Trial misses primary endpoint — patient activation — but improves other health outcomes

Key takeaways:

• The intervention improved depression, meditation and use of exercise in participants.
• Such interventions in primary care can reduce stigma and empower individuals, an expert said.

An intervention failed to increase patient activation, but it helped to improve depression, patient portal management and other health measures among patients with chronic pain on long-term opioids, according to a randomized trial.

“It was encouraging that a relatively limited number of sessions could prompt long-term improvement in some areas,” Monique B. Does, MPH, a senior research project manager from the division of research at Kaiser Permanente, told Healio. “Many traditional interventions for patients with chronic pain are often 8 or 10 weeks long, and our findings show that smaller, less-intensive interventions further upstream in primary care can be really beneficial.”

The ACTIVATE trial, which took place from June 2015 through August 2018, “was intended to promote patient activation by helping participants gain the knowledge, skills and confidence needed to manage chronic pain,” the researchers explained in BMC Health Services Research.

In the study, primary care patients with chronic pain on long-term opioids were assigned to the intervention (n = 189) or usual care (n = 187).

Those who were assigned to the intervention were exposed to four 90-minute sessions that involved goal setting, guided imagery, patient-provider communication role play and practice at patient portal navigation and other skills.

The primary outcome — patient activation — was measured at 12 months using the Patient Activation Measure (PAM). Secondary outcomes included quality of life, use of the patient portal, mood and overall health.

At 12 months, both the usual care and intervention groups had similar PAM scores, suggesting the intervention did not significantly improve patient activation. However, vs. usual care, intervention participants showed:

• less moderate and severe depression (OR=0.4; 95% CI, 0.18-0.87);
• better overall health (OR=3.14; 95% CI, 1.64-6.01);
• greater use of the patient portal’s health and wellness resources (OR=2.5; 95% CI, 1.42-4.4);
• greater use of the patient portal’s lab and immunization history (OR=2.7; 95% CI, 1.29-5.65);
• greater use of meditation (OR=2.72; 95% CI, 1.61-4.58); and
• greater use of exercise and physical therapy (OR=2.24; 95% CI, 1.29-3.88).

“This trial demonstrated that a brief intervention can improve and sustain outcomes important to both patients and clinicians, such as depression and overall health, even without a measurable increase in activation,” Does said. “It is significant that this intervention was provided in the context of primary care management of long-term opioids.”

She added that the various activities in the intervention “are the building blocks of patient activation — empowering individuals to develop the skills to manage their symptoms and health care.”

“Chronic pain can be a long-term condition, so interventions that activate patients and encourage them to engage in their own care and with their providers can improve their lives, even if their medication or other acute care evolves,” she said.

Does noted that future research could look at how to best implement the intervention in busy clinics.

Ultimately, “primary care physicians account for almost half of dispensed opioid prescriptions, and health care providers and patients are interested in behavioral treatment options for chronic pain,” Does said. “Embedding interventions such as this in primary care can help reduce stigma and improve access to nonpharmacological pain management.”