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

在初级保健中实施针对持续性背痛的循证治疗

• 批准号: 8354598
• 负责人: DANIEL C. CHERKIN
• 金额: $ 24万
• 依托单位: KAISER FOUNDATION HEALTH PLAN OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-01 至 2014-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8354598
• 关键词: Acupuncture procedure; Address; American; American College of Physicians; Back Pain; Caring; Chronic; Clinic; Cognitive Therapy; Complementary and alternative medicine; Complex; Development; Educational Materials; Ensure; Evaluation; Evidence based intervention; Evidence based treatment; Familiarity; Future; Guidelines; Health; Healthcare; Integrated Delivery of Health Care; Intervention; Knowledge; Leadership; Learning; Massage; Medical; Methods; Mind-Body Intervention; Modification; Monitor; Muscle relaxation phase; National Center for Complementary and Alternative Medicine; Opioid; Outcome; Pain; Pain management; Patients; Pharmaceutical Preparations; Physicians; Plant Roots; Primary Health Care; Process; Recommendation; Rehabilitation therapy; Research; Research Personnel; Societies; Spinal Manipulation; Staging; System; Techniques; Testing; TimeLine; Washington; Yoga; chronic back pain; clinical care; clinical practice; dissemination research; economic cost; effective therapy; evidence base; evidence based guidelines; health care service organization; implementation research; improved; interest; non-cancer pain; programs; progressive relaxation therapy; response; social; success; systematic review

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. PUBLIC HEALTH RELEVANCE: This proposal addresses the substantial gap between knowledge of effective treatments for persistent back pain (most of which are complementary and alternative and mind/body techniques) and implementation of this knowledge into practice. Formal evaluation of the process of implementing back pain guidelines into practice will provide information critical for the success of future efforts to bridge the gap between research and practice.

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，即确定有效的方法来实施循证干预措施，以“提供结合补充和替代医学方法的疼痛管理策略的医疗保健环境”。持续性背痛的有效治疗方法与将这些知识付诸实践之间存在巨大差距。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，脊柱手法，针灸、按摩、瑜伽、认知行为疗法、渐进式放松）临床医生对这些疗法缺乏了解，这对鼓励患者使用这些疗法提出了特殊的挑战。此外，人们对实施任何基于证据的 CAM 干预措施的挑战知之甚少。实践或如何应对这些挑战。为了帮助克服这些障碍，我们建议正式评估在初级保健实践中实施背痛指南的过程，包括针对慢性背痛的 CAM 和身心治疗。由于背痛在美国造成巨大的个人、社会和经济成本，改善背痛临床护理的潜在好处是巨大的。 我们建议对团体健康 (GHC) 初级保健诊所试点实施针对持续性背痛的循证指南进行形成性评估。形成性评估认识到医疗保健组织是复杂的适应性系统，并且以不可预测的方式不断变化。因此，我们的评估方法将包括持续监控和修改，以识别可能影响项目成功的障碍、促进因素和其他适应性因素。具体目标：在实施之前，我们将识别、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）。在实施过程中，我们将确定计划与其实施之间的差异，并监测影响和实现预期成果的进展指标（目标 2）。实施后，我们将分析前一阶段的经验教训以及利益相关者的汇报，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，并传播给有兴趣在其他环境中实施循证治疗的其他人。 鉴于之前实施背痛指南的结果令人失望，并且缺乏评估在医疗保健环境中实施循证 CAM 和身心治疗效果的研究，我们的研究结果将提供对于成功至关重要的信息未来努力弥合 研究与实践之间的这些差距。 公共卫生相关性：该提案解决了持续性背痛的有效治疗知识（其中大部分是补充性和替代性以及身心技术）与将这些知识付诸实践之间的巨大差距。对将背痛指南实施到实践过程的正式评估将为未来弥合研究与实践之间差距的努力的成功提供至关重要的信息。