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培训计划，旨在将 Travis Lovejoy 博士、公共卫生硕士培养成为一名独立的 VA 健康服务研究与开发 (HSR&D) 调查员，拥有在特殊药物使用障碍 (SUD) 治疗环境中治疗和研究疼痛的专业知识。 Lovejoy 博士是波特兰退伍军人医疗中心的临床心理学家和初级健康服务研究员以及俄勒冈健康与科学大学 (OHSU) 的精神病学助理教授。 Lovejoy 博士的职业发展奖 (CDA) 培训目标包括 (a) 进一步建立疼痛和物质使用障碍方面的内容专业知识，(b) 提高​​使用 VA 管理数据回答关键研究问题的熟练程度，以及 (c)提高应用于临床试验和实施科学的定性和混合方法方法的能力。他的培训计划包括正式课程、高级培训研讨会和导师指导的学习。 Lovejoy 博士得到了一支由健康服务研究人员组成的优秀指导团队的支持，其中包括医学博士 Steven Dobscha，他是改善退伍军人护理参与中心 (CIVIC) 的主任，该中心是波特兰退伍军人医疗中心新资助的 VA HSR&D 创新中心； Linda Ganzini，医学博士、公共卫生硕士、CIVIC 副主任、OHSU 精神病学和医学教授；本杰明·莫拉斯科 (Benjamin Morasco) 博士、CIVIC 研究研究员和 OHSU 精神病学副教授； Dennis McCarty 博士，OHSU 公共卫生和预防医学教授兼副主席； Hildi Hgedorn 博士，明尼阿波利斯退伍军人医疗中心核心研究研究员和 SUD 质量增强研究计划 (SUD QUERI) 实施研究协调员。 OHSU 和波特兰退伍军人医疗中心的资源支持初级研究人员从指导性研究向独立研究的转变。这些资源与导师团队的专家指导相结合，将为 Lovejoy 博士提供理想的机会，使其成为一名独立的 VA HSR&D 调查员。 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 管理数据来描述全国退伍军人样本中疼痛治疗使用情况 专业 SUD 治疗，并将疼痛治疗利用率与同时发生慢性疼痛的退伍军人和不开始专业 SUD 护理的 SUD 进行比较。这项研究的结果将为 VA HSR&D 调查员发起的混合方法研究提案提供信息，该研究将评估高绩效和低绩效 VA SUD 治疗计划在管理退伍军人慢性疼痛方面的实践。研究 2 将定性研究目前在单一 VA 医疗中心接受特殊 SUD 治疗的患有慢性疼痛的退伍军人的疼痛治疗经历和偏好。其他定性焦点小组和对 VA 医疗中心主要利益相关者的访谈将检查在专业 SUD 治疗环境中实施协作疼痛干预的障碍和促进因素。研究 2 的数据将为定制基于证据的、初级保健提供的协作疼痛干预措施提供信息，以便在专业门诊 SUD 治疗环境中实施。研究 3 是一项在专业 SUD 治疗环境中提供定制协作疼痛干预的非对照试点试验。该试点试验的结果将为 VA HSR&D 研究者发起的第二项研究提案提供信息，该提案涉及协作疼痛干预的多站点有效性试验，同时评估干预措施的实施情况。成功完成拟议的研究和培训将使 Lovejoy 博士成为一名独立的 VA HSR&D 调查员，在疼痛和药物使用、临床试验和混合方法研究方面拥有专业知识。