on Chronic Pain Self- Management Program (CPSMP) Attendance Matthew - - PowerPoint PPT Presentation

Influence of Disease Profiles

• n Chronic Pain Self-

Management Program (CPSMP) Attendance

Matthew Lee Smith, PhD, MPH, CHES Marcia G. Ory, PhD, MPH Angelica Herrera-Venson, DrPH, MPH Kristie Kulinski, MSW Kathleen Cameron, MPH

Partner Recognition

Pain and Aging

• About 50% of community-dwelling older adults live with

chronic pain

• About 80% of those residing in residential facilities
• Although common, pain is often under-reported, under-

recognized, and under-treated

• Difficulty detecting true source
• Beliefs that it cannot be treated
• Beliefs that it will lead to expensive medications
• Pain and aging are multi-determined with

contributions across the biopsychosocial spectrum

Sources & Consequences of Pain for Older Adults

SOURCES

• Degenerative joint disease
• Spinal stenosis
• Fractures
• Pressure ulcers
• Neuropathic pain
• Urinary retention
• Post-stroke syndrome
• Improper positioning
• Fibromyalgia
• Cancer pain
• Contractures
• Postherpetic neuralgia
• Oral/dental sources
• Constipation

CONSEQUENCES

• Sleep disturbance
• Functional decline
• Depression, anxiety
• Poly-pharmacy
• Malnutrition
• Increased healthcare utilization
• Prolonged hospital stays
• Inability to perform roles

Opioids Use and Abuse

• The U.S. makes up 4.6% of the world’s population but

consumes 80% of the world’s opioid supply

• More than 214 million opioid prescriptions were written in 2016
• Over 1.9 million Americans are addicted to opioids
• 4 out of 5 heroin users started on prescription opioids

As the opioid crisis continues to plague America, community-based interventions are needed to help adults manage chronic pain and reduce unnecessary pharmaceutical use

Study Purposes

1. Briefly describe the Chronic Pain Self-Management Program (CPSMP) 2. Describe personal characteristics and workshop attributes associated with the national dissemination of CPSMP from 2010-2016 3. Identify factors associated with successful workshop completion (i.e., attending 4+ of 6 workshop sessions) among CPSMP participants

CPSMP

(https://www.selfmanagementresource.com)

• Participants gain the knowledge, skills, and necessary support to

take control of their health and make healthy lifestyle changes

• 6 workshop sessions held once a week
• Each session 2 ½ hours, highly interactive
• Co-facilitated by two trained leaders, one of whom has an
• ngoing health condition
• Core content:
• Symptom management/social role function
• Coping techniques (fatigue, frustration, isolation, sleep)
• Exercises to build self-efficacy
• Problem solving to overcome challenges
• Goal setting and action plans

CPSMP: Breaking the Cycle

Data

• Data were collected from middle-aged and older adults enrolled

in CPSMP nationwide (2010-2016)

• Administrative records and a brief baseline questionnaire
• Analyses of 4,798 participants with complete data
• 506 workshops
• 34 states
• Data Analyses
• Chi-square tests
• Independent sample t-tests
• Binary logistic regression
• Significance: P < 0.05

Measures

• Dependent Variable
• Workshop attendance: Attending 4+ of 6 sessions
• Personal Characteristics
• Age, Sex, Race, Ethnicity, Live alone, Rurality
• Health Indicators
• Self-reported chronic conditions (e.g., heart disease, diabetes)
• Workshop Characteristics
• Number of participants enrolled in the workshop (0 to 20)
• Delivery site type (e.g., healthcare organization, senior center)

Sample Characteristics

• On average, 4.4 sessions attended
• 75% attended 4+ sessions
• On average, age 67.3 years
• 77% female
• 4% Hispanic; 12% African American
• 51% lived with others
• 23% reside in rural area
• On average, 2.9 chronic conditions
• 60% heart disease
• 59% arthritis
• 25% diabetes
• 22% breathing /lung disease
• 19% osteoporosis
• 14% cancer
• 29% attended workshops in AAA or

Senior Centers

• 24% healthcare organizations
• 18% residential facilities
• 11% multi-purpose facilities
• 7% faith-based organizations

Successful Completion

SUCCESSFULLY COMPLETING WORKSHOP SESSIONS (4+ of 6)…

• More likely
• Female
• More chronic conditions
• Reside in rural area
• Less likely (relative to attending workshops in AAA senior center)
• Healthcare organization
• Residential facility
• Educational institution
• Tribal organizations

P OR Lower Upper Number of Self-Reported Chronic Conditions 0.043 1.04 1.00 1.09 Age 0.267 1.00 1.00 1.01 Male

• 1.00
• Female

0.011 1.22 1.05 1.43 Non-Hispanic

• 1.00
• Hispanic

0.372 0.85 0.59 1.22 Race: White

• 1.00
• Race: African American

0.853 1.02 0.83 1.26 Race: Asian/Pacific Islander 0.723 0.90 0.51 1.60 Race: American Indian/Alaska Native 0.953 1.02 0.59 1.77 Race: Hawaiian 0.185 0.41 0.11 1.54 Race: Other/Multiple 0.736 1.06 0.76 1.48 Live Alone

• 1.00
• Live with Others

0.869 0.99 0.86 1.14 Rurality: Urban

• 1.00
• Rurality: Rural

0.001 1.33 1.11 1.58 Number of Participants Enrolled in Workshop 0.498 1.00 0.98 1.01 Delivery Type: AAA/Senior Center

• 1.00
• Delivery Type: Healthcare Organization

<0.001 0.67 0.55 0.81 Delivery Type: Residential Facility <0.001 0.56 0.46 0.69 Delivery Type: Multi-Purpose Organization 0.050 0.79 0.62 1.00 Delivery Type: Faith-Based Organization 0.613 0.92 0.68 1.25 Delivery Type: Educational Institution 0.005 0.44 0.25 0.79 Delivery Type: Governmental Agency 0.260 0.70 0.38 1.30 Delivery Type: Workplace 0.280 2.27 0.51 10.08 Delivery Type: Tribal Organization 0.043 0.39 0.16 0.97 Delivery Type: Other 0.018 0.72 0.55 0.95 * Referent Group: Attending 1 to 3 workshop sessions Factors Associated with Successful Workshop Completion 95% CI

Conclusion

• High completion among participants with complex disease

profiles and in rural areas is encouraging because these populations are disproportionately impacted by the opioid crisis

• Workshop location matters
• Strategic diversification of delivery infrastructure
• Strategic recruitment and retention plans
• Efforts are needed to determine the effectiveness of CPSMP as

an alternative to pharmaceutical interventions for adults with chronic pain

• Complement to (or complemented by) other pain treatments

THANK YOU!

Matthew Lee Smith, PhD, MPH, CHES, FAAHB, FGSA Center for Population Health and Aging Texas A&M University The University of Georgia matthew.smith@tamhsc.edu