Chronic Pain Management: Empowering Patients Monique Does, MPH - - PowerPoint PPT Presentation

Chronic Pain Management: Empowering Patients

Monique Does, MPH

Project Manager Kaiser Permanente Northern California, Division of Research November 1, 2018

#PCORI2018

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Monique Does, MPH

• Nothing to disclose.

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Objectives

At the conclusion of this activity, the participant should be able to

• Describe how the ACTIVATE study addresses the need for patient-

centered research on treating chronic pain in primary care

• Describe approaches to engaging patient partners and

empowering patients with chronic pain taking prescription

• pioids

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Opioid Prescribing in the U.S.

• Continued concern over risks of long-term prescription opioid use

due to rising rates of abuse and overdose

• Opioid prescriptions are decreasing nationally, as result of federal

guidelines and local health system initiatives to reduce high risk and high dose prescribing

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Opioid Prescribing in the U.S.

• Recent paper by Bohnert et al. describes declining rates of opioid use

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Treatment for Patients with Chronic Pain: Addressing the Evidence Gaps

• Chronic pain affects over 100 million adults in U.S.
• Evidence-based research is needed on effective patient-centered

approaches to treating chronic pain, particularly in primary care

• Why focus on primary care?
• Upstream focus (many patients do not want or need pain program)
• Majority of opioid prescriptions in primary care
• Less stigmatized environment

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Treatment for Patients with Chronic Pain: Addressing the Evidence Gaps

• Adopting patient-centered approaches from other disciplines
• Self-management and education of chronic health conditions

(e.g., diabetes, heart disease)

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Treatment for Patients with Chronic Pain: Addressing the Evidence Gaps

• Patient activation
• “Understanding one’s role in care process, and having the knowledge, skills, and

confidence to manage one’s health and health care.”1

• LINKAGE study in addiction treatment
• Intervention designed to engage patients with health care using online resources

and communication with providers2

1 Hibbard JH, Greene J. What the evidence shows about patient activation: better health outcomes and care experiences; fewer data on costs. Health Aff

(Millwood). 2013;32(2):207-214.

2 Weisner CM, Chi FW, Lu Y, et al. Examination of the effects of an intervention aiming to link patients receiving addiction treatment with health care: the

Linkage Study clinical trial. JAMA Psychiatry. 2016;73(8):804-814.

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ACTIVATE Study: A Patient-Centered Activation Intervention in Primary Care

PCORI-funded study IHS-1310-08734 Principal Investigator: Cynthia Campbell, PhD

• Randomized pragmatic trial
• Two large primary care clinics in Northern California
• Usual Care (n=187) vs. Behavioral Intervention (n=189)
• Patient-reported outcomes at baseline, 6 and 12 months
• Qualitative interviews with physicians

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ACTIVATE Study: Patient-Centered Activation Intervention in Primary Care

• Brief behavioral intervention: four 90-minute group sessions
• Designed with input from patients
• Goal was to empower patients to take an active role in pain management

and overall health

• Sessions focused on non-pharmacological strategies for managing pain,

assertive communication skills, using the online patient portal and other

• nline resources

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ACTIVATE Study: Patient Partners

• “Nothing about us without us”
• Five patients from KPNC and public system (FQHC)
• Stigma and marginalization of opioid use
• Heightened importance of patient involvement

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ACTIVATE Study: Patient Partners

• Patient partners involved in all

phases of study (design, recruitment, data collection, dissemination)

• Finding unique opportunities to

engage patients in data analysis

Study concept

Proposal Study design

Data collection

Data analysis

Dissem- ination

Patient partners

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Study Results: How Did the Study Empower Patients?

• Although pain severity and opioid use did not differ between two

arms, there were significant differences in several patient- centered outcome measures

• Participants in intervention arm reported:
• Higher overall health scores
• Higher function scores
• Decreased depression
• Increased use of online portal (especially for health and wellness)
• Increased use of exercise/physical therapy and mindfulness/meditation

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Study Results: How Did the Study Empower Patients?

• Results suggest increased self-care and greater engagement with

health care system can be achieved even with a limited intervention

• Study participants saw the experience as a “stepping stone”

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Study Results: How Did the Study Empower Patients?

“I'm going to ask my doctor to refer me to that Pain Program he has been trying to get me to go to all these

• years. This class helped me see how helpful this kind of

information and support can be. I'm thinking of these 4 weeks as a stepping stone.“

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Study Results: Beyond Empowering Patients

• Sustained engagement by patient partners
• Adoption of curriculum by clinical stakeholders
• Impact on research study team

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ACTIVATE Team

Division of Research

Cynthia Campbell, PhD Constance Weisner, DrPH Monique Does, MPH Nancy Charvat-Aguilar, MPH Cate Marino, PsyD Andrea Kline-Simon, MPH Sara Adams, MPH

Clinical and Operational Stakeholders

Sheryl Sun, MD, Chief AFM, Santa Clara Medical Center, Kaiser Permanente Michael Matsumoto, MD, Chief AFM, San Jose Medical Center, Kaiser Permanente Andrea Rubinstein, MD, Santa Rosa Chronic Pain Program, Kaiser Permanente Steve Offerman, MD, Sacramento Emergency Medicine, Kaiser Permanente Karen Peters, PhD, Santa Clara Chronic Pain, Kaiser Permanente Barb Gawehn, PhD, Santa Clara Chronic Pain, Kaiser Permanente Mason Turner, Department of Psychiatry, San Francisco, Kaiser Permanente Murtuza Ghadiali, MD, San Francisco Chemical Dependency Recovery Program, Kaiser Permanente George Shea, Pharmacy Area Director, Santa Clara Service Area, Kaiser Permanente Ken Saffier, MD, Contra Costa Country Health Services Karen Burt Imira, MD, Contra Costa County Health Services Penney Cowan, American Chronic Pain Association Mark Sullivan, MD, Professor, University of Washington

Patient Partners

Benito Gonzalez Thelma Cox Georgie Hunter Sylvia Turner Kristie Mathews

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Learn More

• www.pcori.org
• info@pcori.org
• #PCORI2018
• @activatestudy

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Thank You!

Monique Does, MPH

Kaiser Permanente Northern California, Division of Research Project Manager November 1, 2018