Dissemination and Implementation of Evidence-based Chronic Pain Management Among Primary Care Providers

Chronic pain and its consequences are pervasive in the United States. Most people living with chronic pain receive care from their primary care providers (PCPs). PCPs are asked to synthesize evidence-based treatments and find the options that work best for their patients. This dissertation leveraged implementation science and Diffusion of Innovations Theory, the Model for Dissemination of Research, and the Consolidated Framework for Implementation Research to identify current and preferred dissemination channels and implementation strategies for evidence-based chronic pain management among primary care providers in Pennsylvania. This study used snowball sampling to survey 101 Pennsylvania PCPs about their current and preferred dissemination channels and implementation strategies and used Cohen’s kappa to assess the degree of concordance. The survey collected professional factors, context factors and predicted moderators of concordance including urbanicity, academic affiliation, openness to trying new treatments, perceptions of incongruence between existing and new practices, and knowledge of evidence-based chronic pain management. Study results found significant dissemination gaps in learning about evidence-based chronic pain management from workshops, clinical experts, seminars, and researchers; and implementation gaps in developing workgroups, creating targeted supports, identifying chronic pain champions, using data to inform care, and engaging patients and families. This sample of Pennsylvania PCPs had average levels of dissemination concordance and implementation concordance higher than that expected by chance. The study used multiple linear regression to understand potential moderators of the congruence relationship. Only self-identifying as female was statistically significantly related to lower levels of dissemination concordance. Increased years of experience was statistically significantly related to slightly higher levels of implementation concordance. It is important to consider the named limitations for interpreting the results and should not be generalized beyond the current sample. Findings hold implications for future methodological approaches in implementation science to quantify and benchmark dissemination and implementation gaps in various settings. The results also highlight the important role of social work practitioners and social work scholars in leveraging their existing roles to bring together interdisciplinary teams and patients and families with the goal to bridge the gap between existing practice and preferences in addressing chronic pain management in primary care