in increasing patient's self-efficacy, readiness to self-manage their chronic pain condition, and engagement in CAM (chiropractic, acupuncture, massage) at 6 months. Secondary outcomes examined changes to quality of life, self-reported pain, opioid medication use, emergency department use, and aberrant opioid use behavior. We also analyzed intervention effects by gender and minority status. Both longitudinal and latent growth curve modeling approaches were applied to test effects.
RESULTS
Qualitative interviews identified key barriers to CPI engagement: inconsistent communication, lack of CAM familiarity, poor patient social support, low health literacy, and logistical challenges. The OPENtext intervention was developed and finalized into a tailored program with over 3000 messages and resources addressing identified gaps. The RCT enrolled 197 patients, attaining 98% through 6-month follow up.
Compared with OPENnav, OPENtext participants reported greater increases:
Activation: Participants enrolled in OPENtext were more likely than participants enrolled in OPENnav to engage in the intervention itself (98% v. 71%). Mental State: Contemplation scores and a trend for increases in maintenance scores reflecting improved readiness to contemplate making changes (b= 0.31, p=0.001) and to maintain made changes (b=0.08, p=.07) in self-management of chronic pain. Pain: Reductions in bodily pain (i.e., pain severity (b= -1.42, p=0.001 at 3 months, b= -0.78, p>0.05 at 6 months and b= -1.65, p=0.001 at 9 months) and pain interference in daily living that impact quality of life (b=5.88, SE=2.80, p=.04 at 6 months). ED Visits: Reductions in healthcare plan-verified emergency department visits (p=0.001), and a trend in self- efficacy to self-manage chronic pain (b=14.31, SE=8.43, p=.09). Resiliency: OPENtext recipients were also more likely than OPENnav recipients to exhibit patterns showing continued moderate CAM engagement over time (p=.03). Resiliency: Both study arms experienced similar overall increases over time in non-medicine-based treatments (CAM) service engagement. Mental State/Activation: Secondary outcomes also showed reductions in depressive symptoms, pain catastrophizing, and increased over-the-counter analgesic use across both groups.
CONCLUSIONS
A text-message intervention (using GoMo Health Personal Concierge: a two-way BOT with a behavioral modification engagement science) can help support self-management of chronic pain, elevate pain-related quality of life, and alter care engagement in CAM among patients heavily affected by health and social disparities who are living with chronic pain. Offering non-pharmacological therapies to patients on Medicaid resulted in alleviation of pain experience, reduced narcotic and opioid use, and better behavioral health outcomes at six months regardless of study arm.
BACKGROUND | ACHIEVING THE TRIPLE AIM WITH CHRONIC PAIN MEDICAID PATIENTS
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