Transforming Pain Management Through the Integration of Complementary and Conventional Care

2017 ◽  
Author(s):  
Heather Tick ◽  
Eric B. Schoomaker
Keyword(s):  
Healthcare Providers ◽  
Peripheral Sensitization ◽  
Veterans Health ◽  
Health Providers ◽  
Health Administration ◽  
Military Health ◽  
Current Program ◽  
The Military ◽  
Pain Care

This chapter discusses some of the assumptions behind the evolution of the current program of pain care and explores different strategies that could inform transformative changes to the system. It addresses the role of self-care, nutrition, mind-body strategies, and movement in improving function. The emerging scientific literature on neuroplasticity, central and peripheral sensitization, energy generation, and mitochondrial dysfunction, and the functional role of fascia is explored. Health providers in a transformed system will potentially work in more diverse settings, collaborate more broadly, and engage patients in conversations driven by patient priorities and emerging evidence-based modalities. The Veterans Health Administration and the Military Health System, acting on alarming increases in the incidence of chronic pain and associated comorbidities, have become the early adopters of transformative policies. Since pain is the most common cause for a healthcare visit, this chapter should be of interest to all healthcare providers, complementary, integrative, and conventional.

scholarly journals Predictors of Veterans Health Administration utilization and pain persistence among soldiers treated for postdeployment chronic pain in the Military Health System

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rachel Sayko Adams ◽  
Esther L. Meerwijk ◽  
Mary Jo Larson ◽  
Alex H. S. Harris
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Chronic Pain ◽  
Veterans Health Administration ◽  
First Year ◽  
Veterans Health ◽  
Health Administration ◽  
Military Health System ◽  
Military Health ◽  
The Military

Abstract Background Chronic pain presents a significant burden for both federal health care systems designed to serve combat Veterans in the United States (i.e., the Military Health System [MHS] and Veterans Health Administration [VHA]), yet there have been few studies of Veterans with chronic pain that have integrated data from both systems of care. This study examined 1) health care utilization in VHA as an enrollee (i.e., linkage to VHA) after military separation among soldiers with postdeployment chronic pain identified in the MHS, and predictors of linkage, and 2) persistence of chronic pain among those utilizing the VHA. Methods Observational, longitudinal study of soldiers returning from a deployment in support of the Afghanistan/Iraq conflicts in fiscal years 2008–2014. The analytic sample included 138,206 active duty soldiers for whom linkage to VHA was determined through FY2019. A Cox proportional hazards model was estimated to examine the effects of demographic characteristics, military history, and MHS clinical characteristics on time to linkage to VHA after separation from the military. Among the subpopulation of soldiers who linked to VHA, we described whether they met criteria for chronic pain in the VHA and pain management treatments received during the first year in VHA. Results The majority (79%) of soldiers within the chronic pain cohort linked to VHA after military separation. Significant predictors of VHA linkage included: VHA utilization as a non-enrollee prior to military separation, separating for disability, mental health comorbidities, and being non-Hispanic Black or Hispanic. Soldiers that separated because of misconduct were less likely to link than other soldiers. Soldiers who received nonpharmacological treatments, opioids/tramadol, or mental health treatment in the MHS linked earlier to VHA than soldiers who did not receive these treatments. Among those who enrolled in VHA, during the first year after linking to the VHA, 49.7% of soldiers met criteria for persistent chronic pain in VHA. Conclusions The vast majority of soldiers identified with chronic pain in the MHS utilized care within VHA after military separation. Careful coordination of pain management approaches across the MHS and VHA is required to optimize care for soldiers with chronic pain.

scholarly journals A Four-System Comparison of Patients With Chronic Illness: The Military Health System, Veterans Health Administration, Medicaid, and Commercial Plans

2009 ◽  
Vol 174 (9) ◽  
pp. 936-943 ◽  
Author(s):  
Teresa B. Gibson ◽  
Todd A. Lee ◽  
Christine S. Vogeli ◽  
Julia Hidalgo ◽  
Ginger Smith Carls ◽  
...  
Keyword(s):  
Chronic Illness ◽  
Health System ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Military Health System ◽  
Military Health ◽  
The Military

Do You Get What You Measure? Research Opportunities Based on the Veterans Health Administration Experience

2014 ◽  
Vol 28 (2) ◽  
pp. 385-413 ◽  
Author(s):  
Nicole Thibodeau ◽  
John Harry Evans ◽  
Nandu J. Nagarajan
Keyword(s):  
Healthcare Delivery ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Performance Incentives ◽  
Healthcare Network ◽  
Similar Patient ◽  
Private And Public ◽  
The U.S

SYNOPSIS Starting in 1995, the Veterans Health Administration (VHA) transformed a bureaucratic healthcare system into a performance-driven, patient-focused integrated healthcare network. The VHA's experience may offer lessons for private and public sector providers as the U.S. explores alternative healthcare delivery systems and payment methods. Similar patient-focused integrated systems are one of the hallmarks of the latest U.S. attempt to improve the quality and efficiency of healthcare delivery. The use of performance incentives to promote cooperation and innovation is also central to both the VHA and the U.S. reform. This study reviews the VHA's experience with an eye to identifying issues and potential research avenues for accounting researchers interested in the role of accounting information for control, coordination, and organizational change.

Women Veterans’ Experiences with Integrated, Biopsychosocial Pain Care: A Qualitative Study

Pain Medicine ◽  
2021 ◽  
Author(s):  
Francesca M Nicosia ◽  
Carolyn J Gibson ◽  
Natalie Purcell ◽  
Kara Zamora ◽  
Jennifer Tighe ◽  
...  
Keyword(s):  
Chronic Pain ◽  
San Francisco ◽  
Women Veterans ◽  
Self Management ◽  
Veterans Health ◽  
Health Administration ◽  
Care Models ◽  
Va Health Care System ◽  
Pain Care ◽  
Gender Specific

Abstract Objectives Biopsychosocial, integrated pain care models are increasingly implemented in the Veterans Health Administration to improve chronic pain care and reduce opioid-related risks, but little is known about how well these models address women veterans’ needs. Design Qualitative, interview-based study. Setting San Francisco VA Health Care System Integrated Pain Team (IPT), an interdisciplinary team that provides short-term, personalized chronic pain care emphasizing functional goals and active self-management. Subjects Women with chronic pain who completed ≥3 IPT sessions. Methods Semistructured phone interviews focused on overall experience with IPT, perceived effectiveness of IPT care, pain care preferences, and suggested changes for improving gender-sensitive pain care. We used a rapid approach to qualitative thematic analysis to analyze interviews. Results Fourteen women veterans (mean age 51 years; range 33–67 years) completed interviews. Interviews revealed several factors impacting women veterans’ experiences: 1) an overall preference for receiving both primary and IPT care in gender-specific settings, 2) varying levels of confidence that IPT could adequately address gender-specific pain issues, 3) barriers to participating in pain groups, and 4) barriers to IPT self-management recommendations due to caregiving responsibilities. Conclusions Women veterans reported varied experiences with IPT. Recommendations to improve gender-sensitive pain care include increased provider training; increased knowledge of and sensitivity to women’s health concerns; and improved accommodations for prior trauma, family and work obligations, and geographic barriers. To better meet the needs of women veterans with chronic pain, integrated pain care models must be informed by an understanding of gender-specific needs, challenges, and preferences.

scholarly journals Diagnostic Evaluation of Hypoglycemia Due To an Insulinoma in a Deployed Infantryman: Significance of Neuroglycopenia and the Role of the Military Health System

2021 ◽  
Author(s):  
Samuel T Olatunbosun ◽  
Ayodeji F Alaketu ◽  
Joseph H McDermott ◽  
Al M Elsayed von Bayreuth
Keyword(s):  
Health System ◽  
Rare Condition ◽  
Service Member ◽  
Hyperinsulinemic Hypoglycemia ◽  
Suspected Case ◽  
Military Health System ◽  
Military Population ◽  
Military Health ◽  
The Military

ABSTRACT Insulinoma, the prototype of endogenous hyperinsulinemic hypoglycemia, is a very rare condition, with an incidence of four cases per million person-years. Its rate of occurrence in the U.S. military population is unknown. Two cases of insulinomas involving active duty service members have been published. However, there has been no reported case of an insulinoma in a deployed service member. We report the case of a 21-year-old infantryman with clinical hypoglycemia of insidious onset, manifesting with overt neuroglycopenic symptoms during his deployment as a combatant soldier, and the ultimate diagnosis of an insulinoma as the underlying cause. The series of multiple clinical evaluations and the unique circumstances leading to the formal evaluation of the patient’s hypoglycemia and treatment are chronicled. The significance of neuroglycopenia and the diagnostic approach to any suspected case of hypoglycemia, the potential challenges and opportunities, and educational aspects of evaluation and management of the insulinoma are elaborated. The potential role of the Military Health System in facilitating the detection and treatment of this rare condition in the service member is discussed as well.

scholarly journals The role of telehealth during COVID-19 outbreak: A systematic review based on current evidence

2020 ◽  
Author(s):  
Elham Monaghesh ◽  
Alireza Hajizadeh
Keyword(s):  
Systematic Review ◽  
English Language ◽  
Healthcare Providers ◽  
Physical Contact ◽  
Current Evidence ◽  
Health Providers ◽  
Search Results ◽  
Effective Option ◽  
Critical Appraisal Skills

Abstract Purpose The outbreak of coronavirus disease-19 (COVID-19) is a public health emergency of international concern. Telehealth is effective option to fight COVID-19 outbreak. The aim of this systematic review was to identify the role of telehealth services during COVID-19 outbreak.Methods This systematic review was conducted through searching five databases including PubMed, Scopus, Embase, Web of Science and Science direct. Inclusion criteria included studies clearly defined role of telehealth services in COVID-19 outbreak, published from December 31, 2019, written in English language and published in peer reviewed. Two reviewers independently assessed search results, extracted data, and assessed quality of included studies. Quality assessment was based on the Critical Appraisal Skills Program (CASP) checklist. Narrative synthesis was undertaken to summarize and report the findings.Results Eight studies met the inclusion out of the 142 search results. Currently, healthcare providers and patients who are self-isolating, telehealth is certainly appropriate to minimizing the risk of COVID-19 transmission. This solution has the potential to avoidance of direct physical contact, provide continuous care to the community and finally reduce morbidity and mortality in COVID-19 outbreak.Conclusions The use of telehealth improves the provision of health services. Therefore, telehealth should be an important tool in caring services while keeping patients and health providers safe as the COVID-19 outbreak.

War-Worn Subjects

2020 ◽  
pp. 107-130
Author(s):  
Sara Rushing
Keyword(s):  
Veterans Health Administration ◽  
Medical Professionals ◽  
Veterans Health ◽  
Health Administration ◽  
Post Traumatic Stress ◽  
Post Traumatic ◽  
Wounded Warriors ◽  
A Site ◽  
And Control ◽  
The Military

This chapter explores how humility and autonomy come into play for “wounded warriors” seeking post-traumatic stress disorder (PTSD) treatment and for the medical professionals treating them within the particular constraints of the military-medical complex. Analyzing military PTSD illustrates how deeply entangled disease construction, diagnosis, and “cure” are with the complex discourse of “choice and control,” or with medicalization under the pressures of neoliberal rationality. Like with birth and death, but perhaps even more so, veteran PTSD as taken up within the Veterans Health Administration is a site of subjection and potential contestation from which we can learn much about the production of citizen-subjectivity in moments of distinct corporeal and psychic vulnerability. This chapter examines how militarism and masculinity conspire with inadequate conceptions of patient (and doctor) humility and autonomy, to produce an assumption of and fatalism about whether “wounded warriors” can be “fixed.”

scholarly journals BEHAVIORAL HEALTH WORKFORCE DEVELOPMENT TO IMPROVE DEMENTIA CARE IN INTEGRATED PRIMARY CARE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S379-S380
Author(s):  
Laura O Wray ◽  
Bonnie M Vest ◽  
Laura Levon Brady ◽  
Paul R King
Keyword(s):  
Primary Care ◽  
Behavioral Health ◽  
Workforce Development ◽  
Professional Education ◽  
Interprofessional Collaboration ◽  
Dementia Care ◽  
Veterans Health ◽  
Health Providers ◽  
Health Administration ◽  
People With Dementia

Abstract People with dementia (PwD) receive most of their health care in primary care, yet timely recognition and optimal management of dementia in that setting continues to be challenging. Implementation of primary care medical home models in the Veterans Health Administration (VHA) holds promise for improving quality and coordination of dementia care through interprofessional collaboration. Integrating behavioral health providers (BHPs) into primary care may help to support the care of people with dementia and their families. However, most integrated BHPs have a generalist training background and likely require professional education to address the unique needs of patients with dementia. We will describe findings from a national VHA education needs survey of integrated BHPs and an in-depth qualitative study examining primary care for PwD in two large VHA healthcare systems. We will discuss how geriatric experts can serve as trainers to address current gaps in primary care of PwD.

scholarly journals “We Want to Build a Network”: Professional Experiences of Case Managers Working With Military Families

2019 ◽  
Vol 6 ◽  
pp. 2333794X1986978 ◽  
Author(s):  
Robyn Englert ◽  
Renee Dell’Acqua ◽  
Shannon Fitzmaurice ◽  
Abigail Marter Yablonsky
Keyword(s):  
Military Families ◽  
Qualitative Content Analysis ◽  
Qualitative Interviews ◽  
Well Being ◽  
Case Managers ◽  
Military Health ◽  
Professional Experiences ◽  
Treatment Facilities ◽  
The Military

Optimizing case management (CM) services increases service member readiness at home and abroad. However, little research has been conducted on the experiences of case managers providing services to military families within the Military Health System. Semistructured qualitative interviews were conducted to explore the professional experiences of case managers to identify factors that may affect care to military families. A total of 53 case managers from military medical treatment facilities (MTFs) varying in size, location, and branch of service were interviewed by telephone to explore their perspectives. Qualitative content analysis was performed. Case managers serve a variety of functions, but specific roles vary between MTFs. Factors that affect CM services for military families were identified: (1) need for pediatric specialization, (2) heavy workload, (3) appropriate staff, (4) patient handoffs, and (5) the role of CM. Recommendations for improving CM services to facilitate the well-being of military families are discussed.

Patient Safety Trilogy: Perspectives from Clinical Engineering

2013 ◽  
Vol 47 (2) ◽  
pp. 137-142 ◽  
Author(s):  
Izabella Gieras ◽  
Paul Sherman ◽  
Dennis Minsent
Keyword(s):  
Patient Safety ◽  
Medical Center ◽  
Academic Medical Center ◽  
Clinical Engineering ◽  
Veterans Health ◽  
Health Administration ◽  
Healthcare Technology ◽  
Academic Medical ◽  
Clinical Engineers

This article examines the role a clinical engineering or healthcare technology management (HTM) department can play in promoting patient safety from three different perspectives: a community hospital, a national government health system, and an academic medical center. After a general overview, Izabella Gieras from Huntington Hospital in Pasadena, CA, leads off by examining the growing role of human factors in healthcare technology, and describing how her facility uses clinical simulations in medical equipment evaluations. A section by Paul Sherman follows, examining patient safety initiatives from the perspective of the Veterans Health Administration with a focus on hazard alerts and recalls. Dennis Minsent from Oregon Health & Science University writes about patient safety from an academic healthcare perspective, and details how clinical engineers can engage in multidisciplinary safety opportunities.

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