Please select the eligibility criteria that correspond to the clinical trial below.
Title: Stepped Care to Optimize Pain Care Effectiveness (SCOPE)
Brief Summary: Pain is the most common physical symptom in primary care, accounting for an enormous burden in terms of patient suffering, quality of life, work and social disability, and health care and societal costs. Pain is particularly prevalent among veterans. Four major barriers to optimal care include underdetection of pain, inadequate initial treatment, failure to monitor adherence and symptom response, and failure to adjust treatment in patients not responding or intolerant of initial therapy. Therefore, we propose to conduct the Stepped Care to Optimize Pain care Effectiveness (SCOPE) study, a randomized clinical effectiveness trial in primary care.


Options:
A: Inclusion Criteria:

1. enrolled for primary care at a VA Pittsburgh Healthcare System (VAPHS)site with at least one visit from June 1, 2004 through December 31, 2005
2. diagnosed with diabetes mellitus with at least 12 months of ongoing pharmacologic treatment (at least one oral hypoglycemic agent, insulin, or both)
3. born in 1926 or later
4. have an HbA1c level \>/= 8.0% at the last assessment (between 6/1/04 and 12/31/05)
5. have an HbA1c level \>/= 7.5% (by finger stick) at the time of enrollment
6. mentally competent to give informed consent

Exclusion Criteria:

1. one or more visits to the VAPHS Diabetes Clinic from June 1, 2004 through December 31, 2005
2. metastatic or inoperable cancer
3. Child-Pugh Class B or C end-stage liver disease
4. HIV/AIDS
5. end-stage renal disease requiring dialysis
6. ongoing home oxygen therapy
7. a history of major organ transplant (i.e., heart, lung, kidney, liver)
8. residence in an institution (e.g. nursing home, personal care home, or prison)
9. incompatible telephone service (i.e., either none or digital)
10. concurrent participation in any other research protocol
B: Inclusion Criteria:

* Stable systolic heart failure
* New York Heart Association functional class II-III, with a decreased pump function (left ventricular ejection fraction (LVEF) \<45%)
* Titrated to the most optimal doses of ACE-inhibitor or Angiotensin Receptor Blocker, and beta-blocker
* Receiving stable doses of at least 3 heart failure medications (at multiple times during the day) for 1 month with no plans to add or adjust heart failure medications or titrate further in the immediate future.

Exclusion Criteria:

* Age younger than 50 years
* Diastolic heart failure (intact pump function)
* Myocardial infarction, invasive treatment (percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG)), or hospitalization within 1 month prior to inclusion
* Life-threatening comorbid conditions (e.g., cancer)
* Diminished mental capacities (suspected cognitive decline will be confirmed by a mini mental state examination (MMSE))
* History of psychiatric disorders apart from affective disorders (depression and anxiety disorders)
C: Inclusion Criteria:

* computer and Internet access at home
* receiving care for type 2 diabetes at the University of Washington, General Internal Medicine Clinic, Roosevelt

Exclusion Criteria:

* non-English speaking
D: Inclusion Criteria:

SCOPE will enroll 250 primary care veterans with persistent (3 months or longer) musculoskeletal pain of moderate severity and randomize them to either the stepped care intervention or usual care control group.

Exclusion Criteria:

Individuals who:

* have filed a pain-related disability claim in the last 6 months;
* do not speak English;
* have moderately severe cognitive impairment;
* have schizophrenia, bipolar disorder, or other psychosis;
* are actively suicidal;
* have current illicit drug use; or
* have an anticipated life expectancy of less than 12 months.

Answer: D