scholarly journals Sex Differences in Chronic Pain Management Practices for Patients Receiving Opioids from the Veterans Health Administration

Pain Medicine ◽  
2015 ◽  
Vol 16 (1) ◽  
pp. 112-118 ◽  
Author(s):  
Elizabeth M. Oliva ◽  
Amanda M. Midboe ◽  
Eleanor T. Lewis ◽  
Patricia T. Henderson ◽  
Aaron L. Dalton ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Sex Differences ◽  
Pain Management ◽  
Management Practices ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Chronic Pain Management ◽  
Health Administration

scholarly journals Barriers to and Facilitators of Multimodal Chronic Pain Care for Veterans: A National Qualitative Study

Pain Medicine ◽  
2020 ◽  
Author(s):  
Chelsea Leonard ◽  
Roman Ayele ◽  
Amy Ladebue ◽  
Marina McCreight ◽  
Charlotte Nolan ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Chronic Pain ◽  
Pain Management ◽  
Health Care Providers ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Care Providers ◽  
Pain Care

Abstract Objective Chronic pain is more common among veterans than among the general population. Expert guidelines recommend multimodal chronic pain care. However, there is substantial variation in the availability and utilization of treatment modalities in the Veterans Health Administration. We explored health care providers’ and administrators’ perspectives on the barriers to and facilitators of multimodal chronic pain care in the Veterans Health Administration to understand variation in the use of multimodal pain treatment modalities. Methods  We conducted semi-structured qualitative interviews with health care providers and administrators at a national sample of Veterans Health Administration facilities that were classified as either early or late adopters of multimodal chronic pain care according to their utilization of nine pain-related treatments. Interviews were conducted by telephone, recorded, and transcribed verbatim. Transcripts were coded and analyzed through the use of team-based inductive and deductive content analysis. Results  We interviewed 49 participants from 25 facilities from April through September of 2017. We identified three themes. First, the Veterans Health Administration’s integrated health care system is both an asset and a challenge for multimodal chronic pain care. Second, participants discussed a temporal shift from managing chronic pain with opioids to multimodal treatment. Third, primary care teams face competing pressures from expert guidelines, facility leadership, and patients. Early- and late-adopting sites differed in perceived resource availability. Conclusions Health care providers often perceive inadequate support and resources to provide multimodal chronic pain management. Efforts to improve chronic pain management should address both organizational and patient-level challenges, including primary care provider panel sizes, accessibility of training for primary care teams, leadership support for multimodal pain care, and availability of multidisciplinary pain management resources.

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.

Sex Differences in Opioid Use Disorder Prevalence and Multimorbidity Nationally in the Veterans Health Administration

2021 ◽  
pp. 1-11
Author(s):  
MacKenzie R. Peltier ◽  
Mehmet Sofuoglu ◽  
Ismene L. Petrakis ◽  
Elina Stefanovics ◽  
Robert A. Rosenheck
Keyword(s):  
Sex Differences ◽  
Veterans Health Administration ◽  
Opioid Use Disorder ◽  
Veterans Health ◽  
Health Administration ◽  
Opioid Use

scholarly journals Implementation of telementoring for pain management in Veterans Health Administration: Spatial analysis

2016 ◽  
Vol 53 (1) ◽  
pp. 147-156 ◽  
Author(s):  
Evan P. Carey ◽  
Joseph W. Frank ◽  
Robert D. Kerns ◽  
P. Michael Ho ◽  
Susan R. Kirsh
Keyword(s):  
Spatial Analysis ◽  
Pain Management ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration

Value Creation in Public Enterprises: An Empirical Analysis of Coordinated Organizational Changes in the Veterans Health Administration

2007 ◽  
Vol 82 (2) ◽  
pp. 483-520 ◽  
Author(s):  
Nicole Thibodeau ◽  
John H. (Harry) Evans ◽  
Nandu J. Nagarajan ◽  
Jeff Whittle
Keyword(s):  
Private Sector ◽  
Organizational Structure ◽  
Management Practices ◽  
Program Planning ◽  
Veterans Health Administration ◽  
The United States ◽  
Veterans Health ◽  
Health Administration ◽  
Public Enterprises ◽  
Remaining Capacity

As part of a federal government initiative to increase efficiency and quality, in 1996 the United States Veterans Health Administration (VHA) radically restructured its organizational design and management processes. This study uses 1992–1998 clinical, workload, and financial data to examine the effect of this reform on performance. Several previous government attempts to introduce private sector management practices, such as management by objectives (MBO) or program planning and budgeting system (PPBS), have been largely unsuccessful. In contrast to prior reforms, the current restructuring introduced coordinated changes in the VHA organizational structure, performance measurement, and reward systems. Our results document that, following the reorganization, the VHA cost per patient declined significantly and various quality measures improved. Our analysis suggests that reduction in excess capacity and the more intense use of remaining capacity are among the primary explanations for the VHA achieving the observed cost reductions. These findings suggest that coordinated changes in organizational structure, performance measures, and incentives can create value for public enterprises even though control mechanisms are generally more limited in these environments than in the private sector.

scholarly journals Evaluation of a Telementoring Intervention for Pain Management in the Veterans Health Administration

Pain Medicine ◽  
2015 ◽  
Vol 16 (6) ◽  
pp. 1090-1100 ◽  
Author(s):  
Joseph W. Frank ◽  
Evan P. Carey ◽  
Katherine M. Fagan ◽  
David C. Aron ◽  
Jeff Todd-Stenberg ◽  
...  
Keyword(s):  
Pain Management ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration

scholarly journals Increased Nonopioid Chronic Pain Treatment in the Veterans Health Administration, 2010–2016

Pain Medicine ◽  
2018 ◽  
Vol 20 (5) ◽  
pp. 869-877 ◽  
Author(s):  
Joseph W Frank ◽  
Evan Carey ◽  
Charlotte Nolan ◽  
Robert D Kerns ◽  
Friedhelm Sandbrink ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Treatment ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Chronic Pain Treatment
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