Pain Management in the Clinic & Community

诊所的疼痛管理

基本信息

批准号：
8576352
负责人：
Kelly Ray Knight
金额：
$ 29.93万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-06-01 至 2016-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8576352
关键词：
Adult Affect Alcohol or Other Drugs use American Analgesics Area Attention Belief Cancer Pain Management Caring Cessation of life Chronic Clinic Clinical Clinical Nursing Code Communities County Data Diabetes Mellitus Diagnosis Dimensions Ethnography Frequencies Goals Health Health Care Costs Health Services Health Services Accessibility Health system Healthcare Heart Diseases Home environment Individual Institute of Medicine (U.S.)Interdisciplinary Study Interview Knowledge Life Low income Malignant Neoplasms Medical Mental Health Methodology Modeling Morbidity - disease rate Opioid Outcome Overdose Pain Pain Clinics Pain Research Pain management Participant Patients Perception Pharmaceutical Preparations Physicians Policies Primary Health Care Principal Investigator Provider Public Health Qualitative Methods Race Recording of previous events Research Research Personnel Risk Sampling San Francisco Services Social Environment Societies Specialist Staging Study models Uncertainty Uninsured United States base clinical practice coping disability experience high risk improved innovation mortality non-cancer pain opioid misuse prescription opioid public health relevance research study safety net social theories

项目摘要

DESCRIPTION (provided by applicant): The proposed study will use qualitative methods to examine the factors impacting primary care providers' and patients' pain management practices in clinical settings and patients' home communities. Chronic non-cancer pain (CNCP), which affects 25% of American adults, is a leading cause of disability and exorbitant health care costs in the United States. Low income patients, who access primary care services in safety net health systems, are more likely to be diagnosed with CNCP than their insured counterparts. CNCP patients with histories of substance use are the highest frequency users of prescribed opioid pain medications with the least access to pain and mental health specialist care. The Institute of Medicine and the American Pain Society have concluded that a dearth of scientific research exists to guide primary care providers' (PCPs') pain management practices, particularly with substance-using patients at high risk for opioid misuse and morbidity and mortality associated with accidental overdose. Arthur Kleinman's model for the anthropological study of pain management suggests that Western clinical health practices encompass individual, interactive and socio- structural dimensions which all influence health outcomes. Pain management practices take place in specific and widely divergent social contexts: the clinic where pain is discussed and responded to biomedically and home environments where patients cope with pain on an everyday basis. By adapting Kleinman's model to target CNCP patients with histories of substance use and their PCPs, the proposed qualitative study will provide needed contextual, observational data to inform CNCP pain management for this high-risk, under- researched patient group. The Specific Aims are: Aim 1: To explore primary care providers' pain management practices in safety net clinical settings with patients who have a history (past or current) of substance use. Aim 2: To explore patients' pain management practices in clinical settings. Aim 3: To explore patients' pain management practices in their home environments. The study will take place in six safety net clinics and patients' home environments in three diverse San Francisco Bay Area Counties. For Aim 1 we will conduct (a) qualitative interviews with 20 PCPs and (b) clinical observation of pain management interactions between the 20 PCPs and 60 of their CNCP patients. For Aim 2, we will conduct (a) qualitative interviews with the 60 CNCP patients and (b) analyze the patient-provider clinical interaction data from the patient perspective. For Aim 3, we will conduct community-based participant observation with a theoretically-selected sample of 20 of the 60 participating patients. Qualitative data will be transcribed, coded and analyzed using grounded theory methodologies. The multidisciplinary research team, consisting of a medical anthropologist/substance use researcher (Early Stage Principal Investigator), a physician/health services researcher (Co-investigator), and a nurse/clinical pain policy expert (Co-investigator), will synthesize the data with the goal of improving our understanding of CNCP management to inform future research and clinical practice.

描述（由申请人提供）：拟议的研究将使用定性方法来检查影响临床环境和患者家庭社区中初级保健提供者和患者疼痛管理实践的因素。影响美国成年人25％的慢性非癌症疼痛（CNCP）是美国残疾和高昂的医疗保健费用的主要原因。与保险人相比，低收入的患者（在安全网卫生系统中获得初级保健服务的患者）更有可能被诊断为CNCP。具有药物使用史的CNCP患者是处方的阿片类止痛药的最高频率使用者，获得疼痛和心理健康专家护理的最少使用。医学研究所和美国疼痛协会得出的结论是，存在科学研究的缺乏是为了指导初级保健提供者（PCPS'）疼痛管理实践，尤其是在使用阿片类药物滥用和发病率和死亡率高的患者中，与意外过量相关的患者。亚瑟·克莱曼（Arthur Kleinman）的疼痛管理人类学研究模型表明，西方临床健康实践包括个人，互动和社会结构方面，都影响了健康结果。疼痛管理实践发生在特定且广泛不同的社会环境中：讨论疼痛和对生物医学和家庭环境的疼痛做出反应的诊所，患者每天都应对疼痛。通过将Kleinman的模型调整为针对CNCP患者具有物质使用史及其PCP的患者，拟议的定性研究将提供所需的上下文，观察数据，以告知CNCP疼痛管理，以供这个高风险，研究不足的患者组。具体目的是：目标1：探索在安全网临床环境中与具有史（过去或当前）药物使用史的患者的疼痛管理实践。目标2：探索在临床环境中患者的疼痛管理实践。目标3：探索患者在家庭环境中的疼痛管理实践。该研究将在旧金山湾区三个县的六个安全网诊所和患者家庭环境中进行。对于AIM 1，我们将对20个PCP进行定性访谈，以及（b）对20个PCP和60名CNCP患者之间疼痛管理相互作用的临床观察。对于AIM 2，我们将对60名CNCP患者进行定性访谈，并（b）从患者的角度分析患者提供者的临床交互数据。对于AIM 3，我们将使用60名参与患者中的20个中的20个样本进行基于社区的参与者观察。定性数据将使用接地理论方法进行转录，编码和分析。多学科研究团队由医学人类学家/药物使用研究人员（早期首席研究员），医师/卫生服务研究员（共同研究人员）以及护士/临床疼痛政策专家（共同研究人员）组成，将综合数据，以改善我们对CNCP管理的了解，以了解我们对CNCP的了解和诊所的了解。