Implementing Evidence-Based Treatments for Persistent Back Pain into Primary Care

描述（由申请人提供）：该提案响应了国家补充和替代医学中心的兴趣，即确定有效的方法，将循证干预措施实施到“提供疼痛管理策略的医疗保健环境中，其中包括补充和替代医学方法。它解决了持续性背痛的有效治疗知识和将这些知识付诸实践之间的巨大差距。高质量指南现在推荐的8种治疗持续性背痛的方法大多是补充和替代医学（CAM）和身心技术（即，脊柱推拿、针灸、按摩、瑜伽、认知行为疗法、渐进式放松）。临床医生缺乏对这些治疗方法的了解，这对鼓励患者使用这些方法提出了特别的挑战。此外，很少有人知道的挑战，实施任何循证CAM干预措施付诸实践或如何解决这些挑战。为了帮助克服这些障碍，我们建议正式评估实施背痛指南的过程，包括CAM和慢性背痛的身心治疗进入初级保健实践。由于美国背痛的巨大个人、社会和经济成本，改善背痛的临床护理的潜在益处是巨大的。 我们提出了一个形成性的评估试点实施的循证指南持续性背痛到一个集团健康（GHC）的初级保健诊所。形成性评价认识到，医疗保健组织是复杂的适应系统，不断以不可预测的方式变化。出于这个原因，我们的评估方法将包括持续的监测和修改，以确定障碍，促进者和其他可适应的因素，可能会影响该计划的成功。具体目标：在实施之前，我们将确定，探索和描述在初级保健试点诊所实施指南的障碍和促进因素，并相应地修改计划（目标1）。在执行过程中，我们将查明计划与其运作之间的差异，并监测实现预期成果的影响和进展指标（目标2）。实施后，我们将分析前几个阶段的经验教训和利益相关者的汇报，以确定结果的替代解释（目标3）。这些信息将用于最终确定实施计划，然后将其传播到其他GHC诊所，并传播给其他有兴趣在其他环境中实施循证治疗的人。 鉴于先前实施背痛指南的努力结果令人失望，并且缺乏评估将循证CAM和身心治疗实施到医疗保健环境中的效果的研究，我们的研究结果将提供对未来成功桥接 这些研究和实践之间的差距。

DESCRIPTION (provided by applicant): This proposal responds to the National Center for Complementary and Alternative Medicine's interest in identifying effective ways to implement evidence-based interventions into "health care settings that deliver pain management strategies which incorporate complementary and alternative medicine approaches. It addresses the substantial gap between knowledge of effective treatments for persistent back pain and implementation of this knowledge into practice. The 8 treatments now recommended for persistent back pain by high quality guidelines are mostly complementary and alternative medical (CAM) and mind-body techniques (i.e., spinal manipulation, acupuncture, massage, yoga, cognitive behavioral therapy, progressive relaxation). Clinicians' lack of knowledge about these treatments presents a particular challenge for encouraging their use by patients. Furthermore, little is known about the challenges of implementing any evidence-based CAM interventions into practice or how these challenges might be addressed. To help overcome these obstacles, we propose to formally evaluate the process of implementing back pain guidelines including CAM and mind/body treatments for chronic back pain into primary care practice. Because of the large personal, social, and economic costs of back pain in the U.S., the potential benefits of improvements in clinical care for back pain are enormous. We propose a formative evaluation of the pilot implementation of evidence-based guidelines for persistent back pain into a Group Health (GHC) primary care clinic. Formative evaluation recognizes that health care organizations are complex adaptive systems which are constantly changing in unpredictable ways. For this reason, our evaluation method will include ongoing monitoring and modification to identify barriers, facilitators and other adaptable factors that could influence th program's success. Specific Aims: Prior to implementation, we will identify, explore, and describe the barriers and facilitators to implementing the guidelines in a primary care pilot clini and modify the plan accordingly (Aim 1). During implementation, we will identify discrepancies between the plan and its operationalization and monitor the impacts and indicators of progress toward desired outcomes (Aim 2). After implementation, we will analyze the lessons from the previous stages and from a debriefing of the stakeholders to identify alternative explanations for the results (Aim 3). This information will be used to finalize the implementation plan before spreading it to other GHC clinics and disseminated to others interested in implementing evidence-based treatments into other settings. In view of the disappointing results of previous efforts to implement back pain guidelines and the lack of research evaluating the effect of implementing evidence-based CAM and mind-body treatments into medical care settings, our findings will provide information that will be critical for the success of future efforts to bridge these gaps between research and practice.