Trajectories of non-pharmacologic and opioid health services for pain management in association with military readiness and health status outcomes: SUPIC renewal

用于疼痛管理的非药物和阿片类药物健康服务与军事准备和健康状况结果相关的轨迹：SUPIC 更新

• 批准号: 10448404
• 负责人: Rachel Sayko Adams
• 金额: $ 76.97万
• 依托单位: BRANDEIS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10448404
• 关键词: Acupuncture Therapy; Adjustment Disorders; Adverse event; Ankle; Anxiety Disorders; Arm Injuries; Back; Back Pain; Caring; Characteristics; Chronic low back pain; Clinical; Clinical Practice Guideline; Clinical Treatment; Data; Data Sources; Databases; Department of Defense; Early treatment; Exercise Therapy; Exposure to; Feeling suicidal; Foundations; Goals; Grant; Headache; Health; Health Care Costs; Health Occupations; Health Personnel; Health Services; Health Services Research; Health Status; Health care facility; Healthcare; Healthcare Systems; High Prevalence; Hospitalization; Improve Access; Individual; Injury; Institute of Medicine (U.S.); Knee; Knowledge; Leadership; Mediator of activation protein; Medical; Medical Surveillance; Mental Depression; Mental Health; Methods; Military Personnel; Modality; Monitor; Moods; Musculoskeletal; National Center for Complementary and Integrative Health; Nonpharmacologic Therapy; Observational Study; Occupational Therapy; Opioid; Organizational Change; Outcome; Overdose; Pain; Pain management; Patients; Physical therapy; Policies; Population; Post-Traumatic Stress Disorders; Practice Management; Pregnancy; Procedures; Productivity; Prospective Studies; Quality of life; Recording of previous events; Reporting; Research; Research Personnel; Sampling; Self Management; Services; Sleep Disorders; Solid; Spinal Manipulation; Structure; Substance Use Disorder; Symptoms; Time; Translational Research; United States; United States Dept. of Health and Human Services; Universities; Update; Variant; Veterans; Veterans Health Administration; Work; active duty; adverse outcome; behavioral health; care seeking; chiropracty; chronic pain; cohort; combat; combat readiness; comorbidity; cost; disability; economic cost; evidence base; experience; follow-up; health administration; health care delivery; high risk; improved; longitudinal database; medical specialties; member; military health system; military veteran; next generation; non-drug; opioid therapy; opioid use; pain reduction; patient oriented; patient subsets; prescription opioid; programs; provider factors; psychologic; research study; response; service member; stressor; study population; substance use; Acupuncture Therapy; Adjustment Disorders; Adverse event; Ankle; Anxiety Disorders; Arm Injuries; Back; Back Pain; Caring; Characteristics; Chronic low back pain; Clinical; Clinical Practice Guideline; Clinical Treatment; Data; Data Sources; Databases; Department of Defense; Early treatment; Exercise Therapy; Exposure to; Feeling suicidal; Foundations; Goals; Grant; Headache; Health; Health Care Costs; Health Occupations; Health Personnel; Health Services; Health Services Research; Health Status; Health care facility; Healthcare; Healthcare Systems; High Prevalence; Hospitalization; Improve Access; Individual; Injury; Institute of Medicine (U.S.); Knee; Knowledge; Leadership; Mediator of activation protein; Medical; Medical Surveillance; Mental Depression; Mental Health; Methods; Military Personnel; Modality; Monitor; Moods; Musculoskeletal; National Center for Complementary and Integrative Health; Nonpharmacologic Therapy; Observational Study; Occupational Therapy; Opioid; Organizational Change; Outcome; Overdose; Pain; Pain management; Patients; Physical therapy; Policies; Population; Post-Traumatic Stress Disorders; Practice Management; Pregnancy; Procedures; Productivity; Prospective Studies; Quality of life; Recording of previous events; Reporting; Research; Research Personnel; Sampling; Self Management; Services; Sleep Disorders; Solid; Spinal Manipulation; Structure; Substance Use Disorder; Symptoms; Time; Translational Research; United States; United States Dept. of Health and Human Services; Universities; Update; Variant; Veterans; Veterans Health Administration; Work; active duty; adverse outcome; behavioral health; care seeking; chiropracty; chronic pain; cohort; combat; combat readiness; comorbidity; cost; disability; economic cost; evidence base; experience; follow-up; health administration; health care delivery; high risk; improved; longitudinal database; medical specialties; member; military health system; military veteran; next generation; non-drug; opioid therapy; opioid use; pain reduction; patient oriented; patient subsets; prescription opioid; programs; provider factors; psychologic; research study; response; service member; stressor; study population; substance use

Summary/Abstract In 2016, the US Department of Health and Human Services released the National Pain Strategy, which outlined a coordinated plan to improve healthcare delivery for patients with pain. It outlined the need for better monitoring methods, supporting patient-centered integrated pain management practices, and improving access to effective non-pharmacological therapies (NPT). The impact of pain in civilian health care systems is mirrored in the military and veteran populations; both the Military Health System (MHS) and Veterans Health Administration (VHA) populations have a higher prevalence of chronic pain compared to civilian populations. The Medical Surveillance Monthly Report identified the top nine reasons for seeking care in the MHS outside of pregnancy services and ill-defined symptoms. Five were related to musculoskeletal (back, knee, ankle, arm) injuries or problems and the remaining top conditions were anxiety, mood/adjustment, and sleep disorders, which in some cases could be comorbidities with pain. The present study is a renewal R01 application to advance knowledge on military readiness, opioid, and health status outcomes associated with different early treatment trajectories of nondrug pain management strategies in the MHS. Investigators from the SUPIC project (Substance Use and Psychological Injury Combat R01AT008404) have generated foundational knowledge about chronic pain and its behavioral health comorbidities in the MHS. We have established a comprehensive, longitudinal database on Army members returning deployment comprised of their MHS and VHA health encounter/claims data and several other data sources. We have investigated the use of early NPT utilization (both complementary [e.g., chiropractic, acupuncture, spinal manipulation, self-management, interdisciplinary pain programs] strategies and integrative [e.g., exercise therapy, physical therapy, occupational therapy, mental health specialty care] strategies, and identified there is high prevalence of opioid medications in the chronic pain cohort. The Specific Aims of the SUPIC renewal application are to: Aim 1: (a) Characterize early trajectories of NPT and opioid therapies for pain management; (b) examine relationships between NPT utilization (e.g., specific modalities, utilization trajectories) and multidimensional outcomes (e.g., military readiness, opioid utilization, health status); and (c) investigate the relationship of NPT trajectories and outcomes in discrete high risk subgroups of patients (comorbid PTSD, depression) and for specific pain conditions (e.g., back pain, other musculoskeletal, headache). Aim 2: Identify facility- and provider-level factors (FTE availability for health occupations, propensity to refer to NPT or prescribe opioids) that explain variation in NPT use and opioid prescribing between MHS facilities. Aim 3: (a) Describe the characteristics of SUPIC Army deployed members with chronic pain in the MHS who do and do not transition to VHA care; (b) identify associations between NPT receipt in the MHS and long-term health outcomes in the VHA (main effects); and (c) identify moderators and mediators of these associations. This renewal grant is poised to efficiently continue much needed work on MHS pain management approaches that will directly inform MHS and VHA leadership and facilitate informed clinical and organizational changes. The SUPIC study population will be expanded to members of all service branches in 2013-2018 (estimated at 2 million or more) and the investigative team is expanded to strengthen our practical knowledge and facilitate rapid translation of research findings into action. Researchers from the Defense & Veterans Center on Integrative Pain Management at the Uniformed Services University, the Department of Defense’s Center of Excellence on pain strategies are joining the investigative team.

摘要/摘要 2016年，美国卫生与公共服务部发布了国家疼痛战略，该战略 概述了一个协调的计划，以改善疼痛患者的医疗保健分娩。它概述了需要更好的 监视方法，支持以患者为中心的综合疼痛管理实践以及改善访问 进行有效的非药理疗法（NPT）。疼痛对平民卫生保健系统的影响反映了 在军队和退伍军人人口中；军事卫生系统（MHS）和退伍军人卫生 与平民相比，行政管理（VHA）人口的慢性疼痛患病率更高。 医疗监视月度报告确定了在MHS外寻求护理的前9个原因 怀孕服务和不确定的符号。五个与肌肉骨骼有关（背部，膝盖，脚踝，手臂） 伤害或问题以及其余的最高条件是焦虑，情绪/调整和睡眠障碍， 在某些情况下，这可能是痛苦的合并症。 本研究是续签R01的应用，以提高有关军事准备，阿片类药物和 与非药物疼痛管理的不同早期治疗轨迹相关的健康状况结果 MHS中的策略。 Supic项目的研究人员（药物使用和心理伤害战斗 R01AT008404）已经产生了有关慢性疼痛及其行为健康的基础知识 MHS合并症。我们已经为陆军成员建立了一个全面的纵向数据库 返回部署完成了其MHS和VHA健康遭遇/索赔数据以及其他几个数据 来源。我们已经调查了早期NPT利用的使用（均完成[例如，脊骨疗法， 针灸，脊柱操纵，自我管理，跨学科疼痛计划]策略和整合 [ 确定慢性疼痛队列中阿片类药物的患病率很高。 超越续订应用的具体目的是：目标1：（a）表征的早期轨迹 NPT和阿片类药物疗法用于疼痛管理； （b）NPT利用之间的检查关系（例如， 特定方式，利用轨迹）和多维成果（例如，军事准备，阿片类药物 利用，健康状况）； （c）研究不可分裂的轨迹和成果在离散高的关系中的关系 患者的风险亚组（合并症，抑郁症）和特定的疼痛状况（例如，背痛，其他 肌肉骨骼，头痛）。目标2：确定设施和提供商级别的因素（健康可用性 占用，保证参考NPT或规定的阿片类药物），解释了NPT使用和阿片类药物的变化 开处方MHS设施之间。目标3：（a）描述部署成员的仰卧特征 MHS的慢性疼痛，他们做也不过渡到VHA护理； （b）确定NPT之间的关联 VHA（主要影响）中MHS和长期健康结果的收到； （c）确定主持人和 这些关联的调解人。 这项更新赠款被毒死以有效地继续在MHS疼痛管理上进行急需的工作 将直接告知MHS和VHA领导的方法，并促进临床和组织 更改。 Supic研究人群将在2013 - 2018年将所有服务分支机构的成员扩展 （估计为200万或更多），调查团队将扩大以增强我们的实践知识 并促进将研究发现的快速转化为行动。国防与退伍军人的研究人员 统一服务大学的综合疼痛管理中心，国防部 疼痛策略卓越中心正在加入调查团队。