Pilot of Peers Enhancing Engagement for Pain Services

同行加强疼痛服务参与试点

• 批准号: 10700218
• 负责人: Sara Edmond
• 金额: --
• 依托单位: VA CONNECTICUT HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-02-01 至 2025-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10700218
• 关键词: Active Listening; Address; Behavioral; Caring; Centers for Disease Control and Prevention (U.S.); Certification; Chronic; Chronic Disease; Clinic; Clinical; Clinical Trials; Data; Development; Distress; Effectiveness; Elements; Employee; Enrollment; Goals; Guidelines; Healthcare; Individual; Intervention; Manuals; Medicine; Mental Health; Methodology; Opioid; Outcome; Outcome Measure; Pain; Pain management; Patients; Persistent pain; Personal Satisfaction; Pharmaceutical Preparations; Physical activity; Primary Care; Prospective Studies; Protocols documentation; Public Health; Quality of life; Randomized, Controlled Trials; Recommendation; Research; Research Personnel; Resources; Role; Self Management; Services; Specialist; Substance Use Disorder; Testing; Time; Training; Veterans; Veterans Health Administration; Walking; Work; acceptability and feasibility; addiction; arm; chronic pain; chronic pain management; chronic pain patient; cost; daily functioning; diabetes self-management; disability; experience; functional improvement; improved; innovation; intervention mapping; intervention refinement; medical appointment; meetings; motivational enhancement therapy; multidisciplinary; multimodality; non-cancer chronic pain; non-opioid analgesic; opioid misuse; opioid overdose; opioid therapy; pain reduction; pain self-management; pain-related disability; patient engagement; patient navigator; pedometer; peer; peer support; physical conditioning; pilot test; pilot trial; randomized trial; rehabilitation research; research and development; skills; team-based care; therapy development; whole health; Active Listening; Address; Behavioral; Caring; Centers for Disease Control and Prevention (U.S.); Certification; Chronic; Chronic Disease; Clinic; Clinical; Clinical Trials; Data; Development; Distress; Effectiveness; Elements; Employee; Enrollment; Goals; Guidelines; Healthcare; Individual; Intervention; Manuals; Medicine; Mental Health; Methodology; Opioid; Outcome; Outcome Measure; Pain; Pain management; Patients; Persistent pain; Personal Satisfaction; Pharmaceutical Preparations; Physical activity; Primary Care; Prospective Studies; Protocols documentation; Public Health; Quality of life; Randomized, Controlled Trials; Recommendation; Research; Research Personnel; Resources; Role; Self Management; Services; Specialist; Substance Use Disorder; Testing; Time; Training; Veterans; Veterans Health Administration; Walking; Work; acceptability and feasibility; addiction; arm; chronic pain; chronic pain management; chronic pain patient; cost; daily functioning; diabetes self-management; disability; experience; functional improvement; improved; innovation; intervention mapping; intervention refinement; medical appointment; meetings; motivational enhancement therapy; multidisciplinary; multimodality; non-cancer chronic pain; non-opioid analgesic; opioid misuse; opioid overdose; opioid therapy; pain reduction; pain self-management; pain-related disability; patient engagement; patient navigator; pedometer; peer; peer support; physical conditioning; pilot test; pilot trial; randomized trial; rehabilitation research; research and development; skills; team-based care; therapy development; whole health

Background: Chronic pain, and particularly high-impact chronic pain (that is, pain last three months or longer that impacts daily functioning in one or more domains) is a leading cause of disability, often associated with declining functioning, lost days of work, and worsened quality of life. The Veterans Health Administration (VHA) identified both improved pain management and reduced opioid-related harms as national priorities, with an emphasis on improving function and pain-related disability. Peer specialists may be an untapped and valuable resource to support Veterans with chronic pain and enhance the effectiveness of pain treatment. Peer specialists are individuals with lived experience who work with Veterans to encourage patient activation and help patients manage chronic conditions. Peer specialists work in a variety of clinical settings, most commonly mental health clinics, and are well-suited to help patients who are harder to engage in services or those needing more support to promote self-management strategies. Peer support is particularly effective for patients with more severe illnesses or higher levels of distress, and thus may be helpful for Veterans with high-impact chronic pain. Significance: Chronic pain is one of the most common and costly problems among Veterans using VHA healthcare. VHA guidelines for pain management and opioid therapy encourage non-pharmacological pain management strategies (NPMs) and non-opioid medications for chronic pain management. However, NPMs that emphasize improved pain-related function are often underutilized. Addressing pain management and opioid misuse are VHA priorities and this research directly aligns with VHA Rehabilitation Research & Development (RR&D) priorities, including promotion of non-pharmacological activity-based interventions for chronic pain, impacting outcomes such as pain; it also aligns with RR&D’s broader goal of maximizing Veteran’s function and quality of life. Innovation & Impact: The role of peer specialists in VHA is rapidly expanding beyond traditional mental health settings, leading to an urgent need for additional research to understand how best to use peer specialists’ unique skills to enhance care for Veterans in a wider range of settings. No studies to date have evaluated the use of peer specialists to support improvements in pain-related function among Veterans with chronic pain. The current proposal is innovative because it proposes, for the first time, using peer specialists to focus on pain management. If proven effective, this project could pave the way for widespread implementation of peer specialists into new settings where they can support pain management. Specific Aims: The specific aims of this project are to (1) Use intervention mapping (IM) to refine our intervention, Peers Enhancing Engagement for Pain Services (PEEPS) and (2) Pilot test the feasibility and acceptability of PEEPS and collect function-focused outcome measures for use in a rigorous prospective study. Methodology: After refining the intervention protocol using intervention mapping, we propose a single arm pilot trial where we will enroll 24 Veterans with high-impact chronic pain to participate in PEEPS, collecting data at baseline and three-months post baseline. Our primary focus will be feasibility and acceptability; we will also collect data on pain-related function, activity (steps walked, using pedometers), and well-being/quality of life. Next Steps/Implementation: These data will inform the development of a larger proposal testing PEEPS in a multicenter randomized controlled trial.

背景：慢性疼痛，尤其是高影响力的慢性疼痛（即持续三个月或更长时间的疼痛 这会影响一个或多个域中的每日功能）是残疾的主要原因，通常与 功能下降，工作日子损失以及生活质量恶化。退伍军人卫生管理局（VHA） 确定疼痛管理的改善和减少与阿片类药物有关的危害是国家优先事项， 强调改善功能和疼痛相关的残疾。同行专家可能是一个未开发和有价值的 支持慢性疼痛的退伍军人的资源，并提高疼痛治疗的有效性。同行 专家是具有现场经验的人，他们与退伍军人一起鼓励患者激活和 帮助患者管理慢性病。同伴专家在各种临床环境中工作，最常见 精神卫生诊所，非常适合帮助更难从事服务或那些人的患者 需要更多的支持来促进自我管理策略。同伴支持对患者特别有效 患有更严重的疾病或更高水平的困扰，因此可能对具有高影响力的退伍军人有帮助 慢性疼痛。 意义：慢性疼痛是使用VHA的退伍军人中最常见和最昂贵的问题之一 卫生保健。 VHA疼痛管理和阿片类药物治疗指南鼓励非药物疼痛 用于慢性疼痛管理的管理策略（NPMS）和非阿片类药物。但是，NPM 这强调改善与疼痛相关的功能通常不足。解决疼痛管理和 Opioid滥用是VHA的优先事项，这项研究直接与VHA康复研究和 开发（RR＆D）优先事项，包括促进基于非药化活动的干预措施 慢性疼痛，影响诸如疼痛之类的结果；它还与RR＆D最大化的更广泛的目标保持一致 退伍军人的职能和生活质量。 创新与影响：同伴专家在VHA中的作用正在迅速扩展到传统心理健康之外 设置，迫切需要进行其他研究，以了解如何最好地使用同伴专家 在更广泛的环境中增强对退伍军人护理的独特技能。迄今为止尚无研究评估 使用同伴专家来支持慢性疼痛的退伍军人中与疼痛相关功能的改善。 当前的提案具有创新性 疼痛管理。如果被证明有效，该项目可能为宽度实施铺平道路 专家进入新的环境，他们可以支持疼痛管理。 具体目的：该项目的具体目的是（1）使用干预映射（IM）来完善我们的 干预，同龄人加强疼痛服务的参与度（PEEPS）和（2）试验测试可行性和 窥视的可接受性并收集以功能为中心的结果指标 学习。 方法论：使用干预映射完善干预协议后，我们提出了一个单臂 试点试验，我们将注册24名患有高影响力慢性疼痛的退伍军人参加窥视，收集 基线后基线和三个月的数据。我们的主要重点将是可行性和可接受性；我们将 还收集有关疼痛相关功能，活动（步行步骤，使用计步器）以及福祉/质量的数据 生活。 下一步/实施：这些数据将告知开发更大的提案测试在 多中心随机对照试验。