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"I'm Not Abusing or Anything": Patient-physician communication about opioid treatment in chronic pain

PATIENT EdUCATION ANd COUNSELING 2013年第2期93卷 197-202页

作者： Matthias, Marianne S. Krebs, Erin E. Collins, Linda A. Bergman, Alicia A. Coffing, Jessica Bair, Matthew J. Roudebush VA Med Ctr VA HSR&D Ctr Implementing Evidence Based Practice Indianapolis IN 46202 USA Regenstrief Inst Inc Indianapolis IN USA Indiana Univ Purdue Univ Dept Commun Studies Indianapolis IN 46202 USA Minneapolis VA Hlth Care Syst Minneapolis MN USA Univ Minnesota Sch Med Dept Med Minneapolis MN 55455 USA Indiana Univ Sch Med Dept Med Indianapolis IN 46202 USA

Objective: To characterize clinical communication about opioids through direct analysis of clinic visits and in-depth interviews with patients. Methods: This was a pilot study of 30 patients with chronic pain, who were audio-recorded in their primary care visits and interviewed after the visit about their pain care and relationship with their physicians. Emergent thematic analysis guided data interpretation. Results: Uncertainties about opioid treatment for chronic pain, particularly addiction and misuse, play an important role in communicating about pain treatment. Three patterns of responding to uncertainty emerged in conversations between patients and physicians: reassurance, avoiding opioids, and gathering additional information. Results are interpreted within the framework of Problematic Integration theory. Conclusion: Although it is well-established that opioid treatment for chronic pain poses numerous uncertainties, little is known about how patients and their physicians navigate these uncertainties. This study illuminates ways in which patients and physicians face uncertainty communicatively and collaboratively. practice implications: Acknowledging and confronting the uncertainties inherent in chronic opioid treatment are critical communication skills for patients taking opioids and their physicians. Many of the communication behaviors documented in this study may serve as a model for training patients and physicians to communicate effectively about opioids. Published by Elsevier Ireland Ltd.

关键词： Chronic pain Opioids Patient-provider communication Qualitative research

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The next-generation electronic health record: perspectives of key leaders from the US department of Veterans Affairs

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JOURNAL OF THE AMERICAN MEdICAL INFORMATICS ASSOCIATION 2013年第E1期20卷 E175-E177页

作者： Saleem, Jason J. Flanagan, Mindy E. Wilck, Nancy R. demetriades, Jim doebbeling, Bradley N. Roudebush VA Med Ctr VA Hlth Serv Res & Dev HSR&D Ctr Implementing Evidence Based Practice Indianapolis IN USA Indiana Univ Ctr Hlth Serv & Outcomes Res Indianapolis IN 46204 USA Regenstrief Inst Inc Indianapolis IN USA Vet Hlth Adm Off Informat & Analyt Washington DC USA IU Sch Med Dept Med Indianapolis IN USA

The rapid change in healthcare has focused attention on the necessary development of a next-generation electronic health record (EHR) to support system transformation and more effective patient-centered care. The department of Veterans Affairs (va) is developing plans for the next-generation EHR to support improved care delivery for veterans. To understand the needs for a next-generation EHR, we interviewed 14 va operational, clinical and informatics leaders for their vision about system needs. Leaders consistently identified priorities for development in the areas of cognitive support, information synthesis, teamwork and communication, interoperability, data availability, usability, customization, and information management. The need to reconcile different EHR initiatives currently underway in the va, as well as opportunities for data sharing, will be critical for continued progress. These findings may support the va's effort for evolutionary change to its information system and draw attention to necessary research and development for a next-generation information system and EHR nationally.

关键词： Clinical decision support systems Cognitive support Electronic health records Interoperability Usability

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Efficiency Strategies for Facilitating Computerized Clinical documentation in Ambulatory Care

Efficiency Strategies for Facilitating Computerized Clinical...

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14th World Congress on Medical and Health Informatics (MEdINFO)

作者： Saleem, Jason J. Adams, Stephanie Frankel, Richard M. doebbeling, Bradley N. Patterson, Emily S. VA HSR&D Ctr Implementing Evidence Based Practice Indianapolis IN 46202 USA Regenstrief Inst Inc Indianapolis IN 46202 USA Indiana Univ Ctr Hlth Serv & Outcomes Res Indianapolis IN 46202 USA Ohio State Univ Coll Med Sch Hlth & Rehabilitat Sci Columbus OH 43210 USA

ISBN: (纸本)9781614992899;9781614992882

Most providers have experienced increased documentation demands with the use of electronic health records (EHRs). We sought to identify efficiency strategies that providers use to complete clinical documentation tasks in ambulatory care. Two observers performed ethnographic observations and interviews with 22 ambulatory care providers in a U.S. Veterans Affairs Medical center. Observation notes and interview transcripts were coded for recurrent strategies relating to completion of the EHR progress notes. Findings included: the use of paper artifacts for handwritten notations;electronic templates for automation of certain parts of the note;use of shorthand and phrases rather than narrative writing;copying and pasting from previous EHR notes;directly entering information into the EHR note during the patient encounter;reliance on memory;and pre-populating an EHR note prior to seeing the patient. We discuss the findings in the context of distributed cognition to understand how clinical information is propagated and represented toward completion of a progress note. The study findings have important implications for improving and streamlining clinical documentation related to human factors workload management strategies.

关键词： Clinical documentation Human factors Workload Workflow Electronic health records

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Patient Activation in Schizophrenia: Insights from Stories of Illness and Recovery

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AdMINISTRATION ANd POLICY IN MENTAL HEALTH ANd MENTAL HEALTH SERVICES RESEARCH 2013年第5期40卷 419-427页

作者： Salyers, Michelle P. Matthias, Marianne S. Sidenbender, Sharon Green, Amethyst IUPUI Dept Psychol Indianapolis IN 46202 USA ACT Ctr Indiana Indianapolis IN USA IU Ctr Hlth Serv & Outcomes Res Regenstrief Inst Indianapolis IN USA Roudebush VAMC VA HSR&D Ctr Implementing Evidence Based Practice Indianapolis IN USA IUPUI Dept Commun Studies Indianapolis IN 46202 USA

Using a mixed-methods approach, we sought a deeper understanding of patient activation in 46 participants with schizophrenia. We qualitatively examined narratives for themes related to patient activation and divided the sample based on the mental health version of the patient activation measure. Participants high in patient activation described acceptance, control over illness, a wide range of activities that help them, and highlighted collaborative treatment experiences. The groups did not differ in understanding the cause of illness, what makes symptoms worse, or things they were proud of. Active management of schizophrenia mirrors physical health activation in several ways.

关键词： Narratives Chronic illness Illness management

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Stepped Care to Optimize Pain care Effectiveness (SCOPE) trial study design and sample characteristics

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CONTEMPORARY CLINICAL TRIALS 2013年第2期34卷 270-281页

作者： Kroenke, Kurt Krebs, Erin Wu, Jingwei Bair, Matthew J. damush, Teresa Chumbler, Neale York, Tish Weitlauf, Sharon McCalley, Stephanie Evans, Erica Barnd, Jeffrey Yu, Zhangsheng Roudebush VA Med Ctr VA HSR&D Ctr Implementing Evidence Based Practice Indianapolis IN USA Indiana Univ Sch Med Dept Med Indianapolis IN USA Regenstrief Inst Inc Indianapolis IN USA Minneapolis VA Hlth Care VA HSR&D Ctr Chron Dis Outcomes Res Minneapolis MN USA Univ Minnesota Sch Med Minneapolis MN 55455 USA Indiana Univ Sch Med Dept Biostat Indianapolis IN USA VA Stroke QUERI Ctr Indianapolis IN USA Indiana Univ Ctr Aging Indianapolis IN 46204 USA Univ Georgia Coll Publ Hlth Dept Hlth Policy & Management Athens GA 30602 USA

Pain is the most common physical symptom in primary care, accounting for an enormous burden in terms of patient suffering, quality of life, work and social disability, and health care and societal costs. Although collaborative care interventions are well-established for conditions such as depression, fewer systems-based interventions have been tested for chronic pain. This paper describes the study design and baseline characteristics of the enrolled sample for the Stepped Care to Optimize Pain care Effectiveness (SCOPE) study, a randomized clinical effectiveness trial conducted in five primary care clinics. SCOPE has enrolled 250 primary care veterans with persistent (3 months or longer) musculoskeletal pain of moderate severity and randomized them to either the stepped care intervention or usual care control group. Using a telemedicine collaborative care approach, the intervention couples automated symptom monitoring with a telephone-based, nurse care manager/physician pain specialist team to treat pain. The goal is to optimize analgesic management using a stepped care approach to drug selection, symptom monitoring, dose adjustment, and switching or adding medications. All subjects undergo comprehensive outcome assessments at baseline, 1, 3, 6 and 12 months by interviewers blinded to treatment group. The primary outcome is pain severity/disability, and secondary outcomes include pain beliefs and behaviors, psychological functioning, health-related quality of life and treatment satisfaction. Innovations of SCOPE include optimized analgesic management (including a stepped care approach, opioid risk stratification, and criteria-based medication adjustment), automated monitoring, and centralized care management that can cover multiple primary care practices. Published by Elsevier Inc.

关键词： Pain Therapy Analgesics Clinical trial Primary care Telehealth

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do persons with schizophrenia who have better metacognitive capacity also have a stronger subjective experience of recovery?

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PSYCHIATRY RESEARCH 2013年第3期209卷 381-385页

作者： Kukla, Marina Lysaker, Paul H. Salyers, Michelle P. Richard L Roudebush VA Med Ctr HSR&D Ctr Excellence Implementing Evidence Based Indianapolis IN 46202 USA Indiana Univ Purdue Univ Dept Psychol Indianapolis IN 46202 USA Richard L Roudebush VA Med Ctr Day Hosp Indianapolis IN 46202 USA Indiana Univ Sch Med Bloomington IN 47405 USA ACT Ctr Indiana Indianapolis IN 46202 USA

Research suggests that persons with schizophrenia experience deficits in the ability to synthesize complex and integrated representations of themselves and others. While impairments in these metacognitive capacities are hypothetically related to the ability to make sense of the challenges of schizophrenia, little is known about their relationship with the subjective experience of recovery from mental illness. To examine this question, this study investigated whether persons with stronger self-reported recovery had better metacognitive capacity, after controlling for severity of psychiatric symptoms. Forty-six outpatients with schizophrenia spectrum disorders who were taking part in a study of the Illness Management and Recovery program were concurrently administered the Recovery Assessment Scale, the Positive and Negative Syndrome Scale, and the Indiana Psychiatric Illness Interview which was scored using the Abbreviated Metacognitive Assessment Scale. Analysis of covariance revealed that metacognitive capabilities reflecting self-reflectivity and decentration were differentially related to several components of recovery beyond the effects of psychiatric symptoms. The metacognitive abilities to think about oneself in a sophisticated way and form integrated ideas about oneself and others within the larger world, understanding that none are the metaphorical center are present in individuals holding strong perceptions of recovery. Published by Elsevier Ireland Ltd.

关键词： Recovery Metacognition Schizophrenia Symptoms

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Job Satisfaction and Burnout Among va and Community Mental Health Workers

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AdMINISTRATION ANd POLICY IN MENTAL HEALTH ANd MENTAL HEALTH SERVICES RESEARCH 2013年第2期40卷 69-75页

作者： Salyers, Michelle P. Rollins, Angela L. Kelly, Yu-Fan Lysaker, Paul H. Williams, Jane R. VA HSR&D Ctr Implementing Evidence Based Practice Indianapolis IN USA Roudebush VA Med Ctr VAMC Indianapolis IN USA Regenstrief Inst Inc Indianapolis IN USA ACT Ctr Indiana Indianapolis IN USA Indiana Univ Purdue Univ Dept Psychol Indianapolis IN 46205 USA Oklahoma City VAMC Oklahoma City OK USA Indiana Univ Sch Med Dept Psychiat Indianapolis IN USA

Building on two independent studies, we compared burnout and job satisfaction of 66 va staff and 86 community mental health center staff in the same city. va staff reported significantly greater job satisfaction and accomplishment, less emotional exhaustion and lower likelihood of leaving their job. Sources of work satisfaction were similar (primarily working with clients, helping/witnessing change). va staff reported fewer challenges with job-related aspects (e.g. flexibility, pay) but more challenges with administration. Community mental health administrators and policymakers may need to address job-related concerns (e.g. pay) whereas va administrators may focus on reducing, and helping workers navigate, administrative policies.

关键词： Staff Job satisfaction Burnout Community mental health

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Proceedings of the 3rd Biennial Conference of the Society for Implementation Research Collaboration (SIRC) 2015: advancing efficient methodologies through community partnerships and team science : Seattle, WA, USA. 24-26 September 2015

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Implementation science : IS 2016年第1期11 Suppl 1卷 85页

作者： Cara Lewis doyanne darnell Suzanne Kerns Maria Monroe-deVita Sara J. Landes Aaron R. Lyon Cameo Stanick Shannon dorsey Jill Locke Brigid Marriott Ajeng Puspitasari Caitlin dorsey Karin Hendricks Andria Pierson Phil Fizur Katherine A. Comtois Lawrence A. Palinkas Patricia Chamberlain Gregory A. Aarons Amy E. Green Mark. G. Ehrhart Elise M. Trott Cathleen E. Willging Maria E. Fernandez Nicholas H. Woolf Shuting Lily Liang Natalia I. Heredia Michelle Kegler Betsy Risendal Andrea dwyer Vicki Young dayna Campbell Michelle Carvalho Yvonne Kellar-Guenther Laura J. damschroder Julie C. Lowery Sarah S. Ono Kathleen F. Carlson Erika K. Cottrell Maya E. O’Neil Travis L. Lovejoy Joanna J. Arch Jill L. Mitchell Cara C. Lewis Brigid R. Marriott Kelli Scott Jennifer Schurer Coldiron Eric J. Bruns Alyssa N. Hook Benjamin C. Graham Katelin Jordan Rochelle F. Hanson Angela Moreland Benjamin E. Saunders Heidi S. Resnick Shannon Wiltsey Stirman Cassidy A. Gutner Jennifer Gamarra dawne Vogt Michael Suvak Jennifer Schuster Wachen Katherine dondanville Jeffrey S. Yarvis Jim Mintz Alan L. Peterson Elisa V. Borah Brett T. Litz Alma Molino Stacey Young McCaughan Patricia A. Resick Nancy Pandhi Nora Jacobson Neftali Serrano Armando Hernandez Elizabeth Zeidler- Schreiter Natalie Wietfeldt Zaher Karp Michael d. Pullmann Barbara Lucenko Bridget Pavelle Jacqueline A. Uomoto Andrea Negrete Molly Cevasco Suzanne E. U. Kerns Robert P. Franks Christopher Bory Edward J. Miech Teresa M. damush Jason Satterfield derek Satre Maria Wamsley Patrick Yuan Patricia O’Sullivan Helen Best Susan Velasquez Miya Barnett Lauren Brookman-Frazee Jennifer Regan Nicole Stadnick Alison Hamilton Anna Lau Scott Roesch Byron J. Powell Thomas J. Waltz Matthew J. Chinman Laura damschroder Jeffrey L. Smith Monica M. Matthieu Enola K. Proctor JoAnn E. Kirchner Monica J. Matthieu Craig S. Rosen Sarah C. Walker Asia S. Bishop Mariko Lockhart Allison L. Rodriguez Luisa Manfredi Andrea Nevedal Joel Rosenthal daniel M. Blonigen Anne M. Mauricio Thomas d. dishion Jenna Rudo-Stern Department of Psychological and Brain Sciences Indiana University Bloomington USA Department of Psychiatry & Behavioral Sciences University of Washington Seattle USA Psychology Department University of Montana Missoula USA Department of Psychology La Salle University Philadelphia USA Division of Public Behavioral Health and Justice Policy University of Washington Seattle USA National Center for PTSD VA Palo Alto Health Care System Menlo Park USA Department of Psychiatry University of Arkansas for Medical Sciences Little Rock USA Department of Psychology University of Washington Seattle USA Department of Speech and Hearing Sciences University of Washington Seattle USA Department of Psychological Sciences University of Missouri Columbia USA Department of Children Youth and Families School of Social Work University of Southern California Los Angeles USA Oregon Social Learning Center Eugene USA Department of Psychiatry University of California San Diego La Jolla USA Child and Adolescent Services Research Center (CASRC) San Diego USA Department of Psychology San Diego State University San Diego USA Pacific Institute for Research and Evaluation Behavioral Health Research Center of the Southwest Albuquerque USA School of Public Health University of Texas Health Science Center at Houston Houston USA Woolf Consulting Santa Barbara USA Rollins School of Public Health Emory University Atlanta USA University of Colorado Cancer Center at Denver Aurora USA South Carolina Primary Health Care Association Columbia USA Veterans Affairs (VA) Ann Arbor Center for Clinical Management Research Ann Arbor USA Personalizing Options through Veteran Engagement (PROVE) Quality Enhancement Research Initiative (QUERI) Program Ann Arbor USA Center to Improve Veteran Involvement in Care (CIVIC) Veterns Affairs (VA) Portland Health Care System (VAPORHCS) Portland USA Department of Family Medicine Oregon Health & Science University Portland USA Division of General Internal Medi

Introduction to the 3rd Biennial Conference of the Society for Implementation Research Collaboration: advancing efficient methodologies through team science and community partnerships Cara Lewis, doyanne darnell, Suzanne Kerns, Maria Monroe-deVita, Sara J. Landes, Aaron R. Lyon, Cameo Stanick, Shannon dorsey, Jill Locke, Brigid Marriott, Ajeng Puspitasari, Caitlin dorsey, Karin Hendricks, Andria Pierson, Phil Fizur, Katherine A. Comtois A1: A behavioral economic perspective on adoption, implementation, and sustainment of evidence-based interventions Lawrence A. Palinkas A2: Towards making scale up of evidence-based practices in child welfare systems more efficient and affordable Patricia Chamberlain A3: Mixed method examination of strategic leadership for evidence-based practice implementation Gregory A. Aarons, Amy E. Green, Mark. G. Ehrhart, Elise M. Trott, Cathleen E. Willging A4: implementing practice change in Federally Qualified Health centers: Learning from leaders’ experiences Maria E. Fernandez, Nicholas H. Woolf, Shuting (Lily) Liang, Natalia I. Heredia, Michelle Kegler, Betsy Risendal, Andrea dwyer, Vicki Young, dayna Campbell, Michelle Carvalho, Yvonne Kellar-Guenther A3: Mixed method examination of strategic leadership for evidence-based practice implementation Gregory A. Aarons, Amy E. Green, Mark. G. Ehrhart, Elise M. Trott, Cathleen E. Willging A4: implementing practice change in Federally Qualified Health centers: Learning from leaders’ experiences Maria E. Fernandez, Nicholas H. Woolf, Shuting (Lily) Liang, Natalia I. Heredia, Michelle Kegler, Betsy Risendal, Andrea dwyer, Vicki Young, dayna Campbell, Michelle Carvalho, Yvonne Kellar-Guenther A5: Efficient synthesis: Using qualitative comparative analysis and the Consolidated Framework for Implementation Research across diverse studies Laura J. damschroder, Julie C. Lowery A6: Establishing a veterans engagement group to empower patients and inform Veterans Affairs (va) health services research Sara

关键词： Veteran Affair Motivational Interview Veteran Health Administration dialectical Behavior Therapy Qualitative Comparative Analysis

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Proceedings of the 8th Annual Conference on the Science of dissemination and Implementation : Washington, dC, USA. 14-15 december 2015

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Implementation science : IS 2016年第2期11 Suppl 2卷 100页

作者： Chambers, david Simpson, Lisa Hill-Briggs, Felicia Neta, Gila Vinson, Cynthia Beidas, Rinad Marcus, Steven Aarons, Gregory Hoagwood, Kimberly Schoenwald, Sonja Evans, Arthur Hurford, Matthew Rubin, Ronnie Hadley, Trevor Barg, Frances Walsh, Lucia Adams, danielle Mandell, david Martin, Lindsey Mignogna, Joseph Mott, Juliette Hundt, Natalie Kauth, Michael Kunik, Mark Naik, Aanand Cully, Jeffrey McGuire, Alan White, dominique Bartholomew, Tom McGrew, John Luther, Lauren Rollins, Angie Salyers, Michelle Cooper, Brittany Funaiole, Angie Richards, Julie Lee, Amy Lapham, Gwen Caldeiro, Ryan Lozano, Paula Gildred, Tory Achtmeyer, Carol Ludman, Evette Addis, Megan Marx, Larry Bradley, Katharine vandeinse, Tonya Wilson, Amy Blank Stacey, Burgin Powell, Byron Bunger, Alicia Cuddeback, Gary Barnett, Miya Stadnick, Nicole Brookman-Frazee, Lauren Lau, Anna dorsey, Shannon Pullmann, Michael Mitchell, Shannon Schwartz, Robert Kirk, Arethusa dusek, Kristi Oros, Marla Hosler, Colleen Gryczynski, Jan Barbosa, Carolina dunlap, Laura Lounsbury, david O’Grady, Kevin Brown, Barry damschroder, Laura Waltz, Thomas Ritchie, Mona Atkins, david Imel, Zac E. Xiao, Bo Can, doğan Georgiou, Panayiotis Narayanan, Shrikanth Berkel, Cady Gallo, Carlos Sandler, Irwin Brown, C. Hendricks Wolchik, Sharlene Mauricio, Anne Marie Mehrotra, Sanjay Chandurkar, dharmendra Bora, Siddhartha das, Arup Tripathi, Anand Saggurti, Niranjan Raj, Anita Hughes, Eric Jacobs, Brian Kirkendall, Eric Loeb, danielle Trinkley, Katy Yang, Michael Sprowell, Andrew Nease, donald Lyon, Aaron Lewis, Cara Boyd, Meredith Melvin, Abigail Nicodimos, Semret Liu, Freda Jungbluth, Nathanial Flynn, Allen Landis-Lewis, Zach Sales, Anne Baloh, Jure Ward, Marcia Zhu, Xi Bennett, Ian Unutzer, Jurgen Mao, Johnny Proctor, Enola Vredevoogd, Mindy Chan, Ya-Fen Williams, Nathaniel Green, Phillip Bernstein, Steven Rosner, June-Marie deWitt, Michelle Tetrault, Jeanette dziura, James Hsiao, Allen Sussman, Scott O’Connor, Patrick Toll, Benjamin Jones, Michael Gassaway, Julie Tobin, Jonathan Zatzic Division of Cancer Control and Population Sciences National Cancer Institute National Institutes of Health Rockville USA AcademyHealth Washington USA Department of Medicine and Welch Center for Prevention Epidemiology and Clinical Research Johns Hopkins Medical Institutions Baltimore USA Psychiatry University of Pennsylvania Philadelphia USA Family Medicine and Community Health University of Pennsylvania Philadelphia USA School of Social Policy and Practice University of Pennsylvania Philadelphia USA Psychiatry UC San Diego La Jolla USA Child & Adolescent Psychiatry The Child Study Center at NYU Langone Medical Center New York NY New York USA Psychiatry and Behavioral Sciences MUSC Charleston USA DBHIDS City of Philadelphia Philadelphia USA CBH City of Philadelphia Philadelphia USA Psychiatry University of Pennsylvania Perelman School of Medicine Philadelphia USA Health Services Research & Development Department of Veterans Affairs & Baylor College of Medicine Houston USA Treatment Core Department of Veterans Affairs Waco USA National Center for PTSD Executive Division Department of Veterans Affairs White River Junction USA HSR&D HSR&D Center for Health Information and Communication Roudebush VA Medical Center Indianapolis USA Psychology Indiana University Purdue University Indianapolis Indianapolis USA Department of Psychiatric Rehabilitation and Counseling Rutgers University Newark USA Health Services Research & Development Richard L. Roudebush VAMC Indianapolis USA IUPUI Department of Psychology ACT Center of Indiana Indianapolis USA Human Development Washington State University Pullman USA Prevention Science Washington State University Pullman USA Group Health Research Institute Group Health Seattle USA Behavioral Health Services Group Health Seattle USA Preventive Care Group Health Seattle USA Health Services Research & Development Primary and Specialty Medical Care Service VA Puget Sound Seattle USA School of Social Work Un

A1 Introduction to the 8th Annual Conference on the Science of dissemination and Implementation: Optimizing Personal and Population Health david Chambers, Lisa Simpson d1 discussion forum: Population health d&I research Felicia Hill-Briggs d2 discussion forum: Global health d&I research Gila Neta, Cynthia Vinson d3 discussion forum: Precision medicine and d&I research david Chambers S1 Predictors of community therapists’ use of therapy techniques in a large public mental health system Rinad Beidas, Steven Marcus, Gregory Aarons, Kimberly Hoagwood, Sonja Schoenwald, Arthur Evans, Matthew Hurford, Ronnie Rubin, Trevor Hadley, Frances Barg, Lucia Walsh, danielle Adams, david Mandell S2 implementing brief cognitive behavioral therapy (CBT) in primary care: Clinicians' experiences from the field Lindsey Martin, Joseph Mignogna, Juliette Mott, Natalie Hundt, Michael Kauth, Mark Kunik, Aanand Naik, Jeffrey Cully S3 Clinician competence: Natural variation, factors affecting, and effect on patient outcomes Alan McGuire, dominique White, Tom Bartholomew, John McGrew, Lauren Luther, Angie Rollins, Michelle Salyers S4 Exploring the multifaceted nature of sustainability in community-based prevention: A mixed-method approach Brittany Cooper, Angie Funaiole S5 Theory informed behavioral health integration in primary care: Mixed methods evaluation of the implementation of routine depression and alcohol screening and assessment Julie Richards, Amy Lee, Gwen Lapham, Ryan Caldeiro, Paula Lozano, Tory Gildred, Carol Achtmeyer, Evette Ludman, Megan Addis, Larry Marx, Katharine Bradley S6 Enhancing the evidence for specialty mental health probation through a hybrid efficacy and implementation study Tonya vandeinse, Amy Blank Wilson, Burgin Stacey, Byron Powell, Alicia Bunger, Gary Cuddeback S7 Personalizing evidence-based child mental health care within a fiscally mandated policy reform Miya Barnett, Nicole Stadnick, Lauren Brookman-Frazee, Anna Lau S8 Leveraging an existing

关键词： Veteran Affair Motivational Interview Qualitative Comparative Analysis Community That Care Supplemental Nutrition Assistance Program

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"There's More to This Pain Than Just Pain": How Patients' Understanding of Pain Evolved during a Randomized Controlled Trial for Chronic Pain

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JOURNAL OF PAIN 2012年第6期13卷 571-578页

作者： Matthias, Marianne S. Miech, Edward J. Myers, Laura J. Sargent, Christy Bair, Matthew J. Roudebush VA Med Ctr VA HSR&D Ctr Implementing Evidence Based Practice Indianapolis IN USA Regenstrief Inst Inc Indianapolis IN USA Indiana Univ Purdue Univ Dept Commun Studies Indianapolis IN 46202 USA Indiana Univ Sch Med Dept Emergency Med Indianapolis IN USA Indiana Univ Sch Med Dept Med Indianapolis IN USA

Chronic pain is prevalent, is costly, and exerts an emotional toll on patients and providers. Little is known about chronic pain in veterans of the recent military conflicts in Afghanistan and Iraq (OEF/OIF/ONd [Operation Enduring Freedom/Operation Iraqi Freedom/Operation New dawn] veterans). This study's objective was to ascertain veterans' perceptions of a multicomponent intervention tested in a randomized controlled trial for OEF/OIF/ONd veterans with chronic musculoskeletal pain (ESCAPE: Evaluation of Stepped Care for Chronic Pain). Qualitative interviews were conducted with patients in the intervention arm of ESCAPE. Questions related to veterans' experiences with trial components, overall perceptions of the intervention, strengths, and suggestions for improvement. Twenty-six veterans (21% of total intervention patients) participated. Patients were purposefully sampled to include treatment responders (defined as >= 30% reduction in pain-related disability or pain severity) and non-responders. Non-completers (completed <50% of the trial) were also sampled. Qualitative analysis was guided by grounded theory, using constant comparative methodology. Both responders and non-responders spoke about their evolving understanding of their pain experience during the trial, and how this new understanding helped them to manage their pain more effectively. This evolution is reported under 2 themes: 1) learning to recognize physical and psychosocial factors related to pain;and 2) learning to manage pain through actions and thoughts. Perspective: Responders and non-responders both described making connections between their pain and other factors in their lives, and how these connections positively influenced how they managed their pain. Traditional quantitative measures of response to pain interventions may not capture the full benefits that patients report experiencing. Published by Elsevier Inc. on behalf of the American Pain Society

关键词： Chronic pain self-management qualitative research veterans randomized controlled trial

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