Optimizing Patient Engagement in a Novel Pain Management Initiative (OPEN)

Chronic pain is a condition that affects the most fundamental aspects of quality of life.
Treatment for chronic pain is challenging and usually takes the form of opioid medication
therapy. But chronic opioid therapy is also associated with high rates of emergency
department use, drug diversion, addiction, and unintentional overdose deaths. The new RI
Medicaid Chronic Pain Initiative (CPI) targets patients who are both high emergency
department users and experiencing chronic pain. In the CPI, patients can be prescribed an
integrated treatment plan of massage, chiropractic, or acupuncture therapies. This is a
novel approach to chronic pain care, but retention and patient engagement are low. It is
important to understand why involvement in the CPI is low, how to improve the patient
experience, and how to support the prescribed CAM therapies.

This study has two aims: The first is to identify what helps to keep patients involved with
the CPI program and to identify features of an ideal text-message-based program for people
enrolled in the CPI. The second aim is to develop the text-message-based program (OPENtext),
then find out how useful this intervention is compared to a patient navigator intervention
(OPENnav) for increasing patient engagement, improving patient's motivation to manage their
chronic pain, and improving patient confidence in self-managing their chronic pain
condition.

Investigators will conduct qualitative interviews with patients, providers, and
administrators. Goals of the interviews will be: to understand the patient experience in the
CPI, including experiences with the navigation approach currently in place; to identify
barriers and facilitators to CPI participation; and to learn how technology—especially cell
phone text-messaging—could help support pain care and CPI engagement. These interviews will
help develop a text-message-based intervention and provide feedback to existing patient
navigator programming. Next, investigators will develop and test the text-message patient
support intervention that will contain patient-identified topics and concerns that emerge
from the qualitative interviews and topic areas discussed by a stakeholder Advisory Board.
Theories of behavior change will be used to help with message development, and patients will
take part in helping to test and fine-tune the intervention. Last, investigators will
compare the text-message and patient navigation interventions in a randomized controlled
study with 300 patients over a nine-month period. Investigators will see which approach
helps patients increase their involvement in the CPI and better manage their chronic pain.
If successful, chronic pain patients across Medicaid programs could benefit from use of the
patient navigation or the text-message intervention.

Inclusion Criteria:

- Enrolled in the Rhode Island Medicaid Chronic Pain Initiative program

Exclusion Criteria:

- Do not speak English