The overall goal of this Mentored Patient-Oriented Research Career Development Award (K23) is to support candidate, Dr. Barbara St. Marie, in developing an independent clinical research program to address effective pain management while minimizing risk for opioid misuse. Dr. St. Marie's training goals are: (1) develop understanding of clinical decision support and how it applies at the point of care; (2) achieve a greater understanding on how evidence-based practice can be implemented and sustain system change; (3) enhance knowledge of information technologies into the design of tools to guide healthcare providers in making evidence based clinical decisions; (4) develop a deeper scientific and technical background in statistics, research methods, to inform future intervention and clinical trial research; (5) gain additional skills and experience in the conduct of research, leadership and scholarly productivity. These career development goals will be completed under the mentorship of an accomplished team of investigators at the University of Iowa, a research-intensive organization with significant and longstanding resources for early-career researchers. These career development goals will provide her with expertise and guidance necessary to address the problems of two significant and intertwined public health crises, undertreated persistent/chronic pain and a national drug abuse epidemic, both requiring immediate and joint resolution. Healthcare providers (MD, DO, NP, PA) are not prepared to address these problems in the primary care settings and evidence based guidelines are under utilized. A gap exists in understanding how to use evidence based guidelines and expert knowledge to manage pain while minimizing risk of opioid misuse that fits into the framework of a primary care practice. To address this gap, the research plan will be to complete the development and test a decision support tool (DS-RPM) that will triage patients with pain into three risk groups, then provide treatment recommendations on the basis of their risk. Alpha and Beta testing (operability) will occur followed by revisions of the decision support tool. Mixed methods will be used to assess feasibility through surveys and interviews. Forty healthcare providers will use the app with vignettes and standardized patients presenting with pain. The acceptability, usability and perceived barriers while using this tool will be measured. Decision support through the use of technology can be an initial first step in promoting effective pain management while minimizing risk for opioid misuse or abuse. This proposal complements the National Institute on Drug Abuse (NIDA) strategic focus to support and conduct drug abuse and addiction research across a broad range of disciplines of health care providers. Results of this study will further refine the decision support tool and Dr. St. Marie will develop and submit an R01 application to evaluate the efficacy of the DS-RPM in a larger scale clinical trial.
In light of the dual crises of escalating rates of chronic pain and drug abuse, health care providers face competing mandates to provide optimal pain management while minimizing risk for opioid abuse. Current management for these linked issues is extremely complex and evidence-based practice guidelines do not integrate the two simultaneously. This proposal will further refine and assess clinical feasibility of a decision support tool that integrates the risk for abuse and optimal pain management at each phase of the healthcare encounter; assessment, treatment recommendations, and follow-up plans.
