Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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4012 — Adoption and Implementation of Complementary and Integrative Health Implementation at the VA

Lead/Presenter: Stephanie Taylor, COIN - Los Angeles
All Authors: Taylor SL (VA Los Angeles, VA Complementary and Integrative Health Evaluation Center, UCLA) Bolton R (Bedford VA, Center for Evaluating Patient-Centered Care in VA) Huynh A (VA Los Angeles) Dvorin K (Bedford VA, Evaluating Patient-Centered Care in VA) Elwy R (Bedford VA, Evaluating Patient-Centered Care in VA, Boston Un) Bokhour B (Bedford VA, Evaluating Patient-Centered Care in VA, Boston Un)

Objectives:
Complementary and integrative health (CIH) therapies such as yoga, meditation and acupuncture are important non-pharmacologic treatment options for anxiety, depression and pain, which are prevalent among Veterans. Veterans are asking for CIH and the VA is mandated to provide CIH per Congress' 2016 Comprehensive Addiction and Recovery Act. Although many VA facilities offer various CIH, it was effectively offered for only a half day total on average in 2015. Also, anecdotal evidence suggests many VA facilities experience challenges implementing CIH and some have adopted strategies to overcome these challenges. However, little is known about these facilitators and challenges, information that is necessary for the VA, and possibly other healthcare systems, to spread CIH.

Methods:
We conducted in-person semi-structured interviews with 122 stakeholders at 8 VA medical centers during two-day site visits between February-August 2015. We selected sites based on their having implemented 3+ types of CIH at least a year prior, geographic location, rural/urban status, and facility size. Stakeholders included executive leadership, CIH-relevant department chairs and their providers, CIH practitioners, and CIH program leaders. We based the interview guide on Greenhalgh's Model of Diffusion in Service Organizations and our prior knowledge of VA CIH implementation issues.

Results:
CIH implementation facilitators and barriers included: 1) organizing the individual types of CIH into one program instead of individually integrating them into departments, 2) having a CIH strategic plan and steering committee, 3) leadership support, 4) providers and Veterans beliefs/skepticism about CIH, 5) demonstrating evidence of CIH effectiveness, 6) having an easy-to-use provider referral process, 7) marketing the CIH programs, 8) positioning CIH as addressing national or local priorities (pain/opioid prevention), 9) practitioner availability, 10) difficulties coding/documenting CIH use, and 11) space.

Implications:
We identified implementation challenges and facilitators that other healthcare settings might face in implementing CIH, some of which are more commonly seen in implementation studies while others seemed particular to novel practices having a mixed evidence base, such as CIH.

Impacts:
The VA and other healthcare systems can use this information to guide their efforts to spread CIH