Addressing Disparities In Pain Management

NIH RePORTER · VA · IK2 · · view on reporter.nih.gov ↗

Abstract

Background: Disparities in pain treatment suggest that Veterans of color and women Veterans (i.e., “diverse Veterans” in this CDA) are subject to unequal treatment when seeking pain care at VA. Mounting evidence points to the importance of guideline-concordant, evidence-based non-pharmacological pain treatments (NPTs) in the management of chronic pain, yet these treatments are not reaching diverse Veterans. Implementation mapping can be used to rigorously plan implementation of evidence-based practices (e.g., NPTs). Using this approach, one can identify key barriers and facilitators to implementation of evidence-based practices and map them to relevant implementation strategies and target users. The purpose of this CDA is to develop and test a tailored implementation blueprint for increasing NPT use among diverse Veterans. Significance/Impact: Over 2 million Veterans suffer from chronic pain. Over the next four decades, Veterans of color are projected to grow exponentially and there is far more racial/ethnic heterogeneity among women than men in the VA. There is a critical need to identify effective implementation strategies that can be used to disseminate NPTs in order to meet the needs of future diverse Veterans with chronic pain. Innovation: This proposal offers three innovations: 1) An integrated conceptual framework mapping key health equity domains to implementation science solutions; 2) An implementation blueprint developed using a comprehensive and rigorous pre-implementation planning approach (i.e., implementation mapping) that is informed by mixed methods research with target users; and 3) a strong focus on health equity and inclusion of diverse Veteran engagement via operational partnerships during each stage of research. Specific Aims: 1) Aim 1: Understand and identify factors driving NPT use among diverse Veterans using mixed methods; Sub-Aim 1.1: Identify sites at which diverse Veterans are not using NPTs despite NPTs being available; Sub-Aim 1.2: Evaluate multi-level stakeholder perspectives necessary for designing an implementation blueprint tailored for diverse Veterans; Sub-Aim 1.3: Assess disparities in NPT use in VA administrative data; 2) Aim 2: Use implementation mapping to identify core and non-core components of NPT uptake and design an implementation blueprint tailored for diverse Veterans; Sub-Aim 2.1: Generate a matrix of change outcomes resulting from use of a tailored implementation blueprint; Sub-Aim 2.2: Develop protocols and materials comprising the tailored implementation blueprint; and 3) Aim 3: Measure pre-implementation outcomes of the tailored blueprint developed in Aim 2, including feasibility, acceptability, appropriateness, dose, complexity, and self-efficacy among target users. Methodology: In Aim 1.1, a quantitative sampling strategy using VA administrative will inform the selection of four implementation sites. In Aim 1.2, qualitative interviews will identify factors driving NPT use among diverse Veteran...

Key facts

NIH application ID
10642345
Project number
1IK2HX003474-01A2
Recipient
VETERANS ADMIN PALO ALTO HEALTH CARE SYS
Principal Investigator
Sarah Jane Javier
Activity code
IK2
Funding institute
VA
Fiscal year
2023
Award amount
Award type
1
Project period
2023-08-01 → 2028-07-31