Scaling-Up Integrative Pain Management in Federally Qualified Health Centers

项目摘要 慢性疼痛影响着五分之一的美国成年人。综合疼痛管理（IPM） 包括正念减压、瑜伽和其他方法在内的干预措施已经证明， 疼痛和功能的改善，现在包括在慢性疼痛条件的临床指南。 尽管有疗效证据，IPM并没有达到慢性疼痛风险最大的低收入人群， 阿片类药物过量低收入社区依靠安全网医疗保健设施获得护理， 哪些联邦合格的卫生中心（FATHCs）是主要提供者。综合医疗集团 针对慢性疼痛的访视（IMGV）是专门为安全网开发的少数有希望的IPM干预措施之一 设置.目前的挑战是审查性别和家庭暴力综合管理在联合国人权事务高级专员办事处的有效性和执行情况， 解决与阿片类药物使用相关的慢性疼痛和风险。目标和目的：罗斯博士的长期职业生涯 目标是成为一名独立的调查员，评估IPM的有效性和实施情况 采取干预措施，以减轻慢性疼痛的负担，特别是在低收入社区。K 01职业生涯 发展奖将使罗斯博士获得先进的技能，在进行试验，可以确定成功的 虫害综合防治措施的实施战略。职业发展活动：K 01应用程序将 提供结构化的教学和实践培训，这将建立在罗斯博士的培训，以社区为基础， 参与性研究和基本的实施科学技能，通过培训集群随机 试验设计、成本计量和评估，以及与联合国粮农组织卫生协调中心开展多地点试点研究。该计划 将从事罗斯博士在强大的培训活动，包括导师，课程，研究项目， 出版和介绍，讲习班和研讨会，赠款写作，以及负责任的研究行为。 导师：Roth博士的导师团队由来自实施科学、临床和医学领域的杰出科学家组成。 综合健康研究、干预流行病学、卫生经济学和综合健康中心。环境：Roth博士 将受益于一个全面的研究培训计划和基础设施的基础上， 医学的中西医结合项目，排名第一的吉林斯公共卫生学院，以及 北卡罗来纳州转化临床科学研究所。北卡罗来纳州社区健康中心 协会将提供培训，在工作中与联合国儿童基金会。研究：Roth博士提出的K 01研究项目 将解决在为低收入患者服务的医疗卫生机构中获得IPM的机会有限的问题。罗斯博士将首先 通过执行情况摸底调查，确定和完善执行战略（目标1）。 然后，她将在两个中非共和国艾滋病毒/艾滋病委员会（一个农村，一个 市区）在北卡罗来纳州（目标2）。该奖项将准备博士罗斯提交未来的竞争性赠款 申请IMGV治疗慢性疼痛的混合型2型有效性-实施试验，

PROJECT SUMMARY Background: Chronic pain impacts a fifth of American adults. Integrative pain management (IPM) interventions including mindfulness-based stress reduction, yoga, and other methods have demonstrated improvements in pain and function, and are now included in clinical guidelines for chronic pain conditions. Despite evidence of efficacy, IPM is not reaching low-income populations at greatest risk for chronic pain and related opioid overdose. Low-income communities rely on safety-net healthcare facilities to access care, of which Federally Qualified Health Centers (FQHCs) are the primary providers. The Integrative Medical Group Visit (IMGV) for chronic pain is one of a few promising IPM interventions developed specifically for safety-net settings. The challenge now is to examine effectiveness and implementation of IMGV in FQHC settings, to address chronic pain and risks associated with opioid use. Goals and Objectives: Dr. Roth’s long-term career goal is to become an independent investigator evaluating effectiveness and implementation of IPM interventions to reduce the burden of chronic pain, particularly in low-income communities. This K01 career development award will allow Dr. Roth to gain advanced skills in conducting trials that can identify successful implementation strategies for IPM interventions. Career Development Activities: The K01 application will provide structured didactic and hands-on training that will build on Dr. Roth’s training in community-based participatory research and foundational implementation science skills, through training in cluster-randomized trial designs, cost measurement and evaluation, and conducting a multi-site pilot study with FQHCs. The plan will engage Dr. Roth in robust training activities including mentorship, coursework, research projects, publishing and presenting, workshops and seminars, grant-writing, and responsible conduct of research. Mentors: Dr. Roth’s mentorship team consists of accomplished scientists from implementation science, clinical integrative health research, intervention epidemiology, health economics, and FQHCs. Environment: Dr. Roth will benefit from a comprehensive research training program and infrastructure based at the UNC School of Medicine’s Program on Integrative Medicine, the top-ranked UNC Gillings School of Public Health, and the North Carolina Translational and Clinical and Sciences Institute. The North Carolina Community Health Center Association will provide training in working with FQHCs. Research: Dr. Roth’s proposed K01 research project will address the limited access to IPM in FQHC settings serving low-income patients. Dr. Roth will first engage key stakeholders through implementation mapping to identify and refine implementation strategies (Aim 1). She will then pilot measures of effectiveness and implementation for IMGV in two FQHCs (one rural, one urban) in North Carolina (Aim 2). This award will prepare Dr. Roth to submit a future competitive grant application for a hybrid type 2 effectiveness-implementation trial of IMGV for chronic pain in FQHC settings.