the proposed study (Phase I), we will conduct an interview-driven formative evaluation to identify potential facilitators and barriers to successful implementation of our pragmatic clinical trial in the UH3 phase (Phase II); ensure the adequacy of our IT infrastructure and EMR data for full implementation in Phase II; and prepare Phase II intervention materials for use by a broad range of health professionals, such as nurse case managers and behavioral specialists. In Phase II, we will build upon the systematic planning conducted in Phase I to conduct a cluster-randomized clinical trial in 40 primary care clinics. Our primary aim is to compare usual care to the effects of our intervention on a number of measures, including patients pain symptoms, functional ability, satisfaction with health care services, and receipt of opiate medication. We will also perform a cost and economic-impact analysis of our intervention to maximize its potential for widespread adoption. Phase II will include evaluations of the interventions reach, effectiveness, adoption, implementation, and maintenance in the participating clinics, and will include the creation and dissemination of an implementation guide. This cross-cutting project, which addresses the multifactorial nature of chronic pain, will provide important data on an intervention that has previously been tested in multiple real-world settings. By testing the PPACT intervention in diverse Kaiser Permanente regions and including federally qualified health centers in our qualitative interviewing process, we will create a highly generalizable resource with strong potential to change the paradigm for the treatment and management of chronic pain.

在美国，慢性疼痛影响着至少1.16亿成年人，并在痛苦中付出了巨大的代价失去了生产力。虽然卫生系统提供专门的疼痛服务，大多数病人在那里寻求和接受疼痛治疗。然而，初级保健提供者往往缺乏具体的培训，更不用说时间，提供有效的疼痛管理护理。为了解决这个问题，我们提出一个混合的方法，集群随机临床试验，将评估整合在三个Kaiser Permanente地区：格鲁吉亚，夏威夷，和西北部。我们的干预积极应对和训练疼痛计划，或PPACT包括由一个多学科团队提供的各种治疗方式，负责让患者参与他们的帮助他们自我管理，并帮助他们越来越多地自我管理。通过参与合作实验室工作组，我们将加强我们的工作，并在整个两阶段项目中共享资源。在拟议研究的UH 2阶段（第一阶段），我们将进行访谈驱动的形成性评估，确定在UH 3成功实施务实临床试验的潜在促进因素和障碍阶段（第二阶段）;确保我们的信息技术基础设施和电子病历数据充足，以便在第二阶段全面实施编写第二阶段干预材料，供广泛的卫生专业人员使用，个案经理和行为专家。在第二阶段，我们会以第一阶段在40个初级保健诊所进行随机分组临床试验。我们的主要目的是比较通常护理我们的干预对包括患者在内的许多措施的影响疼痛症状，功能能力、对卫生保健服务的满意度和接受阿片类药物。我们还将执行一个对我们的干预措施进行成本和经济影响分析，以最大限度地发挥其广泛采用的潜力。相第二部分将包括对干预措施的评价的范围、有效性、采用、实施和维护在参与的诊所，并将包括创建和传播一个实施指南。这个横向项目，它解决了慢性疼痛的多因素性质，将提供重要的数据一种之前已经在多个现实环境中测试过的干预措施。通过测试PPACT 在不同的Kaiser Permanente地区进行干预，并将联邦合格的健康中心纳入我们的定性面试过程，我们将创建一个具有强大的变化潜力的高度概括性的资源治疗和管理慢性疼痛的范例。