scholarly journals Barriers and Facilitators to Implementation of Virtual Reality as a Pain Management Modality in Academic, Community, and Safety-Net Settings: A Qualitative Analysis (Preprint)

10.2196/26623 ◽  
2020 ◽  
Author(s):  
Urmimala Sarkar ◽  
Jane Lee ◽  
Kim Hanh Nguyen ◽  
Sarah Lisker ◽  
Courtney R Lyles
Keyword(s):  
Virtual Reality ◽  
Pain Management ◽  
Qualitative Analysis ◽  
Safety Net ◽  
Academic Community ◽  
Barriers And Facilitators ◽  
Management Modality

Barriers and Facilitators to Implementation of Virtual Reality as a Pain Management Modality in Academic, Community, and Safety-Net Settings: A Qualitative Analysis (Preprint)

2020 ◽  
Author(s):  
Urmimala Sarkar ◽  
Jane Lee ◽  
Kim Hanh Nguyen ◽  
Sarah Lisker ◽  
Courtney R Lyles
Keyword(s):  
Virtual Reality ◽  
Pain Management ◽  
Los Angeles ◽  
Qualitative Analysis ◽  
Safety Net ◽  
Academic Community ◽  
Barriers And Facilitators ◽  
Structured Interviews ◽  
Patient Feedback ◽  
Management Approaches

BACKGROUND Prior studies among primarily White, relatively advantaged populations show that virtual reality (VR) is an efficacious treatment modality for opioid-sparing pain management. OBJECTIVE We conducted a qualitative, theory-informed implementation science study to assess readiness for VR in safety-net settings. METHODS Using the theoretical lens of the Consolidated Framework for Implementation Research (CFIR) framework, we conducted semi-structured interviews with current VR users and non-users based in safety-net health systems (n=15). We investigated barriers and facilitators to a commercially available, previously validated VR technology platform, AppliedVR (Los Angeles, CA). We employed deductive qualitative analysis using the overarching domains of the CFIR framework and performed open, inductive coding to identify specific themes within each domain. RESULTS Interviewees deemed the VR intervention to be useful, scalable, and an appealing alternative to existing pain management approaches. Both users and non-users identified lack of reimbursement for VR as a significant challenge for adoption. Current users cited positive patient feedback, but safety-net stakeholders voiced concern that existing VR content may not be relevant or appealing to diverse patients. All respondents acknowledged the challenge of integrating and maintaining VR in current pain management workflows across a range of clinical settings, and this adoption challenge was particularly acute given resource and staffing constraints in safety-net settings. CONCLUSIONS VR for pain management holds interest for front-line pain management clinicians and leadership in safety-net health settings, but will require significant tailoring and adaption to address the needs of diverse populations. Integration into complex workflows for pain management is a significant barrier to adoption, and participants cited structural cost and reimbursement concerns as impediments to initial implementation and to scaling VR use.

Virtual reality for pain management in advanced heart failure: A randomized controlled study

2021 ◽  
pp. 026921632110412
Author(s):  
Hunter Groninger ◽  
Diana Stewart ◽  
Julia M Fisher ◽  
Eshetu Tefera ◽  
James Cowgill ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Virtual Reality ◽  
Pain Management ◽  
Guided Imagery ◽  
Advanced Heart Failure ◽  
Controlled Study ◽  
Randomized Controlled ◽  
General Distress

Background: Hospitalized patients with advanced heart failure often experience acute and/or chronic pain. While virtual reality has been extensively studied across a wide range of clinical settings, no studies have yet evaluated potential impact on pain management on this patient population. Aim: To investigate the impact of a virtual reality experience on self-reported pain, quality-of-life, general distress, and satisfaction compared to a two-dimensional guided imagery active control. Design: Single-center prospective randomized controlled study. The primary outcome was the difference in pre- versus post-intervention self-reported pain scores on a numerical rating scale from 0 to 10. Secondary outcomes included changes in quality-of-life scores, general distress, and satisfaction with the intervention. Setting/participants: Between October 2018 and March 2020, 88 participants hospitalized with advanced heart failure were recruited from an urban tertiary academic medical center. Results: Participants experienced significant improvement in pain score after either 10 minutes of virtual reality (change from pre- to post −2.9 ± 2.6, p < 0.0001) or 10 minutes of guided imagery (change from pre- to post −1.3 ± 1.8, p = 0.0001); the virtual reality arm experienced a 1.5 unit comparatively greater reduction in pain score compared to guided imagery ( p = 0.0011). Total quality-of-life and general distress scores did not significantly change for either arm. Seventy-eight participants (89%) responded that they would be willing to use the assigned intervention again. Conclusion: Virtual reality may be an effective nonpharmacologic adjuvant pain management intervention in hospitalized patients with heart failure. Trial Registration: ClinicalTrials.gov database (NCT04572425).

Implementation of ultrasound after central venous catheter insertion: A qualitative study in early adopters

2021 ◽  
pp. 112972982110534
Author(s):  
Enyo A Ablordeppey ◽  
Shannon M Keating ◽  
Katherine M Brown ◽  
Daniel L Theodoro ◽  
Richard T Griffey ◽  
...  
Keyword(s):  
Focus Group ◽  
Central Venous Catheter ◽  
Qualitative Analysis ◽  
Focus Groups ◽  
Venous Catheter ◽  
Barriers And Facilitators ◽  
Central Venous ◽  
Focus Group Discussions ◽  
Group Discussions ◽  
Post Procedure

Background: The adoption rate of point of care ultrasound (POCUS) for the confirmation of central venous catheter (CVC) positioning and exclusion of post procedure pneumothorax is low despite advantages in workflow compared to traditional chest X-ray (CXR). To explore why, we convened focus groups to address barriers and facilitators of implementation for POCUS guided CVC confirmation and de-implementation of post-procedure CXR. Methods: We conducted focus groups with emergency medicine and critical care providers to discuss current practices in POCUS for CVC confirmation. The semi-structured focus group interview guide was informed by the Consolidated Framework for Implementation Research (CFIR). We performed qualitative content analysis of the resulting transcripts using a consensual qualitative research approach (NVivo software), aiming to identify priority categories that describe the barriers and facilitators of POCUS guided CVC confirmation. Results: The coding dictionary of barriers and facilitators consisted of 21 codes from the focus group discussions. Our qualitative analysis revealed that 12 codes emerged spontaneously (inductively) within the focus group discussions and aligned directly to CFIR constructs. Common barriers included provider influences (e.g. knowledge and beliefs about POCUS for CVC confirmation), external network (e.g. societal guidelines, ancillary staff, and consultants), and inertia (habit or reflexive processes). Common facilitators included ultrasound protocol advantage and champions. Time and provider outcomes (cognitive offload, ownership, and independence) emerged as early barriers but late facilitators. Conclusion: Our qualitative analysis demonstrates real and perceived barriers against implementation of POCUS for CVC position confirmation and pneumothorax exclusion. Our findings discovered organizational and personal constructs that will inform development of multifaceted strategies toward implementation of POCUS after CVC insertion.

Extended Reality in Patient Care and Pharmacy Practice: A Viewpoint

2020 ◽  
Vol 66 (4) ◽  
pp. 22-27
Author(s):  
Jody Takemoto ◽  
Brittany Parmentier ◽  
Rachel Bratelli ◽  
Thayer Merritt ◽  
Leanne California Health Sciences University
Keyword(s):  
Virtual Reality ◽  
Pain Management ◽  
Patient Care ◽  
Mixed Reality ◽  
Pharmacy Practice ◽  
Educational Practice ◽  
Improve Patient Care ◽  
Pharmacy Education ◽  
Evolution Of Technology ◽  
Improve Patient

The evolution of technology has given practitioners and educators more tools to better treat, manage, and educate both patients and future pharmacists. The objective of this viewpoint publication is to describe the current use of extended reality (XR) in pharmacy and propose ways in which pharmacy practice and education may benefit from incorporation of this technology. While these tools have been used for decades by many other professions, pharmacy is starting to adopt XR in professional and educational practice. XR (virtual reality, mixed reality, and augmented reality) is being used in various aspects of pharmacy care and education, such as pain management, diabetes self-care, cross-checking of prescriptions, treatments for addiction, and (in limited ways) patient and pharmacy education. There is great potential for further integration of XR into pharmacy practice and pharmacy education to ultimately improve patient care and education as well as pharmacy education.

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