Lead/Presenter: Stephanie Taylor,
COIN - Los Angeles
All Authors: Taylor SL (VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP); Los Angeles VA Healthcare System), Giannitrapani G (HSR&D Center for Innovation to Implementation, Palo Alto VA Healthcare System), Ackland PE (HSR&D Center for Chronic Disease and Outcomes Research, Minneapolis VA Health Care System) Holliday J (HSR&D Center for Innovation to Implementation, Palo Alto VA Healthcare System) Reddy K (Integrative Health Coordinating Center, VA Office of Patient-Centered Care and Cultural Transformation) Drake D (Interventional Pain Clinic, Hunter Holmes McGuire VA Medical Center) Federman DG (Dept. of Medicine, VA Connecticut Healthcare System) Kligler B (Integrative Health Coordinating Center, VA Office of Patient-Centered Care and Cultural Transformation)
Given the opioid epidemic, the VA is examining and supporting the implementation of non-pharmacological pain management options. One example is Battlefield Acupuncture (BFA), a rapid protocol-based, five-needle, auricular acupuncture therapy that can be administered by most clinician types. It is intended as complementary treatment for chronic pain and was very recently was shown to provide some immediate pain relief. The VA trained over 2,400 clinicians since 2016 to deliver BFA, however, no one has examined the VA's implementation of BFA. As such, we conducted the first evaluation on BFA's implementation.
We conducted 20-40 minute phone interviews with 62 BFA providers at 55 VA medical centers in diverse locations (region of the country, urban/rural setting) and representing a variety of clinical provider types. Using the i-PARIHS implementation framework, we developed a semi-structured interview guide to elicit information on BFA implementation facilitators and barriers, successful strategies to overcome those barriers, and provider perceptions of BFA. We analyzed verbatim transcripts using a method of constant comparison and produced mutually agreed upon saturated themes.
Providers reported multiple BFA implementation challenges: gap between BFA training and practice, resource limitations, low provider self-efficacy, and negative provider beliefs about BFA effectiveness. Strategies used to overcome implementation challenges included: dedicating specific personnel to deliver BFA, incorporating BFA into existing mental health and/or pain clinics, addressing high patient demand with process changes, facilitating provider buy-in, and boosting self-efficacy through practice. Providers reported that having something (BFA) that relieves pain in real-time can facilitate trust, patient-provider communication about pain, and patient openness to other try other therapies and reduce opioid dose. Providers also reported that BFA can be painful for some and the benefits may not last long, but that BFA is easy to deliver and low-risk for patients.
As a promising, innovative non-pharmacological approach to pain management, BFA faces many implementation challenges that other innovative clinical innovations face. However, some implementation issues appear unique to BFA.
Strategies to facilitate decreased opioid use societally while still addressing patient pain concerns are sorely needed. As BFA is easy to deliver, is low-risk and has clinical and relational utility, efforts to reduce implementation barriers are warranted.