Influence
August 31, 2022

COOPERATE: Regenstrief and VA Research Scientists addressing health disparity at the patient level

triptych of Marianne Matthias, Johanne Eliacin and Matthew Biar

One of first studies focused on empowering Black veterans who have chronic back and other musculoskeletal pain

Black patients have historically faced disparities in pain treatment, reporting less effective and unequal pain care compared to White patients. Consequences of suboptimal care can be especially devastating for Black patients, who have been found to have more severe pain and worse pain-related outcomes.

To help Black veterans receive the chronic pain care they need, U.S. Department of Veterans Affairs and Regenstrief Institute Research Scientists Marianne S. Matthias, PhD; Johanne Eliacin, PhD; and Matthew J. Bair, M.D., are testing COOPERATE (Communication and Activation in Pain to Enhance Relationships and Treat Pain with Equity), one of the first studies focused on equipping Black veterans who have chronic pain with tools to facilitate autonomy and control over their own care.

Research has shown that Black patients, relative to White patients, tend to have lower levels of patient activation (that is, having the knowledge, skills and confidence to manage one’s health). Lower patient activation is associated with negative health outcomes, including depression and anxiety, as well as with poorer physical health. Black patients also report experiencing poorer communication with clinicians, which, combined with lower levels of patient activation, may lead to hesitancy in seeking information, expressing concerns and asking questions about their health, according to Dr. Matthias, a health communication specialist and lead author of the paper presenting COOPERATE’s study design and methods.

In the innovative COOPERATE randomized clinical trial,125 Black veterans received a series of six individual coaching sessions delivered over 12 weeks. COOPERATE fosters patient activation by helping veterans clarify and prioritize their pain management goals and equipping them with communication skills, such as agenda setting and asking questions. These skills are important tools to help patients exercise autonomy and control over their own health. This is especially relevant for chronic musculoskeletal pain including lower back pain, one of the most common reasons individuals seek medical care, because active self-management is key for optimal pain management.

COOPERATE co-investigator Dr. Eliacin, who studies health disparities, notes that while causes of this inequity are complex, ineffective communication is a pervasive barrier to high-quality care, particularly for Black patients, leading to less satisfaction with care. In contrast, she says, productive communication is linked to patient satisfaction, adherence to medical instructions and positive clinical outcomes.

“Black patients with chronic pain have greater pain severity, often interfering with family life, recreational activities including exercise, work effectiveness, sleep, sex life and general mood,” said Dr. Bair, an internist who specializes in treating pain, who is the senior author of the design and methods paper. “Although this is less an issue in the VA, they typically receive lower levels of care for their pain.”

To mitigate pain care disparities, COOPERATE provides coaching that focuses on activating patients to define their personal goals – for example, being able to play with their grandchildren or being able to return to work – and then being able to articulate these goals to providers so patient and provider together can determine how best to manage pain and optimize function.

“It is important to point out that health inequity does not occur because of something patients are doing ‘wrong’,” said Dr. Matthias. “Rather, these inequities are baked into our society, including our healthcare system. Although COOPERATE does not address disparities at the system level, by focusing on the individual, COOPERATE helps patients acquire the tools needed to advocate for themselves in healthcare settings and enable their voices to be heard. Although larger, system-level interventions are still needed, equipping individuals with skills such as this is an important ingredient in optimizing pain care and reducing existing disparities.”

“Many Black patients often leave their healthcare visits feeling unheard by their providers or that the visit was unproductive,” said Dr. Eliacin. “Using self-management tools and coaching methods, COOPERATE is helping patients exercise greater control over their health and receive the care they need.”

Communication and Activation in Pain to Enhance Relationships and Treat Pain with Equity (COOPERATE): Rationale, study design, methods, and sample characteristics,” is published in the peer reviewed Contemporary Clinical Trials.

Authors of the study, in addition to Drs. Matthias, Eliacin and Bair, are Adam Hirsh, PhD, Philip Procento, Kevin L. Rand, PhD, Michelle P. Salyers, PhD, and Mackenzie L. Shanahan, all of the IUPUI School of Science; Jasma Adams, MPH, Perla Flores, B.S., Tetla Menen, Diana J Burgess, PhD, all of the VA Medical Center Minneapolis and University of Minnesota; Joanne Daggy, PhD, and Anthony J. Perkins, M.S., both of the IU School of Medicine; and Laura J. Myers, PhD, VA Medical Center Indianapolis, Regenstrief Institute and IU School of Medicine. Dr. Salyers also is a former Regenstrief research scientist and a current Regenstrief affiliate scientist.

This work was supported by a Department of Veterans Affairs Health Services Research and Development Merit Review Award to Dr. Matthias (IIR 17-032).

Marianne S. Matthias, PhD
In addition to her role as a research scientist at Regenstrief Institute, Marianne S. Matthias, PhD, is a core investigator for the U.S. Department of Veterans Affairs Health Services Research and Development Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis. She is also a senior research professor of medicine at Indiana University School of Medicine.

Johanne Eliacin, PhD
In addition to being a research scientist at Regenstrief Institute, Johanne Eliacin, PhD, is a core investigator at the U.S. Department of Veterans Affairs Health Services Research and Development Center for Health Information and Communication at Richard L. Roudebush VA Medical Center, Indianapolis. She is also an assistant research professor of psychiatry and assistant scientist in psychology at IU School of Medicine and a research scientist at the Indiana Alzheimer’s Disease Research Center.

Matthew J. Bair, M.D., M.S.
In addition to being a research scientist at Regenstrief Institute, Matthew J. Bair, M.D., M.S., is a core investigator at the U.S. Department of Veterans Affairs Health Services Research and Development Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis. He is a professor of medicine at Indiana University School of Medicine.

About Veteran Health Indiana and CHIC        
The Richard L. Roudebush VA Medical Center is the flagship medical center for Veteran Health Indiana, the VA’s healthcare system in central and southern Indiana. The medical center is located in downtown Indianapolis, and is collocated with three large community hospitals and the campus of the Indiana University Schools of Medicine and Nursing. The health system has been serving Hoosier Veterans since 1932. As Indiana’s Level 1a, tertiary care Veteran facility, the medical center serves as home base for a system of inpatient and outpatient care locations serving more than 62,000 Veterans.

The VA Health Services Research and Development (HSR&D) Center for Health Information and Communication (CHIC) group is a diverse cadre of researchers based at Roudebush VA Medical Center who work together to transform the healthcare system, both within and outside the VA so every patient receives consistent, high-quality care.

About Regenstrief Institute
Founded in 1969 in Indianapolis, the Regenstrief Institute is a local, national and global leader dedicated to a world where better information empowers people to end disease and realize true health. A key research partner to Indiana University, Regenstrief and its research scientists are responsible for a growing number of major healthcare innovations and studies. Examples range from the development of global health information technology standards that enable the use and interoperability of electronic health records to improving patient-physician communications, to creating models of care that inform practice and improve the lives of patients around the globe.

Sam Regenstrief, a nationally successful entrepreneur from Connersville, Indiana, founded the institute with the goal of making healthcare more efficient and accessible for everyone. His vision continues to guide the institute’s research mission.

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