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2019 HSR&D/QUERI National Conference Abstract

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4021 — Provider Perspectives of Battlefield Acupuncture: Advantages, Disadvantages and Potential Role in Reducing Opioid Use for Pain

Lead/Presenter: Jesse Holliday,  COIN - Palo Alto
All Authors: Holliday J (VA Palo Alto Healthcare System, Center for Innovation to Implementation), Giannitrapani KF (VA Palo Alto Healthcare System, Center for Innovation to Implementation and Stanford University), ; Ackland P (Center for Chronic Disease and Outcomes Research, Minneapolis VA Health Care System, MN); Olson J (VA Central Iowa Heathcare System, IA); Kligler B (VA Office of Patient Centered Care and Cultural Transformation, NY); Taylor S(VA Greater Los Angeles Healthcare System and UCLA, Los Angeles, CA)

Objectives:
Battlefield Acupuncture (BFA) is an auricular needling protocol used to treat pain. We aimed to identify the advantages and disadvantages of BFA from the provider perspective.

Methods:
We rely on an inductive qualitative approach to explore provider perceptions through thematic analysis of semi-structured interviews with 43 BFA providers from 20 VA facilities.

Results:
Perceived advantages included: (1) BFA can simultaneously effectively control pain while reducing opioid use ("our clinic is trying hard to get our patients off narcotics and BFA is so helpful with that"); (2) BFA may alleviate pain that has been unsuccessfully treated by conventional methods (including medications and surgeries); (3) BFA gives providers a treatment option to offer patients with substance use disorder ("We have a lot of patients coming off of drugs who have SUD and they really need some relief but can't have opioids so we provide them with BFA instead"); (4) BFA helps build a trusting patient-provider relationship through camaraderie and touch ("One of the things that I've noticed with the BFA... having that extra time with the Veteran and getting close to them and touching them... is therapeutic"); (5) BFA can create the opportunity for hope ("It changes the conversation in the moment. It totally gets them out of their pain hole and allows them to see that there is hope"). Disadvantages included: (1) There are under-developed clinical guidelines on when to administer BFA; (2) BFA requires multiple continuous visits; (3) BFA can be uncomfortable; (4) BFA may not be an effective treatment option unless it can be provided "on demand"; and (5) BFA can promote euphoria, which can have deleterious consequences for patient self care.

Implications:
Providers perceive BFA to have many benefits, both clinical and relational, including ways in which it may have utility in addressing the current opioid crisis.

Impacts:
BFA is easy to deliver, low risk and has clinical and relational utility. Efforts to better understand effectiveness and develop clinical practice guidelines are warranted.