Ashcraft Laura Ellen, Hamm Megan E, Omowale Serwaa S, Hruschak Valerie, Miller Elizabeth, Eack Shaun M, Merlin Jessica S
Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
Center for Health Equity Research and Promotion, Corporal Crescenz VA Medical Center, Philadelphia, PA, United States.
Front Pain Res (Lausanne). 2024 Oct 8;5:1376462. doi: 10.3389/fpain.2024.1376462. eCollection 2024.
Most management of chronic pain, a serious illness affecting the physical and psychological wellbeing of millions, occurs in primary care settings. Primary care practitioners (PCPs) attempt to provide evidence-based practices to treat chronic pain. However, there continues to be a gap between the care people receive and the evidence. The objectives for this study were to (1) explore determinants of evidence-based chronic pain management and (2) develop a novel approach to using implementation science to address the evidence-practice gap.
A convenience sample of twenty-one Pennsylvania PCPs participated in one-time semi-structured telephone interviews. Interviews were transcribed verbatim and both deductive and inductive approaches were used during analysis. We used the Consolidated Framework for Implementation Research (CFIR) and the Expert Recommendations for Implementing Change (ERIC) to inform our analysis and findings.
We identified determinants of evidence-based chronic pain management across the CFIR domains of Intervention Characteristics, Characteristics of Individuals, and the Outer Setting and reported implementation strategies. Based on identified themes, we developed a three-step process to support the ongoing and pragmatic implementation of evidence-based chronic pain management in primary care settings.
Previous efforts exist to integrate implementation science into chronic pain management; yet a gap persists. Implementation approaches should prioritize the needs of people living with chronic pain and their families. Further, future approaches or strategies used should build on the current three-step model to include the fourth step of tailoring existing implementation strategies to the specific needs of chronic pain in the clinical context.
慢性疼痛是一种影响数百万人身心健康的严重疾病，其治疗大多在初级保健机构进行。初级保健医生试图提供基于证据的方法来治疗慢性疼痛。然而，人们所接受的治疗与现有证据之间仍存在差距。本研究的目的是：（1）探究基于证据的慢性疼痛管理的决定因素；（2）开发一种利用实施科学来解决证据与实践差距的新方法。
选取21名宾夕法尼亚州的初级保健医生作为便利样本，参与一次性半结构化电话访谈。访谈内容逐字转录，分析过程中采用了演绎法和归纳法。我们使用实施研究综合框架（CFIR）和实施变革专家建议（ERIC）来指导分析和得出研究结果。
我们在干预特征、个体特征和外部环境等CFIR领域中确定了基于证据的慢性疼痛管理的决定因素，并报告了实施策略。基于所确定的主题，我们制定了一个三步流程，以支持在初级保健机构持续且务实地实施基于证据的慢性疼痛管理。
以往曾努力将实施科学纳入慢性疼痛管理，但差距依然存在。实施方法应优先考虑慢性疼痛患者及其家庭的需求。此外，未来使用的方法或策略应在当前三步模型的基础上，纳入根据临床背景中慢性疼痛的具体需求调整现有实施策略的第四步。
