scholarly journals Targeting Chronic Pain in Primary Care Settings by Using Behavioral Health Consultants: Methods of a Randomized Pragmatic Trial

Pain Medicine ◽  
2020 ◽  
Vol 21 (Supplement_2) ◽  
pp. S83-S90
Author(s):  
Jeffrey L Goodie ◽  
Kathryn E Kanzler ◽  
Cindy A McGeary ◽  
Abby E Blankenship ◽  
Stacey Young-McCaughan ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Trial ◽  
Chronic Pain ◽  
Behavioral Health ◽  
Clinical Care ◽  
Pragmatic Trial ◽  
Health Agency ◽  
Military Health ◽  
Pragmatic Clinical Trial ◽  
Functional Changes

Abstract Background Manualized cognitive and behavioral therapies are increasingly used in primary care environments to improve nonpharmacological pain management. The Brief Cognitive Behavioral Therapy for Chronic Pain (BCBT-CP) intervention, recently implemented by the Defense Health Agency for use across the military health system, is a modular, primary care–based treatment program delivered by behavioral health consultants integrated into primary care for patients experiencing chronic pain. Although early data suggest that this intervention improves functioning, it is unclear whether the benefits of BCBT-CP are sustained. The purpose of this paper is to describe the methods of a pragmatic clinical trial designed to test the effect of monthly telehealth booster contacts on treatment retention and long-term clinical outcomes for BCBT-CP treatment, as compared with BCBT-CP without a booster, in 716 Defense Health Agency beneficiaries with chronic pain. Design A randomized pragmatic clinical trial will be used to examine whether telehealth booster contacts improve outcomes associated with BCBT-CP treatments. Monthly booster contacts will reinforce BCBT-CP concepts and the home practice plan. Outcomes will be assessed 3, 6, 12, and 18 months after the first appointment for BCBT-CP. Focus groups will be conducted to assess the usability, perceived effectiveness, and helpfulness of the booster contacts. Summary Most individuals with chronic pain are managed in primary care, but few are offered biopsychosocial approaches to care. This pragmatic brief trial will test whether a pragmatic enhancement to routine clinical care, monthly booster contacts, results in sustained functional changes among patients with chronic pain receiving BCBT-CP in primary care.

Effects of the Family Check-Up 4 Health on Parenting and Child Behavioral Health: A Randomized Clinical Trial in Primary Care

2021 ◽  
Author(s):  
Cady Berkel ◽  
Emily Fu ◽  
Allison J. Carroll ◽  
Charlton Wilson ◽  
Angelica Tovar-Huffman ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Trial ◽  
Behavioral Health ◽  
Randomized Clinical Trial ◽  
The Family

scholarly journals 2135

2017 ◽  
Vol 1 (S1) ◽  
pp. 69-69
Author(s):  
Kathryn E. Kanzler ◽  
Patricia Robinson ◽  
Mariana Munante ◽  
Donald McGeary ◽  
Jennifer Potter ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Behavioral Health ◽  
Control Group ◽  
Health Provider ◽  
Care Clinic ◽  
Integrated Behavioral Health ◽  
Behavioral Health Provider ◽  
Chronic Pain Patients ◽  
Pain Patients

OBJECTIVES/SPECIFIC AIMS: This study seeks to test the feasibility and effectiveness of a brief acceptance and commitment therapy (ACT) treatment for chronic pain patients in a primary care clinic METHODS/STUDY POPULATION: Primary care patients aged 18 years and older with at least 1 pain condition for 12 weeks or more in duration will be recruited. Patients will be randomized into (a) ACT intervention or (b) control group. Participants in the ACT arm will attend 1 individual visit with an integrated behavioral health provider, followed by 3 weekly ACT classes and a booster class 2 months later. Control group will receive enhanced primary care that includes patient education handouts informed by cognitive behavioral science. Data analysis will include 1-way analysis of covariance (ANCOVA), multiple regression with bootstrapping. RESULTS/ANTICIPATED RESULTS: The overall hypothesis is that brief ACT treatment reduces physical disability, improves functioning, and reduces medication misuse in chronic pain patients when delivered by an integrated behavioral health provider in primary care. In addition, it is anticipated that improvements in patient functioning will be mediated by patient change in pain acceptance and patient engagement in value-consistent behaviors. DISCUSSION/SIGNIFICANCE OF IMPACT: This pilot study will establish preliminary data about the effectiveness of addressing chronic pain in a generalizable integrated primary care setting. Data will help support a larger trial in the future. Findings have potential to transform the way chronic pain is currently managed in primary care settings, with results that could decrease disability and improve functioning among patients suffering from chronic pain.

scholarly journals Primary Care Behavioral Health Training in Family Medicine Residencies:

2020 ◽  
Vol 52 (3) ◽  
pp. 174-181
Author(s):  
Ryan R. Landoll ◽  
Ronald M. Cervero ◽  
Jeffrey D. Quinlan ◽  
Lauren A. Maggio
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Family Medicine ◽  
Faculty Development ◽  
Behavioral Health ◽  
Future Research ◽  
Military Health ◽  
Primary Care Behavioral Health ◽  
Educational Processes ◽  
Study Results

Background and Objectives: Primary care behavioral health (PCBH) is a service delivery model of integrated care linked to a wide variety of positive patient and system outcomes. However, considerable challenges with provider training and attrition exist. While training for nonphysician behavioral scientists is well established, little is known about how to train physicians to work efficiently within integrated teams. Methods: We conducted a case study analysis of family medicine residencies in the military health system using a series of 30 to 45-minute semistructured interviews. We conducted qualitative template analysis of these cases to chart programs’ current educational processes related to PCBH. Thirteen individuals consisting of program directors, behavioral and nonbehavioral faculty, and residents across five programs participated in the study. Results: Current educational processes included a variety of content on PCBH (eg, treatment for depression, clinical referral pathways, patient-centered communication), primarily using a mix of didactic and practice-based placements. Resource allocation was seen as a critical contributor to quality. There was variability in the degree to which integrated behavioral health providers were incorporated as residency faculty, such that programs where these specialists were more incorporated reported more intentional curriculum development and health care systems-level content. Conclusions: While behavioral health content was well represented in family medicine residency curriculum, the depth and integration of content was inconsistent. More intentional and integrated curriculum accompanied faculty development and integration of behavioral health faculty. Future research should evaluate if faculty development programs and faculty status of behavioral scientists results in different educational or health care outcomes.

scholarly journals Intensive Care to Improve Adherence to Anti-Hypertensives in Primary Care: a Pragmatic Clinical Trial.

2015 ◽  
Vol 44 (suppl_1) ◽  
pp. i110-i110
Author(s):  
E. T. Santa-Helena ◽  
N. G. Damo ◽  
A. P. Loch ◽  
E. Mitsushiro ◽  
S. Starke
Keyword(s):  
Primary Care ◽  
Clinical Trial ◽  
Intensive Care ◽  
Pragmatic Clinical Trial

scholarly journals 177 Treating Chronic Pain and Preventing Opioid Use Disorders in the Underserved: An Integrated Primary Care Model

CNS Spectrums ◽  
2020 ◽  
Vol 25 (2) ◽  
pp. 312-312
Author(s):  
Tanya R. Sorrell ◽  
Rosario Medina
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Pain Management ◽  
Behavioral Health ◽  
Integrated Primary Care ◽  
Care Model ◽  
Care Clinic ◽  
Holistic Treatment ◽  
Primary Care Model ◽  
Care Assessment

Abstract:This poster builds on the CDC pain management guidelines and the current ASAM recommendations for substance use assessment to build an integrated primary care model for holistic chronic pain management in an urban, underserved primary care clinic. Using a case from our Federally Qualified Health Care Center, which operates in a southwest Denver clinic, a program of integrated care assessment, diagnosis, and holistic treatment planning is outlined for this client with chronic pain, physical, and behavioral health issues. Using a comprehensive care approach for complex clients, which are typical presentations for urban, underserved clients, we discuss the utilization of best practices in medication management for chronic pain (Alternatives to Opioids (ALTOS), prescribed and complementary and alternative practices (e.g., PT, acupuncture, etc), and behavioral health services (psychiatric assessment and treatment, psychotherapy, support groups, etc) to improve outcomes for our clients.

scholarly journals A Toolbox Approach to Obesity Treatment in Urban Safety-Net Primary Care Clinics: a Pragmatic Clinical Trial

2019 ◽  
Vol 34 (11) ◽  
pp. 2405-2413
Author(s):  
David R. Saxon ◽  
Erin L. Chaussee ◽  
Elizabeth Juarez-Colunga ◽  
Adam G. Tsai ◽  
Sean J. Iwamoto ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Trial ◽  
Safety Net ◽  
Obesity Treatment ◽  
Pragmatic Clinical Trial ◽  
Primary Care Clinics ◽  
Urban Safety

scholarly journals Whole Health Options and Pain Education (wHOPE): A Pragmatic Trial Comparing Whole Health Team vs Primary Care Group Education to Promote Nonpharmacological Strategies to Improve Pain, Functioning, and Quality of Life in Veterans—Rationale, Methods, and Implementation

Pain Medicine ◽  
2020 ◽  
Vol 21 (Supplement_2) ◽  
pp. S91-S99
Author(s):  
Karen H Seal ◽  
William C Becker ◽  
Jennifer L Murphy ◽  
Natalie Purcell ◽  
Lauren M Denneson ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Chronic Pain ◽  
Pain Management ◽  
Pragmatic Trial ◽  
Care Group ◽  
Pain Education ◽  
Primary Care Group ◽  
Health Model

Abstract Background The Whole Health model of the U.S. Department of Veterans Affairs (VA) emphasizes holistic self-care and multimodal approaches to improve pain, functioning, and quality of life. wHOPE (Whole Health Options and Pain Education) seeks to be the first multisite pragmatic trial to establish evidence for the VA Whole Health model for chronic pain care. Design wHOPE is a pragmatic randomized controlled trial comparing a Whole Health Team (WHT) approach to Primary Care Group Education (PC-GE); both will be compared to Usual VA Primary Care (UPC). The WHT consists of a medical provider, a complementary and integrative health (CIH) provider, and a Whole Health coach, who collaborate with VA patients to create a Personalized Health Plan emphasizing CIH approaches to chronic pain management. The active comparator, PC-GE, is adapted group cognitive behavioral therapy for chronic pain. The first aim is to test whether the WHT approach is superior to PC-GE and whether both are superior to UPC in decreasing pain interference in functioning in 750 veterans with moderate to severe chronic pain (primary outcome). Secondary outcomes include changes in pain severity, quality of life, mental health symptoms, and use of nonpharmacological and pharmacological therapies for pain. Outcomes will be collected from the VA electronic health record and patient-reported data over 12 months of follow-up. Aim 2 consists of an implementation-focused process evaluation and budget impact analysis. Summary This trial is part of the Pain Management Collaboratory, which seeks to create national-level infrastructure to support evidence-based nonpharmacological pain management approaches for veterans and military service personnel.

Abstract P268: The Impact Of Covid-19 On A Large Pragmatic Clinical Trial Embedded In Primary Care

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Cynthia Hau ◽  
Sarah Leatherman ◽  
Alison Klint ◽  
Peter Glassman ◽  
Addison Taylor ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Data Collection ◽  
Point Of Care ◽  
Pragmatic Trial ◽  
Pragmatic Trials ◽  
Pragmatic Clinical Trial ◽  
Medication Prescription ◽  
Critical Data ◽  
The Impact

Introduction: The COVID-19 pandemic has had a significant impact on traditional clinical trial operations, but it is unclear whether the impact persists in pragmatic trials with a centralized study design. The Diuretic Comparison Project (DCP) is a Point-of Care pragmatic trial that operates through a usual care system to compare chlorthalidone and hydrochlorothiazide at preventing major cardiovascular (CV) events and non-cancer death. We assessed the impact of the COVID-19 pandemic on the centralized recruitment, patient follow-up, data collection, and outcome ascertainment performed in the DCP. Methods: We assessed operations in two 8-month periods: Pre-COVID-19 (Jul 2019 - Feb 2020) and Mid-COVID-19 (Jul 2020 - Feb 2021). Enrollment, study medication adherence, blood pressure (BP) and electrolyte follow-up rates, VA records of CV events, all-cause hospitalization, and death rates were compared. Results: Providers agreed to participate at a lower rate, but more patients were contacted and randomized during mid-COVID-19. While BP evaluations decreased, the rates of electrolyte, major CV, and medication prescription records were comparable to the pre-COVID-19 period ( Table 1 ). Conclusions: The DCP was able to recruit and maintain critical data collection at the pre-COVID-19 levels. There were some decreases in BP evaluations, likely due to fewer in-person visits. All-cause VA hospitalizations also decreased, despite rises in COVID-related hospitalizations and death. While the impact on outcome and safety rates awaits complete data from Medicare, the DCP has demonstrated a promising centralized design that can support pragmatic trial operations during a pandemic.

scholarly journals A feasibility pragmatic clinical trial of a primary care network exercise and education program for people with COPD

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Kelsey M. T. Hurley ◽  
Anne-Marie Selzler ◽  
Wendy M. Rodgers ◽  
Michael K. Stickland
Keyword(s):  
Primary Care ◽  
Clinical Trial ◽  
Disease Management ◽  
Exercise Capacity ◽  
Education Program ◽  
Pulmonary Rehabilitation ◽  
Exercise Program ◽  
Pragmatic Clinical Trial ◽  
Care Network ◽  
Supervised Exercise

Abstract Background Pulmonary rehabilitation is an important component of chronic disease management in chronic obstructive pulmonary disease (COPD) and has been shown to improve shortness of breath, exercise capacity, quality of life, and decrease hospitalizations. However, pulmonary rehabilitation capacity is low. Primary care may be an effective method for delivering disease management services to this population. The objective of this feasibility pragmatic clinical trial was to evaluate enrollment and completion of a primary care network exercise and education program for people with COPD. Methods COPD patients (N = 23; mean age = 65 ± 9 years; FEV1 = 68 ± 20% predicted) were recruited after referral to a primary care network exercise program in Edmonton, Alberta. Participants self-selected either an 8-week 16-session supervised exercise program or an 8-week unsupervised exercise program where they received three visits with an exercise specialist. Both groups self-selected education sessions with clinicians for disease management support. Referrals, completion, and program outcomes (physical activity, exercise capacity and health status) were measured before (T1), immediately after (T2), and 8 weeks following the program (T3). Results Forty-three referrals were received in 10 months, where a minimum of 50 was required in order for the program to be considered feasible. Twenty-three participants provided baseline data, and twenty participants started the exercise program (10 in each exercise group), 16 of which completed the exercise program (80%). On average, 48% of the recommended education sessions were completed by participants. Conclusions Enrollment into a COPD exercise and education program in a primary care network was low indicating the need for improved referral processes from physicians. Completion rates by participants were adequate for exercise but not education. The low referral rate and the lack of enrollment in COPD education by the patients indicate that a large-scale trial of the program as designed is not feasible.

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