PDF(Pubmed)
Abstract：
BACKGROUND: Given significant risks associated with long-term prescription opioid use, there is a need for non-pharmacological interventions for treating chronic pain. Activating patients to manage chronic pain has the potential to improve health outcomes. The ACTIVATE study was designed to evaluate the effectiveness of a 4-session patient activation intervention in primary care for patients on long-term opioid therapy.
METHODS: The two-arm, pragmatic, randomized trial was conducted in two primary care clinics in an integrated health system from June 2015-August 2018. Consenting participants were randomized to the intervention (n = 189) or usual care (n = 187). Participants completed online and interviewer-administered surveys at baseline, 6- and 12- months follow-up. Prescription opioid use was extracted from the EHR. The primary outcome was patient activation assessed by the Patient Activation Measure (PAM). Secondary outcomes included mood, function, overall health, non-pharmacologic pain management strategies, and patient portal use. We conducted a repeated measure analysis and reported between-group differences at 12 months.
RESULTS: At 12 months, the intervention and usual care arms had similar PAM scores. However, compared to usual care at 12 months, the intervention arm demonstrated: less moderate/severe depression (odds ratio [OR] = 0.40, 95%CI 0.18-0.87); higher overall health (OR = 3.14, 95%CI 1.64-6.01); greater use of the patient portal\'s health/wellness resources (OR = 2.50, 95%CI 1.42-4.40) and lab/immunization history (OR = 2.70, 95%CI 1.29-5.65); and greater use of meditation (OR = 2.72; 95%CI 1.61-4.58) and exercise/physical therapy (OR = 2.24, 95%CI 1.29-3.88). At 12 months, the intervention arm had a higher physical health measure (mean difference 1.63; 95%CI: 0.27-2.98).
CONCLUSIONS: This trial evaluated the effectiveness of a primary care intervention in improving patient activation and patient-reported outcomes among adults with chronic pain on long-term opioid therapy. Despite a lack of improvement in patient activation, a brief intervention in primary care can improve outcomes such as depression, overall health, non-pharmacologic pain management, and engagement with the health system.
BACKGROUND: The study was registered on 10/27/14 on ClinicalTrials.gov (NCT02290223).
METHODS: The two-arm, pragmatic, randomized trial was conducted in two primary care clinics in an integrated health system from June 2015-August 2018. Consenting participants were randomized to the intervention (n = 189) or usual care (n = 187). Participants completed online and interviewer-administered surveys at baseline, 6- and 12- months follow-up. Prescription opioid use was extracted from the EHR. The primary outcome was patient activation assessed by the Patient Activation Measure (PAM). Secondary outcomes included mood, function, overall health, non-pharmacologic pain management strategies, and patient portal use. We conducted a repeated measure analysis and reported between-group differences at 12 months.
RESULTS: At 12 months, the intervention and usual care arms had similar PAM scores. However, compared to usual care at 12 months, the intervention arm demonstrated: less moderate/severe depression (odds ratio [OR] = 0.40, 95%CI 0.18-0.87); higher overall health (OR = 3.14, 95%CI 1.64-6.01); greater use of the patient portal\'s health/wellness resources (OR = 2.50, 95%CI 1.42-4.40) and lab/immunization history (OR = 2.70, 95%CI 1.29-5.65); and greater use of meditation (OR = 2.72; 95%CI 1.61-4.58) and exercise/physical therapy (OR = 2.24, 95%CI 1.29-3.88). At 12 months, the intervention arm had a higher physical health measure (mean difference 1.63; 95%CI: 0.27-2.98).
CONCLUSIONS: This trial evaluated the effectiveness of a primary care intervention in improving patient activation and patient-reported outcomes among adults with chronic pain on long-term opioid therapy. Despite a lack of improvement in patient activation, a brief intervention in primary care can improve outcomes such as depression, overall health, non-pharmacologic pain management, and engagement with the health system.
BACKGROUND: The study was registered on 10/27/14 on ClinicalTrials.gov (NCT02290223).
摘要：
背景：鉴于长期处方阿片类药物使用相关的重大风险，需要非药物干预来治疗慢性疼痛.激活患者以管理慢性疼痛具有改善健康结果的潜力。ACTIVATE研究旨在评估长期阿片类药物治疗患者在初级保健中进行4次患者激活干预的有效性。
方法：双臂，务实,随机试验于2015年6月至2018年8月在综合卫生系统的两个初级保健诊所进行.同意的参与者被随机分配到干预（n=189）或常规护理（n=187）。参与者在基线时完成了在线和面试官管理的调查，6个月和12个月的随访。处方阿片类药物的使用是从EHR中提取的。主要结果是通过患者激活测量(PAM)评估的患者激活。次要结果包括情绪，函数,整体健康,非药理学疼痛管理策略，和患者门户使用。我们进行了重复测量分析，并报告了12个月时的组间差异。
结果：在12个月时，干预组和常规护理组的PAM评分相似.然而,与12个月时的常规护理相比，干预组显示:中度/重度抑郁程度较低(比值比[OR]=0.40,95CI0.18-0.87);总体健康状况较高(OR=3.14,95CI1.64-6.01);更多使用患者门户的健康/健康资源(OR=2.50,95CI1.42-4.40)和实验室/免疫史(OR=2.70,95CI1.29-5.65);更多使用冥想(OR=12个月时,干预组的身体健康指标较高(平均差1.63;95CI:0.27-2.98).
结论：该试验评估了初级护理干预在长期阿片类药物治疗的慢性疼痛成人中改善患者激活和患者报告结局的有效性。尽管在患者激活方面缺乏改善，初级保健的短暂干预可以改善抑郁等结果，整体健康,非药理学疼痛管理，以及与卫生系统的接触。
背景：该研究于14年10月27日在ClinicalTrials.gov（NCT02290223）上注册。
方法：双臂，务实,随机试验于2015年6月至2018年8月在综合卫生系统的两个初级保健诊所进行.同意的参与者被随机分配到干预（n=189）或常规护理（n=187）。参与者在基线时完成了在线和面试官管理的调查，6个月和12个月的随访。处方阿片类药物的使用是从EHR中提取的。主要结果是通过患者激活测量(PAM)评估的患者激活。次要结果包括情绪，函数,整体健康,非药理学疼痛管理策略，和患者门户使用。我们进行了重复测量分析，并报告了12个月时的组间差异。
结果：在12个月时，干预组和常规护理组的PAM评分相似.然而,与12个月时的常规护理相比，干预组显示:中度/重度抑郁程度较低(比值比[OR]=0.40,95CI0.18-0.87);总体健康状况较高(OR=3.14,95CI1.64-6.01);更多使用患者门户的健康/健康资源(OR=2.50,95CI1.42-4.40)和实验室/免疫史(OR=2.70,95CI1.29-5.65);更多使用冥想(OR=12个月时,干预组的身体健康指标较高(平均差1.63;95CI:0.27-2.98).
结论：该试验评估了初级护理干预在长期阿片类药物治疗的慢性疼痛成人中改善患者激活和患者报告结局的有效性。尽管在患者激活方面缺乏改善，初级保健的短暂干预可以改善抑郁等结果，整体健康,非药理学疼痛管理，以及与卫生系统的接触。
背景：该研究于14年10月27日在ClinicalTrials.gov（NCT02290223）上注册。
