{Reference Type}: Randomized Controlled Trial
{Title}: A patient activation intervention in primary care for patients with chronic pain on long term opioid therapy: results from a randomized control trial.
{Author}: Does MB;Adams SR;Kline-Simon AH;Marino C;Charvat-Aguilar N;Weisner CM;Rubinstein AL;Ghadiali M;Cowan P;Young-Wolff KC;Campbell CI;
{Journal}: BMC Health Serv Res
{Volume}: 24
{Issue}: 1
{Year}: 2024 Jan 22
{Factor}: 2.908
{DOI}: 10.1186/s12913-024-10558-3
{Abstract}: <B>BACKGROUND: </B>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.<BR><B>METHODS: </B>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.<BR><B>RESULTS: </B>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).<BR><B>CONCLUSIONS: </B>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.<BR><B>BACKGROUND: </B>The study was registered on 10/27/14 on ClinicalTrials.gov (NCT02290223).