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Roth I, Tiedt M, Miller V, Barnhill J, Chilcoat A, Gardiner P, Faurot K, Karvelas K, Busby K, Gaylord S, Leeman J. Integrative medical group visits for patients with chronic pain: results of a pilot single-site hybrid implementation-effectiveness feasibility study. Front Pain Res 2023; 4:1147588. [PMID: 37828973 PMCID: PMC10565345 DOI: 10.3389/fpain.2023.1147588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 08/24/2023] [Indexed: 10/14/2023] Open
Abstract
Background Approximately 20% of adults in the United States experience chronic pain. Integrative Medical Group Visit (IMGV) offers an innovative approach to chronic pain management through training in mindfulness, nutrition, and other mind-body techniques combined with peer support. To date, there are no studies on IMGV implementation, despite its promise as a feasible non-pharmacological intervention for chronic pain management. In this study, we assessed the feasibility of implementing IMGV and assessing its effectiveness for chronic pain. Methods Implementation Mapping was used to develop and evaluate implementation strategies for IMGV. Strategies included disseminating educational materials, conducting ongoing training, and conducting educational meetings. IMGV was delivered by three healthcare providers: an allopathic physician, registered yoga teacher, and naturopathic physician. The effectiveness of IMGV on patient health outcomes was assessed through qualitative interviews and a Patient-Reported Outcomes Scale (PROMIS-29). Provider perspectives of acceptability, appropriateness, and feasibility were assessed through periodic reflections (group interviews reflecting on the process of implementation) and field notes. Paired t-tests were used to assess changes between scores at baseline and post intervention. Qualitative data were coded by three experienced qualitative researchers using thematic content analysis. Results Of the initial 16 patients enrolled in research, 12 completed at least two sessions of the IMGV. Other than fatigue, there was no statistically significant difference between the pre- and post-scores. Patients reported high satisfaction with IMGV, noting the development of new skills for self-care and the supportive community of peers. Themes from patient interviews and periodic reflections included the feasibility of virtual delivery, patient perspectives on acceptability, provider perspectives of feasibility and acceptability, ease of recruitment, complexity of referral and scheduling process, balancing medical check-in with group engagement, and nursing staff availability. Conclusions IMGV was feasible, acceptable, and effective from the perspectives of patients and providers. Although statistically significant differences were not observed for most PROMIS measures, qualitative results suggested that participants experienced increased social support and increased pain coping skills. Providers found implementation strategies effective, except for engaging nurses, due to staff being overwhelmed from the pandemic. Lessons learned from this pilot study can inform future research on implementation of IMGV.
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Affiliation(s)
- Isabel Roth
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Malik Tiedt
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Vanessa Miller
- Gillings School of Global Public Health, Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jessica Barnhill
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Aisha Chilcoat
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Paula Gardiner
- Department of Family Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Keturah Faurot
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Kris Karvelas
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Kenneth Busby
- Division of Pediatrics Hematology Oncology, Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Susan Gaylord
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jennifer Leeman
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Barnhill JL, Roth IJ, Miller VE, Baratta JM, Chilcoat A, Kavalakatt BM, Tiedt MK, Thompson KL, Gardiner P. Pilot Observational Study of Patient Reported Outcome Measures for Long COVID Patients in Virtual Integrative Medical Group Visits. Glob Adv Integr Med Health 2023; 12:27536130231174236. [PMID: 37205321 PMCID: PMC10186579 DOI: 10.1177/27536130231174236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 04/12/2023] [Accepted: 04/19/2023] [Indexed: 05/21/2023]
Abstract
Background Long COVID is a common, debilitating post-infectious illness for which effective management is unknown. Integrative Medical Group Visits (IMGV) are effective interventions for chronic conditions and could benefit Long COVID patients. More information is needed regarding existing patient reported outcome measures (PROMs) to evaluate efficacy of IMGV for Long COVID. Objective This study assessed the feasibility of specific PROMS to evaluate IMGVs for Long COVID. Findings will inform future efficacy trials. Methods The Perceived Stress Scale (PSS-10), General Anxiety Disorder two-question tool (GAD-2), Fibromyalgia Symptom Severity scale (SSS), and Measure Yourself Medical Outcome Profile (MYMOP®) were collected pre- and post-group by teleconferencing platform or telephone and compared using paired t-tests. Patients were recruited from a Long COVID specialty clinic where they participated in 2-hour - 8 weekly IMGV sessions online. Results Twenty-seven participants enrolled and completed pre-group surveys. Fourteen participants were reachable by phone post-group and completed all pre and post PROMs (78.6% female, 71.4% non-Hispanic White, mean age 49). MYMOP® primary symptomatology was fatigue, shortness of breath and "brain fog". Symptoms decreased in interference when compared to pre-group levels (mean difference -1.3 [95% CI-2.2, -.5]). PSS scores decreased (-3.4 [95% CI -5.8, -1.1]), and GAD-2 mean difference was -1.43 (95% CI -3.12, .26). There were no changes in SSS scores of fatigue (-.21 [95% CI -.68,0.25]), waking unrefreshed (.00 [95%CI -.32, -.32]), or trouble thinking (-.21 [95% CI -.78,0.35]). Conclusion All PROMs were feasible to administer via teleconferencing platform or telephone. The PSS, GAD-2 and MYMOP® are promising PROMs to track Long COVID symptomatology among IMGV participants. The SSS, while feasible to administer, did not change compared to baseline. Larger, controlled studies are needed to determine the efficacy of virtual IMGVs to address the needs of this large and growing population.
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Affiliation(s)
- Jessica L Barnhill
- Department of Physical Medicine and
Rehabilitation, University of North Carolina at
Chapel Hill, Chapel Hill, NC, USA
| | - Isabel J Roth
- Department of Physical Medicine and
Rehabilitation, University of North Carolina at
Chapel Hill, Chapel Hill, NC, USA
| | - Vanessa E Miller
- Department of Injury Prevention
Resource Center, University of North Carolina at
Chapel Hill, Chapel Hill, NC, USA
| | - John M Baratta
- Department of Physical Medicine and
Rehabilitation, University of North Carolina at
Chapel Hill, Chapel Hill, NC, USA
| | - Aisha Chilcoat
- Department of Physical Medicine and
Rehabilitation, University of North Carolina at
Chapel Hill, Chapel Hill, NC, USA
| | - Bethany M Kavalakatt
- Department of Physical Medicine and
Rehabilitation, University of North Carolina at
Chapel Hill, Chapel Hill, NC, USA
| | - Malik K Tiedt
- Department of Physical Medicine and
Rehabilitation, University of North Carolina at
Chapel Hill, Chapel Hill, NC, USA
| | - Karla L Thompson
- Department of Physical Medicine and
Rehabilitation, University of North Carolina at
Chapel Hill, Chapel Hill, NC, USA
| | - Paula Gardiner
- Center for Mindfulness and
Compassion, Cambridge Health
Alliance, Cambridge, MA, USA
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Tiedt MK, Kavalakatt BM, Chilcoat A, Barnhill JL, Roth IJ. Aligning Preprofessional Student Experiences in Integrative Group Medical Visits with Integrative Medicine Core Competencies. Integr Med Rep 2022; 1:186-189. [PMID: 36561147 PMCID: PMC9756384 DOI: 10.1089/imr.2022.0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/31/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Malik K. Tiedt
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,*Address correspondence to: Malik K. Tiedt, Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, School of Medicine, CB #7200, Chapel Hill, NC 27599-9500, USA.
| | - Bethany M. Kavalakatt
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Aisha Chilcoat
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jessica L. Barnhill
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Isabel J. Roth
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Sydlowski S, Donovan C, McNair J, Hahn K, Petter K, Marks T, Haberkamp T, Nguyen-Huynh A, Podriznik J, Woodson E. Optimizing Care Delivery by Applying an Innovative Shared Medical Appointment Model for Determination of Cochlear Implant Candidacy. Otol Neurotol 2021; 42:e1008-12. [PMID: 33782259 DOI: 10.1097/MAO.0000000000003154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To develop and implement an innovative group appointment with the potential to improve access to cochlear implantation (CI) while maintaining patient satisfaction and experience. PATIENTS Adult patients with advanced sensorineural hearing loss. INTERVENTIONS Implementation of novel shared medical appointment (SMA) model. MAIN OUTCOME MEASURES Patient satisfaction with group visit; anecdotal description of provider efficiency and experience. RESULTS Survey data were collected from 166 adults who participated in a group CI candidacy appointment from September 2017 to February 2020 as part of a quality improvement initiative. Provider time is anecdotally optimized by accommodating more patients in a shorter timeframe while effectively triaging those candidates most likely to meet candidacy criteria for a full CI evaluation. Most importantly, patient feedback has been positive which suggests that patients find value in this novel format. CONCLUSIONS The current climate of healthcare demands that providers maximize the efficacy and efficiency of patient care. Our large CI program has determined that using an SMA format as an entry point for CI candidacy evaluation offers many benefits. The group appointment improves patient throughput and also provides a positive patient experience. Group visits offer a viable solution for increasing patient access to CI while maintaining quality in a busy academic medical center setting.
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Rohela P, Olendzki B, McGonigal LJ, Villa A, Gardiner P. A Teaching Kitchen Medical Groups Visit with an eHealth Platform for Hypertension and Cardiac Risk Factors: A Qualitative Feasibility Study. J Altern Complement Med 2021; 27:974-983. [PMID: 34357790 DOI: 10.1089/acm.2021.0148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Introduction: Our Whole Lives-Hypertension (OWL-H) is an eHealth toolkit for hypertension and cardiac risks factors. It is a hybrid online self-management platform that teaches blood pressure (BP) self-monitoring and evidence-based lifestyle modifications combined with in-person teaching kitchen medical group visit. Qualitative feedback from participants regarding the facilitators and barriers of using OWL-H has been discussed in this article. Methods: The OWL-H platform was pilot tested in a pre-post trial with two cohorts of participants with hypertension (N = 24). The online intervention utilized OWL-H for teaching mindfulness meditation, the Dietary Approaches to Stop Hypertension nutrition plan, and evidence-based strategies for lifestyle modifications. Three in-person teaching kitchen medical group visits were held to demonstrate cooking skills to reinforce the online platform. Semi-structured focus group discussions (FGDs) were held after the intervention. Results: Fourteen of the 24 participants in the trial participated in the FGDs, and 1 participant provided feedback in a solo interview. Major themes that emerged included: (1) participants' request to tailor OWL-H's recipes and meal planning to suit their own dietary needs or preferences, to personalize the Home Practices (e.g., meditation) according to individual preferences (e.g., addition of nature sounds or guided visual imagery); (2) the strengths and weaknesses of OWL-H as a BP self-monitoring tool; (3) the need for community support in managing BP; and (4) participants noted lack of time, work and commute, Internet connectivity, stress, and sickness as obstacles in using OWL-H. Participants described feeling outpaced by the growth of technology and raised concerns of poor Internet connectivity hampering their use of OWL-H. Conclusion: OWL-H and the accompanying teaching kitchen medical group visit are potential tools to help reduce hypertension and cardiac risk factors. The intervention was found to have acceptability among people with lower income. Clinical Trials Registration#: NCT03974334.
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Affiliation(s)
- Pallavi Rohela
- Department of Family Medicine and Community Health, and University of Massachusetts Medical School, Worcester, MA, USA
| | - Barbara Olendzki
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Lisa J McGonigal
- Department of Family Medicine and Community Health, and University of Massachusetts Medical School, Worcester, MA, USA
| | - Ariel Villa
- Department of Family Medicine and Community Health, and University of Massachusetts Medical School, Worcester, MA, USA
| | - Paula Gardiner
- Department of Family Medicine and Community Health, and University of Massachusetts Medical School, Worcester, MA, USA
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Barrett D, Brintz CE, Zaski AM, Edlund MJ. Dialectical Pain Management: Feasibility of a Hybrid Third-Wave Cognitive Behavioral Therapy Approach for Adults Receiving Opioids for Chronic Pain. Pain Med 2021; 22:1080-1094. [PMID: 33175158 DOI: 10.1093/pm/pnaa361] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES This study evaluated the feasibility, acceptability, and potential effectiveness of a hybrid skills-based group intervention, dialectical pain management (DPM), for adults with chronic pain who are receiving long-term opioid therapy. DPM adapts dialectical behavior therapy, a rigorous psychotherapeutic approach to emotion dysregulation, to treat disorders of physiological dysregulation. METHODS Individuals with chronic pain (N = 17) participated in one of two 8-week DPM intervention cohorts. At pre-test and post-test, participants completed quantitative self-report assessments measuring pain intensity and interference, depressive symptoms, pain acceptance, beliefs about pain medications, and global rating of change. Within 2 weeks after the intervention, participants completed qualitative interviews to assess participant satisfaction and obtain feedback about specific intervention components. RESULTS Of the 17 enrolled, 15 participants completed the group with 12 (70%) attending six or more sessions. Participants reported high satisfaction with the intervention. Preliminary findings suggested a significant increase in pain acceptance and a significant reduction in depressive symptoms. Participants also reported an improved relationship with their pain conditions and increased flexibility in responding to pain and applying coping skills. Several participants showed a reduction in opioid dosage over the course of the intervention. DISCUSSION Findings support that DPM is a feasible and well-received intervention for individuals with chronic pain. Additional research with a control group is needed to further determine the intervention's efficacy and impact.
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Affiliation(s)
- Deborah Barrett
- University of North Carolina School of Social Work, Chapel Hill, North Carolina, USA.,University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Carrie E Brintz
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Amanda M Zaski
- Duke University School of Medicine, Durham, North Carolina, USA
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Roth I, Wells R, Highfield L, Cuccaro P, Misra S, Engebretson J. Implementing an inpatient integrative medicine consult service for children with pain: A qualitative analysis. Complement Ther Med 2021; 58:102698. [PMID: 33639250 PMCID: PMC8504152 DOI: 10.1016/j.ctim.2021.102698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 12/26/2020] [Accepted: 02/22/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Complementary and integrative medicine (CIM) therapies show clinical benefits with minimal side effects, yet challenges to effective integration in hospital settings remain. The current study aimed to better understand the process of integration of CIM therapies at a large urban pediatric hospital from the perspectives of providers, parents, and administrators. DESIGN The study employed an applied medical ethnography. SETTING The ethnography was conducted before, during, and after an Integrative Medicine Pain Consult Service (IM Pilot) was implemented at a large urban pediatric hospital during the spring of 2017. MAIN OUTCOME MEASURES Fieldwork interviews, participant observations, and document review captured aspects of the integration of CIM over a 6-month study period. Ethnographic analysis included thematic content analysis. Participants included providers (n = 10), administrators (n = 5), and parents of patients (n = 11). RESULTS Emergent themes from analysis of the interviews and field notes were organized according to the socio-ecological model. Themes included facilitating factors for CIM pain management at the intrapersonal and community levels (Alignment with Parental Perceptions of Child Needs and Provider Desire to Offer Care, Alignment of CIM with Spiritual Beliefs and Community Norms) and barriers at the interpersonal, organizational, and political levels (Inter-professional Challenges, Lack of Logistics in Place for Referrals and Triaging Patients with Pain, Lack of Remuneration/Insurance Reimbursement for Care). CONCLUSIONS To address barriers, future efforts to implement integrative pain management programs in pediatric hospital settings may consider testing implementation strategies, including engaging program champions and family advocates, providing education on CIM professions and therapies to hospital staff, and billing for provider time rather than individual CIM therapies.
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Affiliation(s)
- Isabel Roth
- Department of Management, Policy, and Community Health, University of Texas Health Science Center School of Public Health (UTHealth), Houston, TX, USA.
| | - Rebecca Wells
- Department of Management, Policy, and Community Health, University of Texas Health Science Center School of Public Health (UTHealth), Houston, TX, USA.
| | - Linda Highfield
- Department of Management, Policy, and Community Health, University of Texas Health Science Center School of Public Health (UTHealth), Houston, TX, USA.
| | - Paula Cuccaro
- Department of Health Promotion and Behavioral Science, UTHealth School of Public Health, Houston, TX, USA.
| | - Sanghamitra Misra
- Department of Academic General Pediatrics, Baylor College of Medicine, Houston, TX, USA.
| | - Joan Engebretson
- Department of Research, UTHealth Cizik School of Nursing, Houston, TX, USA.
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Gardiner P, McGonigal L, Villa A, Kovell LC, Rohela P, Cauley A, Rinker D, Olendzki B. Our Whole Lives for Hypertension and Cardiac Risk Factors (OWL-H)—Combining a Teaching Kitchen Group Visit with an Online Platform: A Feasibility Trial (Preprint). JMIR Form Res 2021; 6:e29227. [PMID: 35576575 PMCID: PMC9152723 DOI: 10.2196/29227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 02/22/2022] [Accepted: 03/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background Hypertension (HTN) affects millions of Americans. Our Whole Lives: an eHealth toolkit for Hypertension and Cardiac Risk Factors (OWL-H) is an eHealth platform that teaches evidence-based lifestyle strategies, such mindfulness and cooking skills, to improve self-management of HTN. Objective The primary goal of this pilot study was to evaluate the feasibility of OWL-H combined with teaching kitchen medical group visits (TKMGVs) in a low-income population of participants with HTN. Methods We conducted a pre-post 8-week study to assess the feasibility of a hybrid program (a web-based 9-module self-management program, which includes mindfulness and Mediterranean and Dietary Approaches to Stop Hypertension diet) accompanied by 3 in-person TKMGVs among patients with HTN. Data including demographics, platform use, and satisfaction after using OWL-H were examined. Outcome data collected at baseline and 8 weeks included the Mediterranean Diet Questionnaire, Hypertension Self-Care Profile Self-Efficacy Instrument, Blood Pressure Knowledge Questionnaire, and the number of self-reported blood pressure readings. For the statistical analysis, we used descriptive statistics, paired sample t tests (1-tailed), and qualitative methods. Results Of the 25 enrolled participants, 22 (88%) participants completed the study. Participants’ average age was 57 (SD 12.1) years, and 46% (11/24) of them reported a household income <US $30,000 per year. Among the 22 participants who logged in to OWL-H, the average number of mindfulness practices completed was 7 and the average number of module sessions accessed was 4. In all, 73% (16/22) of participants reported that they were “very satisfied” with using OWL-H to help manage their HTN. Participants’ blood pressure knowledge significantly increased from baseline (mean 5.58, SD 1.44) to follow-up (mean 6.13, SD 1.23; P=.03). Participants significantly increased their adherence to a Mediterranean diet from baseline (mean 7.65, SD 2.19) to follow-up (mean 9, SD 1.68; P=.004). Participants’ self-efficacy in applying heart-healthy habits, as measured by the Hypertension Self-Care Profile Self-Efficacy Instrument, increased from baseline (mean 63.67, SD 9.06) to follow-up (mean 65.54, SD 7.56; P=.14). At the 8-week follow-up, 82% (18/22) of the participants had self-reported their blood pressure on the OWL-H platform at least once during the 8 weeks. Conclusions The eHealth platform for HTN self-management, OWL-H, and accompanying in-person TKMGVs have the potential to effectively improve lifestyle management of HTN. Trial Registration ClinicalTrials.gov NCT03974334; https://clinicaltrials.gov/ct2/show/NCT03974334
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Affiliation(s)
- Paula Gardiner
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Lisa McGonigal
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Ariel Villa
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Lara C Kovell
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Pallavi Rohela
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Andrew Cauley
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Diana Rinker
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Barbara Olendzki
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
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Abstract
Pain has been known as one of the major universal health concerns about ill children, because of its morbidity and potential mortality. Pain suitable evaluation is a challenge in children because the verbalization is difficult. Low clinical information, few pediatric researches, and the worry of opioid side effects make difficult to provide satisfactory treatments. Many pharmacologic and non-pharmacologic strategies to manage pain exist for pediatric pain treatment. The purpose of this review article is to describe exhaustively pain mechanism, evaluation and management by review literature from January 2000 to January 2019 using PubMed, EMBASE, MEDLINE, LILACS databases. Pharmacological and integrative non-pharmacological therapies has been indicated in acute and chronic pain treatment. Opioids and opioid-sparing agents target nociceptive and neuropathic pain. With due attention to available results, an early combination of pharmacological and integrative non pharmacological treatments are indicated in children pain management.
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Affiliation(s)
| | - Shaqayeq Khosravi
- (1) Department of Emergency Medicine, School of Medicine, Iran University of Medical Sciences, Aliasghar children Hospital, Tehran, Iran
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Gardiner P, D'Amico S, Luo M, Haas N. An Innovative Electronic Health Toolkit (Our Whole Lives for Chronic Pain) to Reduce Chronic Pain in Patients With Health Disparities: Open Clinical Trial. JMIR Mhealth Uhealth 2020; 8:e14768. [PMID: 32224487 PMCID: PMC7154936 DOI: 10.2196/14768] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/29/2019] [Accepted: 10/22/2019] [Indexed: 01/08/2023] Open
Abstract
Background Chronic pain affects millions of Americans. Our Whole Lives, an electronic health (eHealth) toolkit for Chronic Pain (Our Whole Lives for Chronic Pain [OWLCP]), is a mind-body chronic pain management platform that teaches self-management strategies to reduce pain impact and pain medication use. Objective The primary goal of this study was to evaluate the feasibility of OWLCP in reducing pain impact and pain-related outcomes. Methods We conducted a pre-post clinical study (2 cohorts) to assess the feasibility of OWLCP usage among low-income patients with chronic pain. Outcome data, collected at baseline and 9 weeks, included Patient-Reported Outcomes Measurement Information System (PROMIS-29), pain self-efficacy, and pain medication use. In the statistical analysis, we used descriptive statistics, logistic regression, linear regression, and qualitative methods. Results Among the enrolled 43 participants, the average age was 50 years, (39/43) 91% were female, (16/43) 37% were black, and (7/43) 16% were Hispanic. From baseline to follow-up, the PROMIS measures showed a reduction in depression (P=.02), pain interference (P=.003), and average pain impact score (P=.007). Pain self-efficacy increased ((P<.001), whereas opioid use had a 13% reduction (P=.03). Conclusions The eHealth chronic pain management platform, OWLCP, is a potential tool to reduce the impact of chronic pain for low-income racially diverse populations.
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Affiliation(s)
- Paula Gardiner
- Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA, United States
| | - Salvatore D'Amico
- Department of Family Medicine, Boston Medical Center, Boston, MA, United States
| | - Man Luo
- Department of Family Medicine, Boston Medical Center, Boston, MA, United States
| | - Niina Haas
- BrightOutcome, Buffalo Grove, IL, United States
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11
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Abstract
Pain has been known as one of the major universal health concerns about ill children, because of its morbidity and potential mortality. Pain suitable evaluation is a challenge in children because the verbalization is difficult. Low clinical information, few pediatric researches, and the worry of opioid side effects make difficult to provide satisfactory treatments. Many pharmacologic and non-pharmacologic strategies to manage pain exist for pediatric pain treatment. The purpose of this review article is to describe exhaustively pain mechanism, evaluation and management by review literature from January 2000 to January 2019 using PubMed, EMBASE, MEDLINE, LILACS databases. Pharmacological and integrative non-pharmacological therapies has been indicated in acute and chronic pain treatment. Opioids and opioid-sparing agents target nociceptive and neuropathic pain. With due attention to available results, an early combination of pharmacological and integrative non pharmacological treatments are indicated in children pain management.
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Sokol R, Albanese M, Chew A, Early J, Grossman E, Roll D, Sawin G, Wu DJ, Schuman-Olivier Z. Building a Group-Based Opioid Treatment (GBOT) blueprint: a qualitative study delineating GBOT implementation. Addict Sci Clin Pract 2019; 14:47. [PMID: 31882001 PMCID: PMC6935085 DOI: 10.1186/s13722-019-0176-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 12/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Group-Based Opioid Treatment (GBOT) has recently emerged as a mechanism for treating patients with opioid use disorder (OUD) in the outpatient setting. However, the more practical "how to" components of successfully delivering GBOT has received little attention in the medical literature, potentially limiting its widespread implementation and utilization. Building on a previous case series, this paper delineates the key components to implementing GBOT by asking: (a) What are the core components to GBOT implementation, and how are they defined? (b) What are the malleable components to GBOT implementation, and what conceptual framework should providers use in determining how to apply these components for effective delivery in their unique clinical environment? METHODS To create a blueprint delineating GBOT implementation, we integrated findings from a previously conducted and separately published systematic review of existing GBOT studies, conducted additional literature review, reviewed best practice recommendations and policies related to GBOT and organizational frameworks for implementing health systems change. We triangulated this data with a qualitative thematic analysis from 5 individual interviews and 2 focus groups representing leaders from 5 different GBOT programs across our institution to identify the key components to GBOT implementation, distinguish "core" and "malleable" components, and provide a conceptual framework for considering various options for implementing the malleable components. RESULTS We identified 6 core components to GBOT implementation that optimize clinical outcomes, comply with mandatory policies and regulations, ensure patient and staff safety, and promote sustainability in delivery. These included consistent group expectations, team-based approach to care, safe and confidential space, billing compliance, regular monitoring, and regular patient participation. We identified 14 malleable components and developed a novel conceptual framework that providers can apply when deciding how to employ each malleable component that considers empirical, theoretical and practical dimensions. CONCLUSION While further research on the effectiveness of GBOT and its individual implementation components is needed, the blueprint outlined here provides an initial framework to help office-based opioid treatment sites implement a successful GBOT approach and hence potentially serve as future study sites to establish efficacy of the model. This blueprint can also be used to continuously monitor how components of GBOT influence treatment outcomes, providing an empirical framework for the ongoing process of refining implementation strategies.
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Affiliation(s)
- Randi Sokol
- Malden Family Medicine Center, 195 Canal St, Malden, MA 02148 USA
| | - Mark Albanese
- Outpatient Addiction Services, 26 Central St, Somerville, MA 02143 USA
| | - Aaronson Chew
- Malden Family Medicine Center, 195 Canal St, Malden, MA 02148 USA
| | - Jessica Early
- Malden Family Medicine Center, 195 Canal St, Malden, MA 02148 USA
| | - Ellie Grossman
- Somerville Hospital Primary Care, 236 Highland Avenue, Somerville, MA 02143 USA
| | - David Roll
- Revere Care Center, 454 Broadway, Revere, MA 02151 USA
| | - Greg Sawin
- Malden Family Medicine Center, 195 Canal St, Malden, MA 02148 USA
| | - Dominic J. Wu
- Malden Family Medicine Center, 195 Canal St, Malden, MA 02148 USA
| | - Zev Schuman-Olivier
- Center for Mindfulness and Compassion, 1035 Cambridge Street, Suite 21, Cambridge, MA 02141 USA
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Gardiner P, Luo M, D’Amico S, Gergen-Barnett K, White LF, Saper R, Mitchell S, Liebschutz JM. Effectiveness of integrative medicine group visits in chronic pain and depressive symptoms: A randomized controlled trial. PLoS One 2019; 14:e0225540. [PMID: 31851666 PMCID: PMC6919581 DOI: 10.1371/journal.pone.0225540] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 11/05/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Current treatment options for chronic pain and depression are largely medication-based, which may cause adverse side effects. Integrative Medical Group Visits (IMGV) combines mindfulness techniques, evidence based integrative medicine, and medical group visits, and is a promising adjunct to medications, especially for diverse underserved patients who have limited access to non-pharmacological therapies. OBJECTIVE Determine the effectiveness of IMGV compared to a Primary Care Provider (PCP) visit in patients with chronic pain and depression. DESIGN 9-week single-blind randomized control trial with a 12-week maintenance phase (intervention-medical groups; control-primary care provider visit). SETTING Academic tertiary safety-net hospital and 2 affiliated federally-qualified community health centers. PARTICIPANTS 159 predominantly low income racially diverse adults with nonspecific chronic pain and depressive symptoms. INTERVENTIONS IMGV intervention- 9 weekly 2.5 hour in person IMGV sessions, 12 weeks on-line platform access followed by a final IMGV at 21 weeks. MEASUREMENTS Data collected at baseline, 9, and 21 weeks included primary outcomes depressive symptoms (Patient Health Questionnaire 9), pain (Brief Pain Inventory). Secondary outcomes included pain medication use and utilization. RESULTS There were no differences in pain or depression at any time point. At 9 weeks, the IMGV group had fewer emergency department visits (RR 0.32, 95% CI: 0.12, 0.83) compared to controls. At 21 weeks, the IMGV group reported reduction in pain medication use (Odds Ratio: 0.42, CI: 0.18-0.98) compared to controls. LIMITATIONS Absence of treatment assignment concealment for patients and disproportionate group attendance in IMGV. CONCLUSION Results demonstrate that low-income racially diverse patients will attend medical group visits that focus on non-pharmacological techniques, however, in the attention to treat analysis there was no difference in average pain levels between the intervention and the control group. TRIAL REGISTRATION clinicaltrials.gov NCT02262377.
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Affiliation(s)
- Paula Gardiner
- Department of Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Man Luo
- Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, United States of America
| | - Salvatore D’Amico
- Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, United States of America
| | - Katherine Gergen-Barnett
- Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, United States of America
| | - Laura F. White
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Robert Saper
- Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, United States of America
| | - Suzanne Mitchell
- Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, United States of America
| | - Jane M. Liebschutz
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
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14
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Gardiner P, Lestoquoy AS, Negash NL, Luo M, Gergen-Barnett K, Saper R, Penti B, White LF, Liebschutz JM. Lessons Learned and Strategies for Recruitment of Diverse, Low-income Patients into an Integrative Medical Group Visit Clinical Trial. Explore (NY) 2019; 15:215-221. [PMID: 31056423 DOI: 10.1016/j.explore.2019.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 01/10/2019] [Accepted: 01/31/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Description of recruitment methods and lessons learned in a randomized controlled trial of underserved patients using an integrative medical group visits intervention. METHODS Comparison of the demographic characteristics of participants screened and consented to the study as well as description of recruitment methods used. OUTCOME MEASURES This paper examines the characteristics of patients who were eligible compared to those who were not, characteristics of patients at the different sites, and patient characteristics over time (by comparing various cohorts) based on our experiences recruiting underserved patients. RESULTS We screened 338 patients, with 205 (60.6%) meeting eligibility criteria and 159 patients randomized and consented. 133 patients were found ineligible, with the most common reasons being low depression scores (n = 20), manic symptoms (n = 20), and psychotic symptoms (n = 19), and alcohol use (n = 15). We found demographic differences in patients recruited by different methods and at different sites- patients referred by provider letter were older than those referred by self-referral or provider referral (mean age/SD vs. mean age/SD, p = 0.0001). For site-specific differences, patients at DH were older (53 SD = 12.3) than those at the Boston Medical Center (49 SD = 11.3) and CSHC (p = 0.048) in pair-wise comparisons. Patients at DH were also more likely to be white (25%) as compared to BMC (18%) and DH (7%), while those at CSHC were more likely to be black (70%) (p = 0.008).
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Affiliation(s)
- Paula Gardiner
- University of Massachusetts Medical School, 55 Lake Street North Worcester, MA 01655-0002 USA.
| | - Anna Sophia Lestoquoy
- University of Massachusetts Medical School, 55 Lake Street North Worcester, MA 01655-0002 USA
| | - N Lily Negash
- University of Massachusetts Medical School, 55 Lake Street North Worcester, MA 01655-0002 USA
| | - Man Luo
- University of Massachusetts Medical School, 55 Lake Street North Worcester, MA 01655-0002 USA
| | | | - Robert Saper
- University of Massachusetts Medical School, 55 Lake Street North Worcester, MA 01655-0002 USA
| | - Brian Penti
- University of Massachusetts Medical School, 55 Lake Street North Worcester, MA 01655-0002 USA
| | - Laura F White
- University of Massachusetts Medical School, 55 Lake Street North Worcester, MA 01655-0002 USA
| | - Jane M Liebschutz
- University of Massachusetts Medical School, 55 Lake Street North Worcester, MA 01655-0002 USA
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15
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Hurstak E, Chao MT, Leonoudakis-Watts K, Pace J, Walcer B, Wismer B. Design, Implementation, and Evaluation of an Integrative Pain Management Program in a Primary Care Safety-Net Clinic. J Altern Complement Med 2019; 25:S78-S85. [PMID: 30870021 DOI: 10.1089/acm.2018.0398] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To design, implement, and evaluate a comprehensive Integrative Pain Management Program (IPMP) for patients with chronic pain in a safety-net primary care clinic. DESIGN We used a quality improvement "Plan Do Study Act" (PDSA) framework to design, refine, and evaluate an integrative chronic pain program. SETTING An urban federally qualified health center located in a community with high rates of chronic pain, substance use, and opioid overdose. SUBJECTS Eligible participants included individuals with pain for greater than 3 months who were prescribed opioid therapy. OUTCOME MEASURES We designed IPMP using a PDSA framework that promotes continuous evaluation and adaptation of the program to meet the needs of the clinical system. We assessed feasibility and acceptability with program referrals and attendance and evaluated program satisfaction. RESULTS The IPMP delivered a 12-week group-based intervention that involved group support, education on pain etiology and treatments, movement-based interventions, mindfulness-based therapies, acupuncture, and massage therapy. One hundred forty-six patients were referred to IPMP; 58 individuals participated in one of the first three cohorts of the program. Sixty-two percent of participants attended at least half of the sessions. Staff and participants reported high levels of satisfaction with IPMP and demand for longitudinal services. CONCLUSIONS An IPMP delivered within a safety-net primary care clinic could be implemented in a way feasible and acceptable to staff and participants with the support of the local health care system. The application of a PDSA cycle allowed for rigorous implementation and evaluation of a multimodal pain program. Quality improvement frameworks are a strategy to improve and expand the delivery of high-quality patient-centered integrative pain treatments.
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Affiliation(s)
- Emily Hurstak
- 1 Division of General Internal Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, California
| | - Maria T Chao
- 1 Division of General Internal Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, California.,2 Osher Center for Integrative Medicine, University of California, San Francisco, San Francisco, California
| | | | - Joseph Pace
- 3 San Francisco Department of Public Health, San Francisco, California
| | - Blue Walcer
- 3 San Francisco Department of Public Health, San Francisco, California
| | - Barbara Wismer
- 3 San Francisco Department of Public Health, San Francisco, California.,4 Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
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16
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Roth I, Highfield L, Cuccaro P, Wells R, Misra S, Engebretson J. Employing Evidence in Evaluating Complementary Therapies: Findings from an Ethnography of Integrative Pain Management at a Large Urban Pediatric Hospital. J Altern Complement Med 2019; 25:S95-S105. [PMID: 30870018 DOI: 10.1089/acm.2018.0369] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Complementary and Integrative Medicine (CIM) shows positive clinical benefit with minimal side effects, yet, challenges to effective integration of CIM providers in biomedical health care settings remain. This study aimed to better understand the role evidence played in the process of integration of complementary therapies into a large urban pediatric hospital from the perspective of patients, caregivers, providers, and administrators through applied medical ethnography. METHODS An ethnography was conducted over the course of 6 months in a large urban pediatric hospital in the Southern United States. At the time, the hospital was piloting an integrative medicine (IM) pain consult service. Purposive sampling was used to select providers, patients, administrators, and caregivers to follow as they engaged with both the preexisting pain service and pilot IM pain services. Field observation and interviews were conducted with 34 participants. Thematic content analysis was used to analyze field notes, interview transcripts, and documents collected. FINDINGS Analysis of the data revealed five themes regarding the role of evidence in the process of integration: Anecdotal Evidence and Personal Experience Effecting CIM Use, Open to Trying Whatever Works, Resistance to the Unfamiliar, Patients and Parents Trusting Doctors as Experts, and Importance of Scientific Evidence to Biomedicine. All themes address the role of evidence in relationship to acceptance of complementary therapies and correspond with three thought processes: critical thinking, relying on others for evidence, and reactionary thinking. CONCLUSION Both scientific and anecdotal evidence informed CIM use in this context. Biomedical environments seeking to integrate CIM into pain treatment regimens will need to engage all relevant stakeholders in building education, clinical training, and research programs that are critically informed about the context and evidence for CIM.
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Affiliation(s)
- Isabel Roth
- 1 Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Linda Highfield
- 2 Department of Management, Policy, and Community Health, University of Texas Health Science Center School of Public Health (UTHealth), Houston, TX
| | - Paula Cuccaro
- 3 Department of Health Promotion and Behavioral Science, University of Texas Health Science Center School of Public Health (UTHealth), Houston, TX
| | - Rebecca Wells
- 2 Department of Management, Policy, and Community Health, University of Texas Health Science Center School of Public Health (UTHealth), Houston, TX
| | - Sanghamitra Misra
- 4 Department of Academic General Pediatrics, Baylor College of Medicine, Houston, TX
| | - Joan Engebretson
- 5 Department of Family Health, University of Texas Health Science Center Cizik School of Nursing (UTHealth), Houston, TX
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17
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Wren AA, Ross AC, D'Souza G, Almgren C, Feinstein A, Marshall A, Golianu B. Multidisciplinary Pain Management for Pediatric Patients with Acute and Chronic Pain: A Foundational Treatment Approach When Prescribing Opioids. Children (Basel) 2019; 6:E33. [PMID: 30795645 DOI: 10.3390/children6020033] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/07/2019] [Accepted: 02/13/2019] [Indexed: 12/13/2022]
Abstract
Opioid therapy is the cornerstone of treatment for acute procedural and postoperative pain and is regularly prescribed for severe and debilitating chronic pain conditions. Although beneficial for many patients, opioid therapy may have side effects, limited efficacy, and potential negative outcomes. Multidisciplinary pain management treatments incorporating pharmacological and integrative non-pharmacological therapies have been shown to be effective in acute and chronic pain management for pediatric populations. A multidisciplinary approach can also benefit psychological functioning and quality of life, and may have the potential to reduce reliance on opioids. The aims of this paper are to: (1) provide a brief overview of a multidisciplinary pain management approach for pediatric patients with acute and chronic pain, (2) highlight the mechanisms of action and evidence base of commonly utilized integrative non-pharmacological therapies in pediatric multidisciplinary pain management, and (3) explore the opioid sparing effects of multidisciplinary treatment for pediatric pain.
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Abstract
Purpose: Integrative group medical visits (IGMVs) aim to increase access to complementary and integrative health care, which is particularly relevant for low-income people. We sought to describe IGMV programs in US safety-net clinics through a survey of providers. Methods: An online and paper survey was conducted to collect data on the use of complementary health approaches and characteristics of IGMV programs. We recruited a purposive sample of safety-net clinicians via national meetings and listservs. Results: Fifty-seven clinicians reported on group medical visits. Forty percent worked in federally qualified health centers, 57% in safety-net or teaching hospitals, 23% in other settings such as free clinics. Thirty-seven respondents in 11 states provided care in IGMVs, most commonly for chronic pain and diabetes. Nutrition (70%), mindfulness/meditation/breathing (59%), and tai chi/yoga/other movement practices (51%) were the most common treatment approaches in IGMVs. Conclusion: Safety-net institutions in 11 states offered IGMVs to treat a range of chronic conditions. IGMVs are an innovative model to improve access to non-pharmacologic approaches to chronic illness care and health promotion. They may advance health equity by serving patients negatively impacted by health and health care disparities.
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Affiliation(s)
| | - Paula Gardiner
- Department of Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Maria T. Chao
- Division of General Internal Medicine and Osher Center for Integrative Medicine, UC San Francisco, San Francisco, California
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Lestoquoy AS, Laird LD, Mitchell S, Gergen-Barnett K, Negash NL, McCue K, Enad R, Gardiner P. Living with chronic pain: Evaluating patient experiences with a medical group visit focused on mindfulness and non-pharmacological strategies. Complement Ther Med 2017; 35:33-38. [PMID: 29154064 DOI: 10.1016/j.ctim.2017.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 09/01/2017] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES Little is known about the acceptance of non-pharmacological group strategies delivered to low income racially diverse patients with chronic pain and depression. This paper examines how the Integrative Medical Group Visit (IMGV) addresses many of the deficits identified with usual care. DESIGN AND SETTING Six IMGVs cohorts were held at a safety net hospital and two federally funded community health centres. Data was gathered through focus groups. Transcripts were analysed using both a priori codes and inductive coding. INTERVENTION The intervention included ten sessions of Integrative Medical Group Visits with a primary care provider and a meditation instructor. The curriculum uses principles of Mindfulness Based Stress Reduction and evidence based integrative medicine. The visit is structured similarly to other group medical visits. MAIN OUTCOME MEASURES Data was gathered through four focus groups held after the cohorts were completed. RESULTS Participants (N=20) were largely low income minority adults with chronic pain and comorbid depression. Six themes emerged from the coding including: chronic pain is isolating; group treatment contributes to better coping with pain; loss of control and autonomy because of the unpredictability of pain as well as dependence on medication and frequent medical appointments; groups improve agency and control over one's health condition; navigating the healthcare system and unsatisfactory treatment options; and changes after the IMGV due to non-pharmacological health management. CONCLUSIONS The IMGV is a promising format of delivering integrative care for chronic pain and depression which addresses many of the problems identified by patients in usual care.
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Affiliation(s)
- Anna Sophia Lestoquoy
- Department of Family Medicine, Boston Medical Center, Dowling 5 South, 1 Boston Medical Center Place, Boston, MA 02118, USA
| | - Lance D Laird
- Department of Family Medicine, Boston Medical Center, Dowling 5 South, 1 Boston Medical Center Place, Boston, MA 02118, USA; Boston University School of Medicine, 72 E Concord St, Boston, MA 02118, USA
| | - Suzanne Mitchell
- Department of Family Medicine, Boston Medical Center, Dowling 5 South, 1 Boston Medical Center Place, Boston, MA 02118, USA; Boston University School of Medicine, 72 E Concord St, Boston, MA 02118, USA
| | - Katherine Gergen-Barnett
- Department of Family Medicine, Boston Medical Center, Dowling 5 South, 1 Boston Medical Center Place, Boston, MA 02118, USA
| | - N Lily Negash
- Department of Family Medicine, Boston Medical Center, Dowling 5 South, 1 Boston Medical Center Place, Boston, MA 02118, USA
| | - Kelly McCue
- Department of Family Medicine, Boston Medical Center, Dowling 5 South, 1 Boston Medical Center Place, Boston, MA 02118, USA
| | - Racquel Enad
- Department of Family Medicine, Boston Medical Center, Dowling 5 South, 1 Boston Medical Center Place, Boston, MA 02118, USA
| | - Paula Gardiner
- Department of Family Medicine, Boston Medical Center, Dowling 5 South, 1 Boston Medical Center Place, Boston, MA 02118, USA; Boston University School of Medicine, 72 E Concord St, Boston, MA 02118, USA.
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20
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Cornelio-Flores O, Lestoquoy AS, Abdallah S, DeLoureiro A, Lorente K, Pardo B, Olunwa J, Gardiner P. The Latino Integrative Medical Group Visit as a Model for Pain Reduction in Underserved Spanish Speakers. J Altern Complement Med 2017; 24:125-131. [PMID: 28885858 DOI: 10.1089/acm.2017.0132] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Chronic pain is a common problem in the United States, one for which there is a dearth of effective treatments. Nonpharmacological options are a promising alternative, especially for Spanish-speaking Latinos. This pilot study would like to assess the feasibility of an adapted Integrative Medical Group Visit (IMGV) curriculum for a Spanish-speaking Latino chronic pain population. DESIGN AND INTERVENTION We translated and adapted the curriculum of the IMGV for a Spanish-speaking Latino chronic pain population. We then tested the feasibility of using this model with two pilot groups (N = 19) using a pre-postdesign. SUBJECTS This intervention was targeted for underserved Spanish-speaking Latino patients with chronic pain. SETTINGS/LOCATION This study took place at a safety net academic teaching hospital, the Boston Medical Center, and at a community health center located in a majority Latino neighborhood, the East Boston Neighborhood Health Clinic. OUTCOME MEASURES We used the validated Spanish translations of the Patient-Reported Outcomes Measurement Information System (PROMIS-29) (short version), Personal Health Questionnaire (PHQ-8), and Perceived Stress Scale (PSS-10). We also gathered qualitative information through focus groups and in-depth interviews. RESULTS Using PROMIS measures, there was a statistically significant reduction in pain interference (p = 0.01), fatigue (p = 0.01), and depression (p = 0.01). Qualitative data also indicated the participants felt they benefited from the visits and having care in Spanish was unique. CONCLUSIONS This model offers a promising nonpharmacological option for Spanish-speaking patients with chronic pain and could offer an alternative for addressing disparities for this population.
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Affiliation(s)
| | | | - Sheila Abdallah
- 1 Department of Family Medicine, Boston Medical Center , Boston, MA
| | | | | | - Bryan Pardo
- 2 Boston University School of Medicine , Boston, MA
| | - Joseph Olunwa
- 3 Departments of Health Policy and Management, and Epidemiology, Boston University School of Public Health , Boston, MA
| | - Paula Gardiner
- 1 Department of Family Medicine, Boston Medical Center , Boston, MA
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