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2023 HSR&D/QUERI National Conference Abstract

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1168 — Applications of the Consolidated Framework for Implementation Research

Lead/Presenter: Katharine Bloeser,  The War Related Illness and Injury Study Center at the VA New Jersey Health Care System
All Authors: Bloeser KJ (The War Related Illness and Injury Study Center at The VA New Jersey Health Care System), Kimber, J (Department of Educational and Counseling Psychology the State University of New York at Albany) Santos, SL (The War Related Illness and Injury Study Center at The VA New Jersey Health Care System) Krupka, CB (The VA New York Harbor Health Care System, Brooklyn, NY) McAndrew, LM (The War Related Illness and Injury Study Center at The VA New Jersey Health Care System)

Objectives:
Every healthcare system must address the specialty needs of populations they serve (e.g., sexual and gender minorities, older adults), but are often unsuccessful. The needs of distinct populations go overlooked for many reasons—lack of provider knowledge, leadership does not feel concerns warrant special attention, or failure of policy makers to note their significance. Environmental exposures, such as toxic substances (e.g., Agent Orange) and airborne hazards (e.g., sand, dust, particulate matter), are central to the healthcare needs of Veterans. Despite efforts to educate and train medical, behavioral health, and dedicated on-site champions in the form of environmental health clinicians, research demonstrates that Veterans do not receive adequate interdisciplinary care for environmental exposure concerns. We conducted an operational needs assessment of providers to examine educational needs regarding Veterans’ environmental exposure concerns.

Methods:
We surveyed 2,775 Veterans Health Administration (VHA) medical and behavioral health providers. Our assessment was informed by the Consolidated Framework for Implementation Research (CFIR) and assessed barriers and facilitators to the uptake and application of knowledge regarding interdisciplinary care for environmental exposure concerns. We used a point-in-time survey to assess CFIR domains among VHA providers. The survey was emailed to providers across the country representing a variety of disciplines and practice settings to reflect the interdisciplinary approach to care for environmental exposures.

Results:
Medical and behavioral health providers in VHA report low knowledge of environmental exposures and related conditions. While VHA providers were motivated to learn more, they did not perceive a facility-level culture that supported care for environmental exposures. Less than half of medical and behavioral health providers have ever discussed key environmental exposures with a Veteran and the majority of VHA medical and behavioral health clinicians report low to no knowledge of environmental exposure concerns. We find 88% of medical and 91% of behavioral health providers report they are ready to learn more about environmental exposures while half of medical and behavioral health providers report they have access to information on environmental exposures. Results of a multivariate model suggest interdisciplinary providers’ knowledge of and discussion with Veterans about environmental exposures are influenced by contextual factors at the organizational level.

Implications:
Healthcare systems need policies and procedures for delivering care to special populations. Despite being common and pervasive among Veterans, environmental exposures are largely overlooked by healthcare providers. Our findings point to the importance of individual-level factors and organizational culture when supporting interdisciplinary care for environmental exposures.

Impacts:
Veterans are frustrated by lack of provider knowledge of environmental exposure concerns. With the passage of the PACT Act, Congress will require training in and improved monitoring of environmental exposures among Veterans. Implementation science can help us to better plan for successful implementation of this call to improve care for environmental exposure concerns.