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Contemp Clin Trials. 2019 Feb;77:76-85. doi: 10.1016/j.cct.2018.12.006. Epub 2018 Dec 17.

Optimizing pain treatment interventions (OPTI): A pilot randomized controlled trial of collaborative care to improve chronic pain management and opioid safety-Rationale, methods, and lessons learned.

Author information

1
San Francisco Veterans Affairs Health Care System, United States; University of California, San Francisco, San Francisco, CA, United States. Electronic address: Karen.Seal@va.gov.
2
San Francisco Veterans Affairs Health Care System, United States; University of California, San Francisco, San Francisco, CA, United States.
3
San Francisco Veterans Affairs Health Care System, United States.
4
University of California, San Francisco, San Francisco, CA, United States.
5
Center to Improve Veteran Involvement in Care, VA Portland Health Care System, United States; Department of Psychiatry, Oregon Health and Science University, United States.
6
VA Palo Alto Health Care System, Center for Innovation to Implementation (Ci2i), United States; Program Evaluation and Resource Center (PERC), VA Office of Mental Health Operations, United States.
7
VA Palo Alto Health Care System, Center for Innovation to Implementation (Ci2i), United States.

Abstract

Veterans seeking care in VA medical facilities have high rates of chronic pain, which often co-occur with mental health and substance use disorders, including prescription opioid misuse. The overall goal of the Optimizing Pain Treatment Interventions (OPTI) study was to pilot a 12-week Collaborative Care intervention to improve opioid safety, chronic pain disability, and use of non-pharmacological pain management strategies in veterans in VA primary care. Between November 2014 and January 2017, 100 veteran patients with chronic pain and high-risk prescription opioid use (e.g., high-dose therapy, early refills, etc.) were enrolled and completed an initial one-hour study visit with a primary care provider (PCP) within 4 weeks of enrollment. Study PCPs were guided by a web-based opioid management decision support program and templated notes in the VA electronic medical record. After assessment and education, study PCPs used Shared Decision-Making to formulate a Pain Care Plan aligned with a participant's personal values and goals. After the initial visit, patients randomized to Collaborative Care received one Motivational Interviewing (MI) session with a Care Manager followed by 3 Care Manager-delivered brief telephone MI sessions at 6, 8, and 12 weeks to reinforce Pain Care Plans; patients randomized to an Attention Control condition met with a Care Manager briefly, followed by 3 brief scripted telephone psychoeducation sessions at 6, 8, and 12 weeks. Masked evaluators assessed outcomes at baseline, end of intervention (12 weeks), and after eight weeks of no contact (20 weeks). We present study rationale, detailed methods, preliminary results and lessons learned.

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