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Access to Pain Care From Compensation Clinics: A Relational Coordination Perspective.

Rosen MI, Martino S, Sellinger J, Lazar CM, Fenton BT, Mattocks K. Access to Pain Care From Compensation Clinics: A Relational Coordination Perspective. Federal practitioner : for the health care professionals of the VA, DoD, and PHS. 2020 Jul 1; 37(7):336-342.

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Background: The Compensation and Pension (CandP) determination process is a potential gateway to accessing pain treatment in the Veterans Health Administration (VHA). However, attitudes about CandP as a gateway and about collaboration with CandP clinics among VHA staff are unknown. Methods: In preparation for an initiative to link veterans seeking compensation for musculoskeletal disorders to treatment, clinical and administrative staff from the 8 VHA medical centers in New England were invited to complete a relational coordination survey that examined how different workgroups collaborate (communication and relationships) to provide pain care to veterans. A subset of those staff also participated in a semistructured interview about pain treatment referral practices within their medical centers. VHA staff were from primary care, administration, pain management, and CandP teams. Results: Eighty-three VHA staff were invited to complete the relational coordination survey; 66 completed the survey and 39 participated in the semistructured interview. Most CandP staff interviewed thought of the compensation examination as a forensic process and that CandP-based efforts to engage veterans might interfere with the examination or were not their responsibility. However, some examiners described their efforts to determine new veterans'' eligibility for VHA care and to connect them to specific treatments. VHA staff reported that there was little communication between the CandP team and other teams. The survey results supported this finding. The CandP group''s relational coordination composite scores were lower than any other workgroup. Conclusion: Outreach to veterans at New England CandP clinics was inconsistent, and CandP teams rated low on a measure of coordination with workgroups involved in pain treatment. Compensation examinations appear to be underused opportunities to help veterans access treatment. CandP-based treatment engagement is feasible; it is being done by some Compensation teams.

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