Chronic Pain Management in Veterans with Co-occurring Substance Use Disorders

患有同时发生的药物使用障碍的退伍军人的慢性疼痛管理

• 批准号: 9757713
• 负责人: Travis Ian Lovejoy
• 金额: --
• 依托单位: PORTLAND VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-11-01 至 2019-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9757713
• 关键词: AODD relapse; Address; Adult; Affect; Alcohol or Other Drugs use; Award; Caring; Case-Control Studies; Characteristics; Chronic; Clinic; Clinical; Clinical Trials; Combined Modality Therapy; Competence; Data; Doctor of Philosophy; Dropout; Educational workshop; Effectiveness; Effectiveness of Interventions; Feasibility Studies; Feedback; Focus Groups; Funding; Group Interviews; Guidelines; Health; Health Sciences; Health Services; Health Services Research; Hybrids; Individual; Intervention; Investigator-Initiated Research; K-Series Research Career Programs; Knowledge; Medical center; Medicine; Mentors; Methods; Monitor; Oregon; Outcome; Outpatients; Pain; Pain management; Patient Education; Patients; Physical therapy; Population; Preventive Medicine; Primary Health Care; Provider; Psychiatry; Psychologist; Public Health; Qualitative Evaluations; Quality of life; Recommendation; Research; Research Methodology; Research Personnel; Research Proposals; Research Training; Resources; Sampling; Services; Site; Substance Use Disorder; Substance abuse problem; Symptoms; Testing; Training; Training Programs; Universities; Veterans; base; care seeking; career; case finding; chronic pain; clinical implementation; collaborative care; collaborative trial; disability; effective intervention; effectiveness trial; evidence base; experience; health care settings; implementation research; implementation science; implementation trial; improved; improved outcome; innovation; medical specialties; mid-career faculty; non-cancer chronic pain; opioid therapy; pain reduction; patient population; pilot trial; preference; prescription opioid; prescription opioid abuse; professor; psychosocial; reduced substance abuse; research and development; therapy design; treatment as usual; treatment program

DESCRIPTION (provided by applicant): This application proposes a mentored training program to develop Travis Lovejoy, PhD, MPH into an independent VA Health Services Research & Development (HSR&D) investigator with expertise in the treatment and study of pain in specialty substance use disorder (SUD) treatment settings. Dr. Lovejoy is a Clinical Psychologist and junior Health Services Researcher at the Portland VA Medical Center and Assistant Professor of Psychiatry at Oregon Health & Science University (OHSU). Dr. Lovejoy's training objectives for the Career Development Award (CDA) include (a) establishing further content expertise in pain and substance use disorders, (b) developing proficiency in the use of VA administrative data to answer key research questions, and (c) enhancing competency in qualitative and mixed methods approaches as they apply to clinical trials and implementation science. His training plan consists of formal coursework, advanced training workshops, and mentor-guided study. Dr. Lovejoy is supported by an accomplished mentoring team of health services researchers that includes Steven Dobscha, MD, Director of the Center to Improve Veteran Involvement in Care (CIVIC), the newly funded VA HSR&D Center of Innovation at Portland VA Medical Center; Linda Ganzini, MD, MPH, Associate Director of CIVIC and Professor of Psychiatry and Medicine at OHSU; Benjamin Morasco, PhD, CIVIC Research Investigator and Associate Professor of Psychiatry at OHSU; Dennis McCarty, PhD, Professor and Vice Chair of Public Health and Preventive Medicine at OHSU; and Hildi Hagedorn, PhD, Core Research Investigator at the Minneapolis VA Medical Center and Implementation Research Coordinator for the SUD Quality Enhancement Research Initiative (SUD QUERI). The resources at OHSU and the Portland VA Medical Center support the transition of junior researchers from mentored study to research independence. These resources, combined with the expert guidance of the mentoring team, will provide the ideal opportunity for Dr. Lovejoy to develop into an independent VA HSR&D investigator. Dr. Lovejoy will complete three interrelated studies during the CDA. Study 1 will use VA administrative data to characterize pain treatment utilization in a national sample of Veterans following initiation of specialty SUD treatment and compare pain treatment utilization to that of Veterans with co-occurring chronic pain and SUDs who do not initiate specialty SUD care. Findings from this study will inform a VA HSR&D Investigator Initiated Research proposal for a mixed methods study that will evaluate practices of high-and low- performing VA SUD treatment programs in managing Veterans' chronic pain. Study 2 will qualitatively examine pain treatment experiences and preferences in Veterans with chronic pain currently receiving specialty SUD treatment at a single VA Medical Center. Additional qualitative focus groups and interviews with key VA Medical Center stakeholders will examine barriers and facilitators to implementation of a collaborative pain intervention into a specialty SUD treatment setting. Data from study 2 will inform tailoring of an evidence- based, primary care-delivered collaborative pain intervention for implementation in a specialty outpatient SUD treatment setting. Study 3 is a pilot non-controlled trial of the tailored collaborative pain intervention delivered in the specialty SUD treatment setting. Findings from this pilot trial will inform a second VA HSR&D Investigator Initiated Research proposal for a multi-site effectiveness trial of the collaborative pain intervention that concurrently evaluates intervention implementation. Successful completion of the proposed research and training will prepare Dr. Lovejoy to become an independent VA HSR&D investigator with expertise in pain and substance use, clinical trials, and mixed methods research.

描述（由申请人提供）： 该申请提出了一项指导的培训计划，以开发Travis Lovejoy博士，MPH，成为独立的VA卫生服务研究与发展（HSR＆D）研究人员，该研究人员在治疗和研究特种药物使用障碍（SUD）治疗环境方面具有专业知识。 Lovejoy博士是波特兰VA医学中心的临床心理学家和初级健康服务研究员，俄勒冈州健康与科学大学（OHSU）的精神病学助理教授。 Lovejoy博士的职业发展培训目标（CDA）包括（a）建立疼痛和药物使用障碍方面的进一步内容专业知识，（b）在应用临床试验和实施科学方面提高使用VA行政数据来回答关键研究问题的能力来回答关键研究问题。他的培训计划包括正式的课程，高级培训研讨会和导师指导的研究。 Lovejoy博士得到了一支精通的卫生服务研究人员的指导团队，其中包括史蒂文·多布萨（Steven Dobscha），医学博士，医学博士，改善了老兵参与护理（CIVIC）的总监，这是新资助的VA HSR＆D创新中心，位于波特兰VA VA Medical Center的Innovation中心； OHSU的Civic and Medicine和Medicine教授MPH，MPH，MPH，MPH； Linda Ganzini； Benjamin Morasco博士，OHSU的公民研究研究员兼精神病学副教授； OHSU的公共卫生和预防医学教授兼副主席丹尼斯·麦卡蒂（Dennis McCarty）博士； Minneapolis VA医疗中心的核心研究研究员Hildi Hagedorn博士和SUD质量增强研究计划的实施研究协调员（SUD QuERI）。 OHSU和波特兰VA医疗中心的资源支持初级研究人员从指导研究到研究独立性的过渡。这些资源以及指导团队的专家指导，将为LoveJoy博士提供发展成为独立的VA HSR＆D调查员的理想机会。 Lovejoy博士将在CDA期间完成三项相互关联的研究。研究1将使用VA行政数据来表征在启动后国家退伍军人样本中的疼痛治疗利用 专业SUD治疗和将慢性疼痛的退伍军人与不启动专业SUD护理的慢性疼痛和SUD的退伍军人进行了比较。这项研究的结果将为VA HSR＆D研究者提供了一项混合方法研究的研究建议，该研究将评估高表现的VA SUD治疗计划的实践，以管理退伍军人的慢性疼痛。研究2将定性检查慢性疼痛的退伍军人的疼痛治疗经历和偏好，目前在一个VA医疗中心接受专业SUD治疗。其他定性焦点小组以及对VA关键医疗中心利益相关者的访谈将检查障碍和促进者，以将协作性疼痛干预实施到特殊的SUD治疗环境中。研究2中的数据将为您的基于循证的，基于循证的初级保健协作疼痛干预措施的裁缝提供裁缝，以在特殊的门诊SUD治疗设置中实施。研究3是一项针对特殊SUD治疗设置中提供的量身定制的协作疼痛干预措施的试验非控制试验。这项试验试验的发现将为第二次VA HSR＆D研究者提供研究建议，以对合作疼痛干预的多站点有效性试验，该试验同时评估干预实施。拟议的研究和培训的成功完成将使Lovejoy博士成为一名独立的VA HSR＆D研究者，该研究人员在疼痛和药物使用，临床试验和混合方法研究方面具有专业知识。