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

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，美国卫生与公众服务部发布了《国家疼痛战略》， 它概述了一项协调计划，以改善疼痛患者的医疗服务，并概述了更好的需求。 监测方法，支持以患者为中心的综合疼痛管理实践，并改善可及性 有效的非药物疗法（NPT）反映了疼痛对民用医疗保健系统的影响。 军队和退伍军人群体；军事卫生系统 (MHS) 和退伍军人健康 与平民相比，政府 (VHA) 人群的慢性疼痛患病率更高。 医疗监测月度报告确定了在 MHS 寻求治疗的九大原因（除以下原因外）： 怀孕服务和不明确的症状有五项与肌肉骨骼（背部、膝盖、脚踝、手臂）有关。 受伤或问题，其余的首要条件是焦虑、情绪/适应和睡眠障碍， 在某些情况下，这可能是疼痛的合并症。 本研究是一项更新的 R01 应用程序，旨在增进有关军事准备、阿片类药物和药物的知识 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 SUPIC 项目（药物使用和心理伤害打击）的研究人员。 R01AT008404）已经生成了有关慢性疼痛及其行为健康的基础知识 我们建立了一个关于陆军成员的综合纵向数据库。 返回的部署包括其 MHS 和 VHA 健康遭遇/索赔数据以及其他一些数据 我们研究了早期 NPT 的利用（两者是互补的[例如脊椎按摩疗法、 针灸、脊柱推拿、自我管理、跨学科疼痛项目]策略和综合 [例如，运动疗法、物理疗法、职业疗法、心理健康专业护理]策略，以及 发现慢性疼痛人群中阿片类药物的流行率很高。 SUPIC 续展申请的具体目标是： 目标 1：(a) 描述早期轨迹 (b) 检查 NPT 利用之间的关系（例如， 具体方式、利用轨迹）和多维结果（例如军事准备、阿片类药物 (c) 研究离散高水平中 NPT 轨迹与结果的关系 患者的风险亚组（共病 PTSD、抑郁症）和特定疼痛状况（例如背痛、其他疼痛） 目标 2：确定设施和提供者层面的因素（健康领域的 FTE 可用性）。 职业、提及 NPT 或开阿片类药物的倾向）解释了 NPT 使用和阿片类药物的变化 目标 3： (a) 描述 SUPIC 陆军部署成员的特征。 (b) 确定《不扩散核武器条约》之间的关联 MHS 中的收据和 VHA 中的长期健康结果（主要影响）；以及 (c) 确定调节因素和 这些协会的调解人。 这笔续签拨款将有效地继续开展 MHS 疼痛管理方面急需的工作 将直接告知 MHS 和 VHA 领导层并促进知情的临床和组织的方法 2013-2018 年，SUPIC 研究人群将扩大到所有服务部门的成员。 （预计200万以上），扩大调查队伍，强化实践知识 并促进国防和退伍军人研究人员将研究成果快速转化为行动。 国防部综合疼痛管理中心 疼痛策略卓越中心正在加入调查团队。