Scaling-Up Integrative Pain Management in Federally Qualified Health Centers

项目总结 背景：慢性疼痛影响着五分之一的美国成年人。综合疼痛管理(IPM) 包括基于正念的减压、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的临床指南中。 尽管有证据表明IPM有效，但IPM并没有接触到患慢性疼痛和 相关的阿片类药物过量。低收入社区依赖于安全网医疗设施来获得 哪些联邦合格的卫生中心(FQHC)是主要提供者。综合医疗集团 针对慢性疼痛的探访(IMGV)是少数几个有希望的IPM干预措施之一，专门为安全网开发 设置。现在的挑战是检查IMGV在FQHC环境中的有效性和实施情况，以 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 目标是成为独立的调查员，评估IPM的有效性和实施情况 旨在减轻慢性疼痛负担的干预措施，特别是在低收入社区。这是K01职业生涯 发展奖将允许罗斯博士在进行试验时获得高级技能，以确定成功的 综合防治措施的实施战略。职业发展活动：K01应用程序将 以Roth博士在社区为基础的培训为基础，提供结构化的教学和实践培训 参与性研究和基础性执行科学技能，通过分组培训--随机 试验设计、成本测量和评估，并与FQHC进行多地点试点研究。这个计划 将让罗斯博士参加强有力的培训活动，包括指导、课程作业、研究项目、 出版和展示、研讨会和研讨会、赠款的编写以及负责任的研究。 导师：罗斯博士的导师团队由来自实施科学、临床 综合卫生研究、干预流行病学、卫生经济学和口蹄疫控制中心。环境：罗斯博士 将受益于北卡罗来纳大学学院的综合研究培训计划和基础设施 医学综合医学项目，顶尖的北卡罗来纳大学吉林斯公共卫生学院，以及 北卡罗来纳州翻译、临床和科学研究所。北卡罗来纳州社区卫生中心 协会将提供与FQHC合作的培训。研究：罗斯博士提出的K01研究项目 将解决在为低收入患者服务的FQHC环境中获得IPM的有限机会。罗斯博士将首先与 通过实施图确定和改进实施战略(目标1)，以确定主要利益攸关方。 然后，她将在两个初级卫生保健中心(一个是农村的，一个是农村的)试行IMGV的有效性和实施措施 城市)在北卡罗来纳州(目标2)。这一奖项将为罗斯博士提交未来的竞争性拨款做好准备 申请一项混合型2型有效性-IMGV在FQHC环境下治疗慢性疼痛的实施试验。

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.