Interdisciplinary team-based care for patients with chronic pain on long-term opioid treatment in primary care (PPACT) – Protocol for a pragmatic cluster randomized trial
| Autor: | William M. Vollmer, Ashli Owen-Smith, Carmit K. McMullen, Francis J. Keefe, David H. Smith, Charles Elder, Lynn DeBar, Lindsay Benes, Richard A. Deyo, Meghan Mayhew, Michael C. Leo, Allison Bonifay, Connie Mah Trinacty |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Behavior Control Male Biopsychosocial model medicine.medical_specialty Article 03 medical and health sciences 0302 clinical medicine Patient satisfaction Adaptation Psychological Health care Humans Pain Management Medicine Pharmacology (medical) 030212 general & internal medicine Cluster randomised controlled trial Pain Measurement Patient Care Team Primary Health Care business.industry Public health Chronic pain Patient Preference Recovery of Function General Medicine medicine.disease Analgesics Opioid Clinical trial Treatment Outcome Economic evaluation Quality of Life Physical therapy Female Chronic Pain business Low Back Pain 030217 neurology & neurosurgery |
| Zdroj: | Contemporary Clinical Trials. 67:91-99 |
| ISSN: | 1551-7144 |
| DOI: | 10.1016/j.cct.2018.02.015 |
| Popis: | Background Chronic pain is one of the most common, disabling, and expensive public health problems in the United States. Interdisciplinary pain management treatments that employ behavioral approaches have been successful in helping patients with chronic pain reduce symptoms and regain functioning. However, most patients lack access to such treatments. We are conducting a pragmatic clinical trial to test the hypothesis that patients who receive an interdisciplinary biopsychosocial intervention, the Pain Program for Active Coping and Training (PPACT), at their primary care clinic will have a greater reduction in pain impact in the year following than patients receiving usual care. Methods/design This is an effectiveness-implementation hybrid pragmatic clinical trial in which we randomize clusters of primary care providers and their patients with chronic pain who are on long-term opioid therapy to 1) receive an interdisciplinary behavioral intervention in conjunction with their current health care or 2) continue with current health care services. Our primary outcome is pain impact (a composite of pain intensity and pain-related interference) measured using the PEG, a validated three-item assessment. Secondary outcomes include pain-related disability, patient satisfaction, opioids dispensed and health care utilization. An economic evaluation assesses the resources and costs necessary to deliver the intervention and its cost-effectiveness compared with usual care. A formative evaluation employs mixed methods to understand the context for implementation in the participating health care systems. Discussion This trial will inform the feasibility of implementing interdisciplinary behavioral approaches to pain management in the primary care setting, potentially providing a more effective, safer, and more satisfactory alternative to opioid-based chronic pain treatment. Clinical Trials Registration Number: NCT02113592 |
| Databáze: | OpenAIRE |
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