ABSTRACT
BACKGROUND: In 2011, the Sheffield Primary Care Trust piloted a Health Trainer (HT) programme targeted specifically to people with chronic pain. The programme aimed to determine whether patients presenting to primary care with chronic pain would benefit from self-management support, thereby reducing the burden on primary care and secondary care services. METHODS: We conducted a formative mixed-methods evaluation of the pilot programme, focusing on four aspects of implementation: general practitioner (GP) referral to the programme, HT's ability to use cognitive behavioural (CB) approaches, short-term outcomes for clients and adequacy of resources. Qualitative data were collected via interviews with GPs, HTs and the chronic pain team; supervision sessions with HTs; and client case studies. Quantitative data were collected on satisfaction with training, HT's self-reported confidence to implement CB and clients' self-rated well-being before and after participation. RESULTS: A total of 143 clients with pain for 1 year or more were referred, exceeding the projected 90 referrals by over 50%. A total of 70% of the clients came from the most deprived areas of Sheffield, 40% were listed as permanently sick/disabled and only 20% were working. Qualitative analysis indicated that the CB training was delivered as intended. Clients reported that 75% of their goals were either achieved or partly achieved, and at follow-up 43% of them reported maintaining strategies for self-management. Financial resources were supplemented by indirect resources, including GP 'champions' with a special interest in pain, and a multidisciplinary chronic pain team. The prior history of working with community organizations was critical in ensuring credibility in client communities and addressing client needs. CONCLUSION: A HT programme promoting self-management of chronic pain can be successfully implemented when supported by community organisations. Preliminary data indicate that the programme can be instrumental in helping clients to actively participate in identifying their own problems, set achievable goals for self-management and successfully manage the challenges of everyday life. SUMMARY POINTS: Community-based Health Trainer programmes can be successfully established to promote self-management of chronic pain among clients in the deprived areas using multidisciplinary pain management teams. Utilising a community organization infrastructure that has experience of delivering successful programmes was instrumental in ensuring credibility of the initiative and access for clients. Health trainers can integrate cognitive behavioral training with their existing skills to work with clients who have chronic pain.
ABSTRACT
PURPOSE: To determine the change in vision-related quality-of-life scores after providing eyeglasses to American Indian/Alaska Natives with undercorrected refractive error. STUDY DESIGN: Prospective, comparative (nonrandomized) interventional study. METHODS: We compared a group with undercorrected refractive error to a control group who did not need a change in eyeglasses. Undercorrected refractive error was defined as distance visual acuity 20/40 or worse in the better-seeing eye that could be improved by at least 2 lines in Snellen visual acuity. Intervention was the provision of new glasses to the undercorrected refractive error group members, based on results of manifest refraction. The main outcome measures were the differences in the 25-Item National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) scores from baseline (Time 1) to the time after providing eyeglasses (Time 2). RESULTS: The NEI VFQ-25 median Composite score at Time 1 was significantly lower in those with undercorrected refractive error when compared to the control group (75 vs 92, P = .001). The median Composite score for the undercorrected refractive error group improved to 96 (P < .001) at Time 2 when compared to Time 1, while the control group remained stable at 93 (P = .417). The undercorrected refractive error group showed significantly greater improvement than the control group in 8 of 12 subscale scores and in the overall Composite score (all P values ≤ .05). A multivariate linear regression analysis, which controlled for differences in age, percent self-identified American Indian/Alaskan Native, and best-corrected visual acuity between the undercorrected refractive error and control group, showed eyeglasses to be significantly associated with improvement in NEI VFQ-25 composite score. CONCLUSION: Visual impairment from undercorrected refractive error is common in American Indian/Alaskan Natives. Providing eyeglasses results in a large, significant increase in vision-related quality of life.
