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Addressing Consumer and Patients' Preferences and Needs Whole Health System of Care Improves Health and Well-Being and Reduces Opioid Use for Veterans with Chronic Pain
Bokhour BG, Gelman H, Gaj L, Thomas E, Barker A, Whittington M, Douglas J, DeFaccio R, Taylor S, Zeliadt S. Addressing Consumer and Patients' Preferences and Needs Whole Health System of Care Improves Health and Well-Being and Reduces Opioid Use for Veterans with Chronic Pain. [Abstract]. Health services research. 2020 Aug 20; 55(51):7-8.
VHA is piloting the Whole Health System of Care (WHS) at 18 sites to shift care from a disease-focused "find-it, fix-it" model to one driven by patients' personal health goals, to foster patient self-management, and to improve well-being. As part of the Comprehensive Addiction and Recovery Act, VHA initiated a demonstration program in 18 VA Medical Centers to implement WHS. We report on its impact on Veterans.
A longitudinal survey of Veterans with chronic pain at the 18 flagship medical centers. Veterans were surveyed at baseline and 6 months using 12 patient-reported outcome measures. Outcomes were compared between Veterans who did not use WHS services and Veterans with different levels of WHS service use, using standardized mean differences/Cohen's D. We conducted a longitudinal cohort analysis of Veterans who started using WHS after April 2018. This analysis compared opioid dose levels using administrative pharmacy data (quarterly morphine equivalents) for the 6-month period before using WHS to opioid levels one year later. This analysis included Veterans from the same time periods who did not use WHS services.
Survey: a random sample of Veterans with chronic musculoskeletal pain at 18 VA medical centers; we report on 3622 patients who completed baseline and 6-month surveys (response rate: 49.3% baseline; 74.2% follow-up). Administrative cohort analysis: 112 202 Veterans with chronic pain who received continuous VA care between October 2017 and March 2019 and used > 2 WHS (without WHS services prior to April 2018) or no WHS throughout the evaluation period.
46% of survey respondents and 5.9% of the administrative cohort used > 2 WHS services. Effect sizes for survey measures were small overall; however, those who used WHS services reported greater improvements in perceptions of care, engagement in health care and self-care, life meaning and purpose, pain, and perceived stress. Opioid use among Veterans using WHS decreased 23% compared with 11% decrease among those with no WHS use.
WHS use, especially high levels of WHS use, was positively associated with improvements in several patient-reported health and well-being outcomes. While effect sizes were small for survey measures over this 6-month period, they are promising for the future impact of VHA's WHS initiative. Administrative data identified meaningful reductions in opioid use among WHS users.
Implications for Policy or Practice
The use of WHS services among Veterans with chronic pain has important implications for pain management, and Veteran health and well-being. Implementing a system of care that is designed to provide these services to patients presents an opportunity to radically change the way health care is delivered and impact patients' lives and not just fix their diseases