Equitable Primary Care for Pain Care (EquiP PC)

University Of Washington, Seattle WA

Investigators

Abstract

Project Summary for Equitable Primary Care for Pain Care (EquiP PC) Introduction: Based on data showing that 25% of the U.S. population suffers from chronic pain (CP) and that ~1/2 the CP population seek relief in primary care (PC), there is consensus that multidisciplinary coordinated care within PC is critical for treating CP. Integrating behavioral health (IBH) within PC has been shown to improve patient outcomes for mental and chronic physical health conditions but has not been applied to CP management. With PCORI funding, we have developed and tested an IBH Primary Care (IBH-PC) toolkit, which provides a multi-faceted implementation strategy to improve IBH. Given use of the IBH-PC Toolkit has demonstrated improved behavioral health integration, we propose to adapt this toolkit to improve equitable access to CP care, train BHPs in CP care, and augment it with implementation of digital therapeutic app tools for home use, to improve quality of care and ensure sustainability. Approach: We will conduct a large multi-site pragmatic 3-arm cluster randomized control trial comparing the IBH-PC toolkit + apps vs. IBC-PC toolkit only vs. treatment as usual, and use the PRISM RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to evaluate implementation outcomes. To address Reach, we will recruit 2,025 patients with CP and randomize PC practices from partnered practice based research networks and healthcare system (HCS) partners that treat underserved communities including BIPOC (Black, Indigenous and people of color), Hispanic, and people with low socioeconomic status (SES). In the UG3 phase, we will convene a Community Advisory Board (CAB) to develop the infrastructure to ensure UH3 RCT success: AIM 1: Finalize outcome measures, practice and patient recruitment process, and establish a centralized data coordinating infrastructure. We will incorporate the HEAL Common Data Elements and develop a strategy for participation in the NIH Pragmatic Trials Collaboratory Resource Coordinating Center working groups.. AIM 2: Recruit 27 PC practices and create a Community Advisory Board (CAB) from the practices. The CAB will be comprised of patients, primary care providers, BHPs, HCS administrators, and practice facilitation experts. AIM 3: Refine the IBH-PC Toolkit for CP care, choose DTx apps for homecare use, and adapt the BHP training materials. In the UH3 phase, we will execute a 3-arm cluster-randomized pragmatic randomized control trial across 27 PC clinics: AIM 1: To determine effectiveness of the adapted (1) IBH-PC Toolkit + apps vs. (2) IBC-PC Toolkit only vs. (3) treatment as usual for improving pain interference and level of integration of IBH. AIM 2: Evaluate Implementation of the interventions: IBH-PC Toolkit + apps and IBH Toolkit only. AIM 3: Evaluate equity in access and outcomes of CP care in PC. This proposal is innovative as it equitably expands access within existing PC practices through IBH multidisciplinary coordinated care teams, integrates evidence-based apps and is expected to have a positive impact on transforming PC to equitably treat over half of all patients suffering from CP.