Abstract
In response to the opioid epidemic and high rates of chronic pain among the veteran population, the U.S. Department of Veterans Affairs implemented the TelePain-Empower Veterans Program (EVP), a nonpharmacological pain management program for veterans. Delivered virtually, TelePain-EVP incorporates integrated health components (Whole Health, Acceptance and Commitment Therapy, and Mindful Movement) through interdisciplinary personalized coaching. The objective of this quality improvement project was to evaluate the implementation of TelePain-EVP to identify determinants to implementation, benefits and challenges to participation, and recommendations for future direction. We used a qualitative descriptive design to conduct semistructured telephone interviews with TelePain-EVP leaders (n = 3), staff (n = 10), and veterans (n = 22). The interview guides aligned with the Consolidated Framework for Implementation Research (CFIR). Thematic content analysis organized and characterized findings. Several CFIR domains emerged as determinants relevant to program implementation, including innovation (eg, design); individuals (eg, deliverers, recipients); inner (eg, communications) and outer settings (eg, local conditions); and implementation process (eg, reflecting and evaluating). Identified determinants included facilitators (eg, virtual delivery) and barriers (eg, staff shortages). Participants reported improvements in pain management coping skills, interpersonal relationships, and sense of community, but no self-reported reductions in pain or medication use. Program improvement recommendations included using centralized staff to address vacancies, collecting electronic data, offering structured training, and providing course materials to veteran participants. Qualitative data can inform the sustained implementation of TelePain-EVP and other similar telehealth pain management programs. These descriptive data should be triangulated with quantitative data to objectively assess participant TelePain-EVP outcomes and associated participant characteristics. Perspective: A qualitative evaluation of a telehealth program to manage chronic pain, guided by the CFIR framework, identified determinants of program implementation. Additionally, participants reported improvements in pain management coping skills, interpersonal relationships, and sense of community, but no self-reported reductions in pain or medication use.
| Original language | English (US) |
|---|---|
| Article number | 104493 |
| Journal | Journal of Pain |
| Volume | 25 |
| Issue number | 7 |
| DOIs | |
| State | Published - Jul 2024 |
Funding
The Department of Veterans Affairs, Veterans Health Administration, Office of Rural Health (OMAT ID# 16403,16404, 16405, 16489, 16490); and the Pain Management, Opioid Safety and Prescription Drug Monitoring Program Office (PMOP ID# SP8E-PMTIA160) supported the development of this manuscript (Co-PI\u2019s: Haun, Saenger). Early versions of this work (PI: Saenger) were supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Patient-Centered Care and Cultural Transformation (OPCCCT), and the Veterans Integrated Service Network \u2212\u20097 (VISN 7). The Authors declare that there is no conflict of interest. When asked about the factors that facilitated or hindered implementation of TelePain-EVP, respondents rarely described CFIR\u2019s Outer Setting Factors, or the broader environment in which the program operates. Nevertheless, our evaluation team is aware of some of the contextual factors that may have also facilitated implementation. Specifically, program leaders in the VA Maryland Healthcare System received substantial funding from the Pain Management, Opioid Safety, and Prescription Drug Monitoring Program (PMOP) Office of the VA to support TelePain-EVP. Additionally, the move from the traditional, in-person EVP to TelePain-EVP coincided with the COVID-19 pandemic. Program leaders and staff were well positioned to offer the program in a virtual environment when in-person classes were not feasible.
Keywords
- Chronic pain
- opioid
- quality of life
- remote intervention
- veterans
ASJC Scopus subject areas
- Neurology
- Clinical Neurology
- Anesthesiology and Pain Medicine
