Collaborative Care for Chronic Pain in Primary Care

描述（由申请人提供）：慢性疼痛影响了美国至少1.16亿成年人，并且在痛苦和生产力损失方面造成了巨大的成本。虽然卫生系统提供专门的疼痛服务，但大多数患者是在初级保健环境中寻求和接受疼痛护理的。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，我们提出了一项混合方法、集群随机的实用临床试验，以评估在三个Kaiser Permanente地区（乔治亚州、夏威夷和西北部）将社会心理服务整合到初级保健环境中的情况。我们的干预——积极应对和训练疼痛项目，简称ppact——包括由一个多学科团队提供的各种治疗方式，负责让患者参与自己的护理，并帮助他们越来越多地自我管理自己的病情。通过参与合作工作小组，我们将加强我们的工作，并在整个两阶段的项目中共享资源。在拟议研究的UH2期（I期），我们将进行访谈驱动的形成性评估，以确定在UH3期（II期）成功实施我们的实用临床试验的潜在促进因素和障碍；确保我们有足够的资讯科技基础设施和电子病历资料，以便在第二阶段全面推行；并准备第二阶段干预材料，供广泛的卫生专业人员使用，如护士病例管理人员和行为专家。在第二阶段，我们将在第一阶段进行的系统规划的基础上，在40个初级保健诊所进行集群随机临床试验。我们的主要目的是比较常规护理和我们的干预措施在一系列措施上的效果，包括患者的疼痛症状、功能能力、对医疗服务的满意度和接受

DESCRIPTION (provided by applicant): 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 intervention-the Pain Program for Active Coping and Training, or PPACT-includes 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 intervention's 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. PUBLIC HEALTH RELEVANCE: Chronic pain is a widespread and costly problem in the United States, and the use of opiate drugs to treat pain has increased dramatically in recent years. This study, conducted in primary care settings, will combine a number of treatment approaches, including physical therapy and psychological interventions. Patients will be supported to take a more active role in managing their pain, and primary care providers will receive additional support and guidance in treating patients with chronic pain.