Global advances in integrative medicine and health Pub Date : 2025-02-26 eCollection Date: 2025-01-01 DOI:10.1177/27536130251321460
Shivani Bahl, Vadan Ritter, Ariana Thompson-Lastad, Denise Ruvalcaba, Jhia Jackson, Christa M Fernando, Candice Turchin, Mary Ann Finch, Antonella Soldaini, Pamela Swedlow, Jesse Wennik, Maria T Chao
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摘要

背景:COVID-19 大流行加剧了低收入人群在疼痛护理方面的不平等。远程健康综合疼痛管理计划(t-IPMP)的制定旨在为旧金山健康网络(SFHN)公共卫生诊所的患者提供疼痛管理服务。t-IPMP 根据现有计划改编,在现场医疗服务受到限制的情况下,通过远程医疗小组提供多模式疼痛治疗:这项混合方法研究评估了 t-IPMP 的可行性和可接受性:我们对 t-IPMP 的三个组别进行了单臂评估,包括每周 12 次、每次两小时的在线课程,内容涉及疼痛教育、正念、治疗性运动和自我按压。参与者是由 SFHN 初级保健提供者转介的慢性疼痛成人患者。我们进行了基线调查、为期三个月的调查和定性访谈(n = 15);对每个组群的三次课程进行了参与者观察;以及 3 个焦点小组(n = 20)。混合方法分析包括描述性统计、使用 t 检验的前后比较和编码本主题分析:t-IPMP 共收到来自 11 家诊所 52 名医疗服务提供者的 107 份转介申请,其中 35% 的转介申请者加入了该计划。参与者(37 人)平均参加了 6 次治疗。完成调查的参与者(n = 15)大多是顺性别女性(67%),财富低于平均水平(87%),来自不同的种族和民族。定性数据强调,t-IPMP 创造了一个支持性环境,促进了社会联系,减少了社会隔离。社会支持鼓励人们使用新的身心疗法来治疗疼痛。尽管有些参与者更喜欢面对面的交流,但远程医疗还是受到了欢迎。从基线到三个月的随访,身体功能(平均 = 1.9,95% CI 0.2-3.6)、整体生活质量(平均 = 3.8,95% CI 1.6-6.0)和疼痛自我效能(平均 = 5.3,95% CI 0.9-9.7)的平均得分均有所提高:结论:通过远程医疗小组提供综合、多模式疼痛管理在初级保健安全网患者中是可行的,但并非对所有人都是最佳选择。研究结果表明,提供在线或面对面参与的选择可能最能满足患者的需求和偏好。
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Evaluating Feasibility and Acceptability of a Telehealth Integrative Pain Management Program Among Primary Care Safety-Net Patients.

Background: The COVID-19 pandemic exacerbated pain care inequities for low-income people. The Telehealth Integrative Pain Management Program (t-IPMP) was developed to provide pain management services for patients in public health clinics of the San Francisco Health Network (SFHN). Adapted from an existing program, t-IPMP delivered multimodal pain treatment via telehealth groups when in-person healthcare was restricted.

Objective: This mixed-methods study evaluates the feasibility and acceptability of t-IPMP.

Methods: We conducted a single-arm evaluation of three cohorts of t-IPMP, comprising 12 two-hour weekly online sessions on pain education, mindfulness, therapeutic movement, and self-acupressure. Participants were adults with chronic pain referred by SFHN primary care providers. We conducted baseline surveys, three-month surveys, and qualitative interviews (n = 15); participant observation of three sessions per cohort; and 3 focus groups (n = 20). Mixed-methods analysis included descriptive statistics, pre/post comparisons using t-tests, and codebook thematic analysis.

Results: The t-IPMP received 107 referrals from 52 providers at 11 clinics, and 35% of referrals enrolled. Participants (n = 37) attended an average of 6 sessions. Participants who completed surveys (n = 15) were majority cisgender women (67%) with below-average wealth (87%) from diverse racial and ethnic identities. Qualitative data highlighted that t-IPMP created a supportive environment which fostered social connection and reduced social isolation. Social support encouraged use of new mind-body practices for pain. Telehealth was well received, though some participants preferred in-person interaction. From baseline to three-month follow up, average scores increased on measures of physical function (mean = 1.9, 95% CI 0.2-3.6); global quality of life (mean = 3.8, 95% CI 1.6-6.0); and pain self-efficacy (mean = 5.3, 95% CI 0.9-9.7).

Conclusion: Integrative, multimodal pain management delivered through telehealth groups is feasible among primary care safety net patients, however, may not be optimal for all. Findings indicate that offering options for participating either online or in-person may best address patient needs and preferences.

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