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SDR 14-204 – HSR&D Study

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SDR 14-204
WRIISC as a Model of Care for Chronic Multisymptom Illness
Lisa Marie McAndrew PhD
East Orange Campus of the VA New Jersey Health Care System, East Orange, NJ
East Orange, NJ
Funding Period: March 2016 - February 2020

BACKGROUND/RATIONALE:
Gulf War Veterans (GWVs) with Chronic Multisymptom Illness (CMI) experience levels of disability as severe as other major medical illnesses. Beliefs about their condition (illness perceptions) account for 33% of variability in disability levels among GWVs with CMI's, and may be the most important determinant of health outcomes. This is because patients use their illness perceptions (e.g., "my CMI is improved by staying active") to guide their management (e.g., increase physical activity). What is not known is how providers should address illness perceptions. Previously attempted interventions to change GWVs with CMI's "maladaptive" illness perceptions have generally suffered from poor adherence or low efficacy. An alternative approach is to acknowledge that while providers are experts in medical science, patients are experts in their health experience. Both sets of expertise are needed to improve the care for the individual. Thus, GWVs with CMI and their providers need to develop aligned or concordant illness perceptions. This approach is consistent with the approach used at the VA's War Related Illness and Injury Study Center (WRIISC), a specialized clinic for deployed Veterans with CMI. Over 97% of Veterans seen at the WRIISC are satisfied with their care. We need to know if concordant illness perceptions explain this high satisfaction rate and ultimately improve adherence to recommendations for future healthcare utilization, self-management, and lower disability.

OBJECTIVE(S):
AIM 1: Determine the relationship between degree of concordance in illness perceptions between providers and GWVs with CMI and outcomes over time.
H1: Encounters where there is a greater degree of concordance in illness perceptions (assessed through an observer rating system) will result in GWVs with CMI reporting better outcomes (greater satisfaction, greater adherence to provider recommendations for utilization, greater adherence to provider recommendations for self-management, and reduced disability) one week, three months and one year after the encounter.
H2: GWVs with CMI who perceive greater concordance in illness perceptions (assessed immediately after the encounter by the Illness Concordance Scale) will report better health outcomes (defined in H1) one week, three months and one year after the encounter.
AIM 2: Compare the impact of concordance in illness perceptions on health-related outcomes in WRIISC vs. PCP encounters.
H3: WRIISC providers will spend a greater proportion of their encounters eliciting and addressing illness perceptions (assessed through an observer rating system) than VHA PCPs.
H4: Patients seen at the WRIISC will perceive more concordant illness perceptions and better health outcomes (defined in H1) one week, three months and one year after the encounter than patients seen by a PCP only.
AIM 3: Use qualitative analysis of interviews with GWVs with CMI and qualitative analysis of patient-provider encounters to identify the communication practices and other factors that contribute to concordance in illness perceptions.

METHODS:
We will conduct an observational prospective study to examine the relationship between degree of concordance in illness perceptions between GWVs with CMI and providers and health outcomes. We will audio record the clinical encounters of 100 GWVs with CMI seen at the WRIISCs, and 100 GWVs with CMI seen by VHA Primary Care Physicians. We will measure patients' perceived concordance of illness perceptions with an observer rating system and by using the Illness Concordance Questionnaire. Health outcomes will be measured one week, three months and one year after the encounter. We will conduct qualitative interviews with 30 of the GWVs with CMI.

FINDINGS/RESULTS:
No results yet

IMPACT:
If concordant illness perceptions are prospectively associated with improved health outcomes for GWVs with CMI, the ability to achieve concordant illness perceptions could be targeted as an important competency of providers.

PUBLICATIONS:

Journal Articles

  1. Avery T, Blasey C, Rosen C, Bayley P. Psychological Flexibility and Set-Shifting Among Veterans Participating in a Yoga Program: A Pilot Study. Military medicine. 2018 Nov 1; 183(11-12):e359-e363.
  2. Mathersul DC, Mahoney LA, Bayley PJ. Tele-yoga for Chronic Pain: Current Status and Future Directions. Global advances in health and medicine. 2018 Apr 2; 7:2164956118766011.
  3. Frank L, Wesson Ashford J, Bayley PJ, Borson S, Buschke H, Cohen D, Cummings JL, Davies P, Dean M, Finkel SI, Hyer L, Perry G, Powers RE, Schmitt F. Genetic Risk of Alzheimer's Disease: Three Wishes Now That the Genie is Out of the Bottle. Journal of Alzheimer's Disease : Jad. 2018 Jan 1; 66(2):421-423.
  4. Schulz-Heik RJ, Meyer H, Mahoney L, Stanton MV, Cho RH, Moore-Downing DP, Avery TJ, Lazzeroni LC, Varni JM, Collery LM, Bayley PJ. Results from a clinical yoga program for veterans: yoga via telehealth provides comparable satisfaction and health improvements to in-person yoga. BMC complementary and alternative medicine. 2017 Apr 4; 17(1):198.
  5. Liu Y, Lin W, Liu C, Luo Y, Wu J, Bayley PJ, Qin S. Memory consolidation reconfigures neural pathways involved in the suppression of emotional memories. Nature communications. 2016 Nov 29; 7:13375.


DRA: Military and Environmental Exposures, Health Systems
DRE: none
Keywords: Gulf War, Gulf War Illness
MeSH Terms: none