居家疼痛护理,增强功能:协议条款。

Anne C Black, Sara N Edmond, Joseph W Frank, Audrey Abelleira, Jennifer L Snow, Danielle M Wesolowicz, William C Becker
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引用次数: 0

摘要

指南推荐了优化阿片类药物安全性的策略,包括经常重新评估长期阿片类药物治疗的益处和危害。开处方者主要是初级保健提供者(PCP),他们可能缺乏培训或资源来实施这些与指南一致的做法。目前已设计出两种干预措施来帮助初级保健医生,并在退伍军人健康管理局 (VHA) 中进行了测试。远程医疗协作管理(TCM)主要通过护理经理-开处方者团队提供药物管理支持。合作疼痛教育和自我管理(COPES)通过认知行为疗法技术促进慢性疼痛的自我管理策略。事实证明,每种干预措施都能改善处方和/或患者的治疗效果。将这些干预措施结合起来的附加值尚未得到验证。在美国国立卫生研究院 "帮助戒除毒瘾长期计划"(HEAL)的 "慢性疼痛和阿片类药物使用障碍综合管理促进整体康复"(IMPOWR)网络的资助和集中协调下,我们将在美国志愿医疗服务协会(VHA)内开展一项多站点患者级随机混合 II 效果实施试验,比较中医与中医 + COPES 在疼痛干扰和阿片类药物安全性的主要综合结果,酒精使用、焦虑、抑郁和睡眠的次要结果,以及 IMPOWR 网络的其他共识措施。通过对医疗服务提供者的访谈了解到的实施促进策略将针对特定地点的需求。这些策略对中医药实施的影响将通过既定的形成性和总结性评估技术进行评估。经济分析将评估干预措施的成本效益。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Pain Care at Home to Amplify Function: Protocol Article.

Guidelines recommend strategies to optimize opioid medication safety, including frequent reassessment of the benefits and harms of long-term opioid therapy. Prescribers, who are predominantly primary care providers (PCPs), may lack the training or resources to implement these guideline-concordant practices. Two interventions have been designed to assist PCPs and tested within the Veterans Health Administration (VHA). Telemedicine Collaborative Management (TCM) provides primarily medication management support via care manager-prescriber teams. Cooperative Pain Education and Self-Management (COPES) promotes self-management strategies for chronic pain via cognitive behavior therapy techniques. Each intervention has been shown to improve prescribing and/or patient outcomes. The added value of combining these interventions is untested. With funding and central coordination by the Integrative Management of Chronic Pain and Opioid Use Disorder for Whole Recovery (IMPOWR) Network of the National Institutes of Health Helping to End Addiction Long-term (HEAL) Initiative, we will conduct a multisite patient-level randomized hybrid II effectiveness-implementation trial within VHA to compare TCM to TCM + COPES on the primary composite outcome of pain interference and opioid safety, secondary outcomes of alcohol use, anxiety, depression, and sleep, and other consensus IMPOWR Network measures. Implementation facilitation strategies informed by interviews with healthcare providers will target site-specific needs. The impact of these strategies on TCM implementation will be assessed via established formative and summative evaluation techniques. Economic analyses will evaluate intervention cost-effectiveness.

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