Integrating Nonpharmacologic Strategies for Pain with Inclusion, Respect, and Equity (INSPIRE): Tailored digital tools, telehealth coaching, and primary care coordination

将非药物治疗疼痛策略与包容、尊重和公平相结合 (INSPIRE)：定制数字工具、远程医疗指导和初级保健协调

• 批准号: 10536567
• 负责人: JASON M SATTERFIELD
• 金额: $ 161.42万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-15 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10536567
• 关键词: Address; Affect; African American; Anxiety; Awareness; Black race; Caring; Chinese; Clinical; Cognitive Therapy; Collection; Common Data Element; Communities; Data Collection; Decision Making; Development; Documentation; Education; Educational Intervention; Electronic Health Record; Evidence based intervention; Focus Groups; Future; Health Care Costs; Health Personnel; Health Services Accessibility; Healthcare; Hybrids; Improve Access; Individual; Intake; Integrative Therapy; Intervention; Interview; Knowledge; Language; Latinx; Limited English Proficiency; Linguistics; Low Income Population; Measures; Mediator of activation protein; Medical; Mental Depression; Methods; Minority; Modeling; Morbidity - disease rate; Motivation; Multilingualism; Opioid; Outcome; Pain; Pain intensity; Pain interference; Participant; Pathway interactions; Patient Isolators; Patient Outcomes Assessments; Patient Recruitments; Patients; Persons; Phase; Physical therapy; Pilot Projects; Primary Health Care; Process; Protocols documentation; Provider; Quality of Care; Quality of life; Records; Reporting; Risk; Self Efficacy; Social Network; Social isolation; Stigmatization; Substance Use Disorder; Support Groups; Surveys; System; Testing; Time; Trust; Validation; Visit; Visualization; acceptability and feasibility; arm; base; behavioral health; care coordination; chronic pain; chronic pain management; chronic pain patient; clinically relevant; community engagement; comorbidity; compliance behavior; dashboard; design; digital; digital health; dissemination strategy; ethnic minority; evidence base; flexibility; health care disparity; health disparity; health disparity populations; health literacy; high standard; human centered design; implementation evaluation; implementation outcomes; implementation strategy; improved; informant; literacy; medical specialties; mindfulness; mindfulness meditation; mobile application; opioid use disorder; overdose death; pain outcome; pain reduction; pain symptom; participant retention; pilot test; prescription opioid; primary outcome; process evaluation; programs; provider networks; psychiatric comorbidity; psychologic; racial minority; randomized trial; satisfaction; secondary outcome; smartphone Application; social; social stigma; standard of care; substance use; success; telehealth; theories; tool; treatment as usual; treatment effect; treatment program; tutoring

PROJECT SUMMARY/ABSTRACT Chronic pain (CP) is one of the most common and debilitating medical conditions resulting in substantial morbidity, lower quality of life and tremendous health care costs. With ongoing and tragic consequences, opioids were overprescribed creating a surge in opioid use disorders and overdose deaths. Although non- pharmacologic interventions have a strong evidence base, these interventions are rarely available and expensive. The common co-morbidities of psychiatric and substance use disorders trigger further stigma and lower quality care. Subjective reports of pain symptoms and the cultural meanings ascribed to them create a situation ripe for health care disparities driven by multilevel biases on individual, provider, and systemic levels. These biases are manifested in stigmatizing language and the denial of interventions to reduce pain and alleviate suffering. Multiple studies have shown that racial and ethnic minorities with CP are especially mistreated. It is essential to accelerate the creation of hybrid CP management programs that improve access to treatments while simultaneously addressing the stigma, bias, and mistrust that further harm and isolate patients with CP. The INSPIRE CP intervention creates a hybrid blend of tailored cognitive-behavioral therapy, physical therapy, mindfulness, and pain education delivered via a trilingual mobile app and supported by a telehealth pain coach providing essential care coordination with PCPs within the EHR. PROs for pain, depression, anxiety, substance use, and a range of social risks and needs will be regularly collected, summarized in the coaching dashboard, and shared with PCPs. The intervention builds on an existing, in person pain program for marginalized patients but significantly improves reach, expands cultural and linguistic adaptations, and directly addresses multilevel bias and stigma through intensive community engagement, individual and group support, and the provision of “tech tutoring” to improve digital health literacy. The two year R61 development phase includes 3 specific aims with matched milestones: 1) creation of the digital tool and coaching protocol using intensive community engagement, 2) iterative development of educational and implementation strategies for health care staff and providers, and 3) a 3 month pilot test to further assess acceptability and feasibility. The three year R33 validation phase includes 3 additional specific aims 1) perform a pragmatic RCT with n=586 patients comparing INSPIRE to enhanced usual care, 2) analyze secondary outcomes and the treatment effects model, and 3) a mixed method evaluation of implementation outcomes using Normalization Process Theory to better design strategies for future scale.

项目摘要/摘要 慢性疼痛（CP）是最常见和令人衰弱的医疗状况之一，导致了大量 发病率，较低的生活质量和巨大的医疗保健费用。持续不断的后果， 卵虫类药物过多地处方，从而导致卵毒素使用障碍和过量死亡人数激增。虽然非 - 药理学干预措施具有强大的证据基础，这些干预措施很少可用，并且 昂贵的。精神病和物质使用障碍的常见合并症引发了进一步的污名和 质量较低的护理。 疼痛症状和归因于它们的文化含义的主观报道使情况成熟 由个人，提供商和全身级别的多层次偏见驱动的医疗保健分布。这些偏见 表现出污名化的语言和拒绝减轻疼痛和减轻痛苦的干预措施。 多项研究表明，具有CP的种族和少数民族尤其受到虐待。至关重要 加速建立混合CP管理计划，以改善治疗的机会 同样，解决了进一步伤害CP患者的污名，偏见和不信任。 Inspire CP干预创造了量身定制的认知行为疗法的混合融合 通过三语移动应用进行的治疗，正念和疼痛教育，并得到远程医疗的支持 疼痛教练在EHR中与PCP提供基本的护理协调。疼痛，抑郁的优点 焦虑，物质使用以及一系列社会风险和需求将定期收集，总结在 指导仪表板，并与PCPS共享。干预措施建立在现有的，亲自痛苦的计划的基础上 边缘化的患者，但显着改善了覆盖范围，扩大了文化和语言适应，直接 通过密集的社区参与，个人和团体支持，解决多层偏见和污名， 以及提供“技术辅导”以提高数字健康素养。 两年R61开发阶段包括3个具有匹配里程碑的特定目标：1）创建 使用密集社区参与的数字工具和教练协议，2）迭代发展 医疗保健人员和提供者的教育和实施策略，以及3）3个月的试点测试 进一步评估可接受性和可行性。三年R33验证阶段包括3个其他特定 目的1）进行务实的RCT，n = 586名患者比较激发启发到增强的常规护理，2）分析 次要结果和治疗效果模型，以及3）实施的混合方法评估 使用归一化过程理论的结果来更好地设计策略，以实现未来的规模。