Acupuncture to Decrease Disparities in Outcomes of Pain Treatment (ADDOPT)

描述（由申请人提供）：慢性疼痛是一个重要的公共卫生问题，与身体和心理功能的损害有关。虽然一般人群中有三分之一或更多的人可能患有慢性疼痛，但在卫生保健机构中，这种疾病往往得不到充分认识和治疗。低收入和少数群体样本在慢性疼痛患病率、有效疼痛治疗的可及性和疼痛咨询方面存在差异。大量文献表明，针灸在慢性疼痛的管理中提供了潜在的好处，但它很少适用于低收入患者。针灸减少疼痛治疗结果差异（ADDOPT）项目将介绍和评估针灸对不同种族、低收入初级保健患者慢性疼痛的管理。该项目代表了纽约市研究和改进网络小组（NYC RING）之间的合作，这是一个以实践为基础的研究网络，致力于通过初级保健研究减少健康差距，连续健康和治疗中心以及瑞典针灸研究所学校。我们的干预措施将包括在3个城市初级保健诊所增加每周针灸疗程。在每次实践的培训课程中，初级保健提供者将熟悉针灸和转诊指征。如果患者因颈部疼痛、背部疼痛或骨关节炎而经历慢性疼痛，则符合条件。在格拉斯哥的RE- AIM框架的指导下，我们的过程评估将评估在繁忙的城市实践中实施和采用干预措施的障碍以及患者和提供者的可接受性。我们将采用准实验设计来评估主要结果（疼痛和生活质量），并获得每个健康中心干预的次要结果（医疗保健利用和成本）的初步估计。这种设计将允许跨站点的比较，以辨别在吸收和结果的实践水平差异。

DESCRIPTION (provided by applicant): Chronic pain is a significant public health problem, associated with impairments of physical and psychological functioning. While a third or more of the general population may suffer from chronic pain, it is often under recognized and under treated in health care settings. Low income and minority samples experience disparities in the prevalence of chronic pain, in perceived access to effective pain treatment, and in consultations for pain. A great deal of literature suggests that acupuncture offers potential benefit in the management of chronic pain, but it is rarely available to low income patients. The Acupuncture to Decrease Disparities in Outcomes of Pain Treatment (ADDOPT) project will introduce and evaluate the addition of acupuncture to the management of chronic pain for ethnically diverse, low-income primary care patients. The project represents a collaboration between the New York City Research and Improvement Networking Group (NYC RING), a practice-based research network dedicated to decreasing health disparities through primary care research, the Continuum Center for Health and Healing, and The Swedish Institute School of Acupuncture. Our intervention will involve addition of weekly acupuncture sessions at 3 urban primary care practices. During training sessions at each practice, primary care providers will become familiar with acupuncture and indications for referral. Patients will be eligible if they experience chronic pain due to neck pain, back pain, or osteoarthritis. Our process evaluation, guided by Glasgow's RE- AIM framework, will assess barriers to implementation and adoption of the intervention in busy urban practices and acceptability to patients and providers. We will employ a quasi- experimental design to assess primary outcomes (pain and quality of life) and obtain preliminary estimates of secondary outcomes (health care utilization and costs) of the intervention at each health center. This design will permit comparison across sites to discern practice level differences in uptake and outcomes. PUBLIC HEALTH REVELANCE: Chronic pain is often under recognized and under treated, especially in vulnerable populations. Acupuncture offers a potentially effective addition to pain management often not available to low-income patients. Our project will introduce acupuncture into chronic pain treatment in urban safety net primary care sites and evaluate the acceptability to patients, the effectiveness of acupuncture in reducing pain and improving quality of life, and obtain preliminary estimates of the effect on health care utilization, medication use, and cost.