SBIRT (Pain Management) for Veterans Filing Compensation Claims

针对退伍军人提出赔偿索赔的 SBIRT（疼痛管理）

• 批准号: 8657718
• 负责人: Marc I Rosen
• 金额: $ 18.65万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-30 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8657718
• 关键词: Address; Alcohol consumption; Alcohol or Other Drugs use; Back; Caring; Chronic; Clinical Trials; Confidentiality; Congresses; Counseling; Data; Databases; Diagnosis; Disability Evaluation; Evaluation; Financial compensation; Forensic Medicine; Fostering; Freedom; Goals; Health; Healthcare; Illicit Drugs; Injury; Intervention; Interview; Joints; Knee; Manuals; Mental Health; Military Personnel; Modification; Motivation; Musculoskeletal Diseases; Neck; Opioid; Outcome; Pain; Pain intensity; Pain management; Patient Self-Report; Phase; Populations at Risk; Post-Traumatic Stress Disorders; Prevention strategy; Procedures; Process; Professional counselor; Randomized; Randomized Clinical Trials; Readiness; Reporting; Research; Resources; Risk; Services; Severities; Shoulder; Staging; Substance Use Disorder; Substance abuse problem; Techniques; Telephone; Testing; Time; Training; United States Department of Veterans Affairs; Veterans; Videotape; chronic pain; comorbidity; disability payment; drinking; effective intervention; experience; follow-up; high risk; improved; indicated prevention; information gathering; motivational enhancement therapy; operation; prescription opioid; preventive intervention; primary outcome; psychologic; public health relevance; reduced substance use; screening; screening, brief intervention, referral, and treatment; secondary outcome

DESCRIPTION (provided by applicant): This proposed project involves modifying and pilot-testing an established SBIRT intervention for Veterans being evaluated for painful musculoskeletal disorders (MSD) who are at risk for substance use disorders. The modified intervention, SBIRT-PM (Pain Management) is for Veterans who have filed a claim for a (military) service-connected injury for which they have requested financial compensation. Projections are that at least half of OEF/OIF/OND (Operations Enduring Freedom, Iraqi Freedom, New Dawn) Veterans will have some compensable service-connected condition with 140,452 already compensated for back/neck conditions and comparable numbers for other joint conditions. For a significant proportion, the disability evaluation is their first encounter with V healthcare. The disability evaluation is a perfectly-timed opportunity to enlist Veterans in a preventive intervention but this opportunity is typically missed. In our group's completed clinical trial, Veterans applying for Compensation for PTSD were able to be engaged in health-promoting activities significantly more often if they received active counseling around the time of their Compensation claim than controls, but counseling after Compensation exams has not been piloted in Veterans applying for MSD. SBIRT-PM will be delivered around the time of the Compensation examination by a counselor, with confidentiality assured. The counselor will explain that treating both physical and psychological aspects of pain leads to the best outcomes, and will outline what VA services are available to Veterans. After discussing management of pain and things that can impact pain, the counselor will then explain that while substances are sometimes used for pain relief, they can negatively impact pain control. The counselor will then segue into SBIRT. This project will involve two stages: (1) a Counseling Refinement phase during which SBIRT-PM will be pre-piloted in 20 Veterans, qualitative data will be collected immediately after counseling sessions, and the intervention's appeal to Veterans will be optimized; and (2) a randomized clinical trial in which 100 Veterans with MSD and recent risky substance use will be assigned to a No Additional Referral condition, a Pain Module Only condition, or SBIRT- PM in a 1:1:2 ratio and followed for 12 weeks. The primary outcome to be estimated is the slope of weeks with risky substance use. Secondary analyses will estimate the slope of pain intensity and the relationship of substance use and pain slopes, controlling for stage-of-change. Screening and referral to treatment at Compensation examinations can transform a widely-used point of entry to VA into a health-promoting encounter.

描述（由申请人提供）：该拟议的项目涉及对有可能患有药物使用障碍风险的疼痛肌肉骨骼疾病（MSD）评估的退伍军人进行修改和试点测试。修改后的干预措施SBIRT-PM（疼痛管理）是针对对（军事）服务相关伤害提出索赔的退伍军人，他们要求经济赔偿。预测是，至少一半的OEF/OIF/OND（持续自由的操作，伊拉克自由，新黎明）退伍军人将拥有一些可补偿的服务连接状态，其中140,452已获得了背部/颈部条件的补偿，其他关节条件的可比数量。对于很大的比例，残疾评估是他们与V Healthcare的第一次相遇。残疾评估是一个完美的机会，可以在预防干预的情况下招募退伍军人，但通常会错过这种机会。在我们小组完成的临床中 审判，申请PTSD赔偿的退伍军人，如果他们在左右获得积极咨询的情况下，可以更频繁地从事促进健康的活动。 他们的薪酬索赔比对照组，但是在申请MSD的退伍军人中，尚未在薪酬考试后进行咨询。 Sbirt-PM将在咨询师的薪酬检查期间交付，并保证保证。辅导员将解释说，治疗疼痛的身体和心理方面会带来最佳结果，并概述退伍军人可用的VA服务。在讨论了疼痛的管理和可能影响疼痛的事情之后，辅导员将解释说，尽管有时将物质用于缓解疼痛，但它们会对疼痛控制产生负面影响。然后，辅导员将进入Sbirt。该项目将涉及两个阶段：（1）咨询改进阶段，在此期间将在20名退伍军人中预先调查SBIRT-PM，在咨询课程后将立即收集定性数据，并且将优化干预对退伍军人的呼吁； （2）一项随机临床试验，其中有100名具有MSD和最近风险物质的退伍军人将被分配给没有其他转诊条件，仅疼痛模块的条件或以1：1：2的比例分配给SBIRT-PM，然后持续12周。要估计的主要结果是使用风险使用物质的几周斜率。次级分析将估计疼痛强度的斜率以及使用物质使用和疼痛斜率的关系，从而控制了变化阶段。在补偿考试中筛查和转介到治疗可以将广泛使用的VA进入点转化为促进健康的遭遇。