Study Protocol for the Opioid and Pain Treatment in Indigenous Communities Trial: A Systems Level Intervention for Enhanced Screening and Brief Intervention and Referral for Co-Occurring Chronic Pain and Opioid Use Disorder.

Angel R Vasquez, Matthew R Pearson, Hanna M Hebden, Melanie Nadeau, Nachya George, Karen Lizzy, Kamilla L Venner
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Abstract

American Indian/Alaska Native (AI/AN) individuals have the highest rates of opioid overdose mortality and chronic pain (CP) compared to other racial/ethnic groups in the United States. These individuals also report higher rates of pain anxiety and pain catastrophizing, which are both associated with poorer outcomes and risk for opioid misuse (OM) and opioid use disorder (OUD) among individuals with CP. Yet, no prior studies have examined rates of comorbid pain and OUD among AI/AN adults. This commentary describes an implementation research partnership of 3 AI/AN-serving clinics and a university team that utilizes an implementation hybrid type III design to examine the impact of implementation strategies on adoption and sustainability of evidence-based screening and brief intervention for CP and OM/OUD among AI/AN clients. As part of our community-engaged approach, we embrace both AI/AN models and Western models, and a collaborative board of 10 individuals guided the research throughout. We hypothesize that our culturally centered approach will increase rates of screening and brief intervention and improve identification of and outcomes among AI/AN clients with CP and OUD who receive treatment at participating sites. Each site convenes a workgroup to evaluate and set goals to culturally center screening and brief interventions for CP and OM/OUD. Data collected include deidentified electronic health records to track screening and brief interventions and rates of CP and OUD; provider and staff surveys beginning prior to implementation and every 6 months for 2 years; and a subset of clients will be recruited (N = 225) and assessed at baseline, 6, and 12 months to examine biopsychosocial and spiritual factors and their experiences with culturally centered screening and brief intervention. Cultural adaptations to the measures and screening and brief intervention as well as barriers and facilitators will be addressed. Recommendations for successful Tribal health clinic-university partnerships are offered.

土著社区阿片类药物和疼痛治疗试验研究方案:针对慢性疼痛和阿片类药物使用紊乱并发症的强化筛查、简单干预和转诊的系统级干预。
与美国其他种族/族裔群体相比,美国印第安人/阿拉斯加原住民(AI/AN)的阿片类药物过量死亡率和慢性疼痛(CP)发病率最高。这些人还报告了较高的疼痛焦虑率和疼痛灾难化率,而这两种情况都与较差的治疗效果以及慢性疼痛患者滥用阿片类药物(OM)和阿片类药物使用障碍(OUD)的风险有关。然而,之前的研究并未对阿拉斯加原住民/印第安人成人中合并疼痛和阿片类药物滥用症的比例进行研究。本评论介绍了由 3 家为亚裔美国人/印第安人服务的诊所和一个大学团队合作开展的一项实施研究,该研究采用了实施混合型 III 设计,以检查实施策略对亚裔美国人/印第安人客户中采用循证筛查和简短干预 CP 和 OM/OUD 的影响及可持续性。作为我们社区参与方法的一部分,我们同时接受美国印第安人模式和西方模式,并由一个由 10 人组成的合作委员会全程指导研究工作。我们的假设是,我们以文化为中心的方法将提高筛查率和简短干预率,并改善对在参与地点接受治疗的患有 CP 和 OUD 的亚裔美国人/印第安人客户的识别和治疗效果。每个医疗点都会召集一个工作组,以评估和设定目标,针对 CP 和 OM/OUD 进行以文化为中心的筛查和简单干预。收集的数据包括:用于跟踪筛查和简短干预以及 CP 和 OUD 患病率的去标识化电子健康记录;在实施前和两年内每 6 个月进行一次的医疗服务提供者和工作人员调查;将招募一部分客户(N = 225)并在基线、6 个月和 12 个月时对其进行评估,以检查生物心理社会因素和精神因素以及他们对以文化为中心的筛查和简短干预的体验。此外,还将探讨从文化角度对措施、筛查和简单干预的适应性以及障碍和促进因素。此外,还将就部落健康诊所与大学之间成功的合作关系提出建议。
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