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

Monique Does, MPH • Nothing to disclose. 2 • November 21, 2018

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 opioids 3 • November 21, 2018

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 4 • November 21, 2018

Opioid Prescribing in the U.S. • Recent paper by Bohnert et al. describes declining rates of opioid use 5 • November 21, 2018

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 6 • November 21, 2018

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) 7 • November 21, 2018

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 providers 2 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. 8 • November 21, 2018

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 9 • November 21, 2018

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 online resources 10 • November 21, 2018

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 11 • November 21, 2018

ACTIVATE Study: Patient Partners Study • Patient partners involved in all concept phases of study (design, Dissem- Proposal recruitment, data collection, ination dissemination) Patient partners • Finding unique opportunities to engage patients in data analysis Data Study design analysis Data collection 12 • November 21, 2018

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 13 • November 21, 2018

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” 14 • November 21, 2018

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.“ 15 • November 21, 2018

Study Results: Beyond Empowering Patients • Sustained engagement by patient partners • Adoption of curriculum by clinical stakeholders • Impact on research study team 16 • November 21, 2018

ACTIVATE Team Clinical and Operational Stakeholders Patient Partners Division of Research Sheryl Sun, MD, Chief AFM, Santa Clara Medical Center, Benito Gonzalez Cynthia Campbell, PhD Kaiser Permanente Constance Weisner, DrPH Thelma Cox Michael Matsumoto, MD, Chief AFM, San Jose Medical Center, Kaiser Permanente Monique Does, MPH Georgie Hunter Andrea Rubinstein, MD, Santa Rosa Chronic Pain Nancy Charvat-Aguilar, MPH Program, Kaiser Permanente Sylvia Turner Cate Marino, PsyD Steve Offerman, MD, Sacramento Emergency Medicine, Kaiser Permanente Kristie Mathews Andrea Kline-Simon, MPH Karen Peters, PhD, Santa Clara Chronic Pain, Kaiser Sara Adams, MPH 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 17 • November 21, 2018

Learn More • www.pcori.org • info@pcori.org • #PCORI2018 • @activatestudy 18 • November 21, 2018

Thank You! Monique Does, MPH Kaiser Permanente Northern California, Division of Research Project Manager November 1, 2018 19 • November 21, 2018