Equity Using Interventions for Pain and Depression (EQUIPD)

公平使用疼痛和抑郁干预措施 (EQUIPD)

• 批准号: 10595133
• 负责人: Marianne Matthias
• 金额: $ 155.76万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-21 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10595133
• 关键词: Address; Adherence; Administrator; Anxiety; Appointment; Caring; Clinic; Clinic Visits; Clinical Trials; Consultations; Control Groups; Data; Data Collection; Decision Aid; Development; Effectiveness; Fostering; Goals; Health; Health system; Healthcare; Healthcare Systems; Individual; Intervention; Intervention Trial; Interview; Knowledge; Learning; Life Style; Manuals; Mental Depression; Outcome; Pain; Pain interference; Pain management; Patients; Pharmaceutical Preparations; Phase; Primary Health Care; Procedures; Protocols documentation; Provider; Randomized; Randomized Controlled Trials; Reach Effectiveness Adoption Implementation and Maintenance; Research; Resources; Sampling; Structure; System; Testing; Time; Waiting Lists; Work; arm; black patient; care providers; chronic depression; chronic pain; chronic pain patient; comorbid depression; comorbidity; comparison intervention; depressive symptoms; effectiveness implementation study; effectiveness study; effectiveness testing; empowered; evidence base; experience; follow-up; future implementation; heuristics; implementation barriers; implementation facilitation; improved; individual patient; intervention delivery; multilevel analysis; multimodality; novel; novel strategies; pain catastrophizing; pain outcome; patient engagement; patient-clinician communication; patient-level barriers; pilot test; preference; primary outcome; racial disparity; recruit; safety net; secondary outcome; socioeconomic disadvantage; treatment adherence; treatment comparison; treatment guidelines

Project Summary Nonpharmacological pain treatments (NPTs) are supported by evidence and widely recommended in treatment guidelines. However, these approaches remain underused. Even as access increases, several patient-related barriers remain, including lack of knowledge about NPT availability and effectiveness, poor patient-provider communication, and challenges to engagement and adherence –particularly important as NPTs typically require more commitment, time, and effort than taking medications. These barriers may be especially pronounced for patients with comorbid depression, since depressive symptoms can interfere with pain management, and for Black patients, who continue to experience disparities in pain treatment, including being offered fewer treatment options than White patients. The overall goal of this proposal is to refine, test, and prepare to implement a novel approach to overcoming patient-related barriers to NPT use that is tailored to Black patients with comorbid pain and depression. EQUIPD (Equity Using Interventions for Pain and Depression) uses 1) a decision aid focused on NPTs to increase use, and 2) a coach to foster patient engagement and treatment adherence. Drawing on a heuristic model of multi-level mechanisms of racial injustice in pain outcomes, EQUIPD begins by focusing on the individual, while laying the groundwork for later intervention at the structural level (i.e., clinic/healthcare system) through subsequent system-wide implementation. In Phase 1, we will establish a patient engagement panel, elicit primary care providers’ perspectives on the decision aid, and conduct a 2-arm pilot randomized controlled trial (RCT) of the intervention to test and refine procedures. In Phase 2 we will conduct a fully powered (N=250) RCT and evaluate facilitators and barriers to system-wide implementation. The primary outcome of EQUIPD is pain interference (at 6 months); secondary outcomes include depression, NPT use, anxiety, pain catastrophizing, and patient engagement. To facilitate implementation planning, we will conduct interviews with a purposefully sampled subset of intervention patients and with clinicians, administrators, and other clinic staff to optimize the intervention and elucidate critical factors for system-wide implementation. EQUIPD simultaneously addresses disparities pervasive in pain treatment and challenges related to comorbid pain and depression, by partnering with and empowering minoritized patients to find safe, effective approaches to chronic pain that best match their values, preferences, and lifestyles. Moreover, EQUIPD helps to advance the National Pain Strategy by promoting multi-modal approaches to pain care that is tailored to individual patients’ needs.

项目概要 非药物疼痛治疗 (NPT) 有证据支持并在治疗中被广泛推荐 然而，即使使用机会增加，这些方法仍然没有得到充分利用。 障碍依然存在，包括缺乏对 NPT 可用性和有效性的了解、患者提供者不力 沟通以及参与和遵守方面的挑战——尤其重要，因为《不扩散核武器条约》通常 与服用药物相比，这些障碍可能尤其需要更多的承诺、时间和努力。 对于患有抑郁症的患者来说很明显，因为抑郁症状会干扰疼痛 对于黑人患者来说，他们在疼痛治疗方面仍然存在差异，包括 提供的治疗选择比白人患者少 该提案的总体目标是改进、测试和改进。 准备实施一种新方法来克服与患者相关的 NPT 使用障碍，该方法是为 患有共病疼痛和抑郁的黑人患者 EQUIPD（公平使用疼痛和抑郁干预措施） 抑郁症）使用 1） 专注于 NPT 的决策辅助来增加使用，以及 2） 教练来培养患者 借鉴种族多层次机制的启发式模型。 为了应对疼痛结果的不公正，EQUIPD 首先关注个人，同时为以后奠定基础 通过随后的全系统在结构层面（即诊所/医疗保健系统）进行干预 在第一阶段，我们将建立一个患者参与小组，征求初级保健提供者的意见。 对决策援助的看法，并进行了一项 2 臂试点随机对照试验 (RCT) 在第 2 阶段，我们将进行全面的（N=250）随机对照试验并进行干预。 评估全系统实施的促进因素和障碍 EQUIPD 的主要结果是痛苦。 干扰（6 个月时）；次要结果包括抑郁、NPT 使用、焦虑、灾难性疼痛、 为了促进实施计划，我们将有目的地进行访谈。 对干预患者的子集以及圣人、管理人员和其他诊所工作人员进行抽样，以优化 EQUIPD 同时解决干预和阐明全系统实施的关键因素。 通过合作，解决疼痛治疗中普遍存在的差异以及与共病疼痛和抑郁相关的挑战 与少数患者合作并帮助其找到最适合的安全、有效的慢性疼痛方法 此外，EQUIPD 通过以下方式帮助推进国家疼痛战略。 推广针对个体患者需求的多模式疼痛护理方法。