Patient Experiences With Integrated Pain Care: A Qualitative Evaluation of One VA’s Biopsychosocial Approach to Chronic Pain Treatment and Opioid Safety

Abstract

Background Mounting concern about the risks and limited effectiveness of opioid therapy for chronic pain has spurred the implementation of novel integrated biopsychosocial pain care models in health-care systems like the Department of Veterans Affairs (VA). However, little is known about patient experiences with these new care models. Objective We conducted a qualitative study to examine patient experiences with a pain care model currently being disseminated at the VA: interdisciplinary, integrated pain teams (IPTs) embedded in primary care. Method We interviewed 41 veterans who received care from VA’s first IPT to learn how working with the team impacted their pain care and quality of life. We asked about their overall experience with IPT, what worked and did not work for them, and what changes they would recommend to improve IPT care. Results The interviews revealed a wide spectrum of patient experiences and varying perspectives on the extent to which the new model improved their pain and quality of life. Thematic analysis shed light on factors impacting patients’ experiences, including pretreatment goals and expectations as well as attitudes toward opioids and nonpharmacological treatments. Conclusion We discuss the implications of our findings for national efforts to implement biopsychosocial pain care, and we offer recommendations to promote patient-centered implementation.

What do patients experience? Interprofessional collaborative practice for chronic conditions in primary care: an integrative review

“…Across studies there was a total of n = 3803 participants, including patients, informal carers and family members. Studies were mostly conducted in the USA ( n = 13) [ 29 , 40 , 42 , 44 , 54 , 55 , 59 , 61 , 65 , 67 – 69 , 72 ], Australia ( n = 11) [ 26 – 28 , 30 , 34 , 36 , 41 , 52 , 57 , 63 , 66 ], UK ( n = 7) [ 31 , 39 , 46 – 48 , 53 , 60 ], Sweden ( n = 4) [ 38 , 49 – 51 ], Canada ( n = 3) [ 32 , 35 , 45 ] and The Netherlands ( n = 2) [ 9 , 64 ] with one study undertaken each in Belgium [ 62 ], Italy [ 71 ], France [ 33 ], New Zealand [ 43 ], Norway [ 58 ], Qatar [ 56 ] and, Spain [ 70 ], and one study conducted across multiple European countries [ 37 ]. Key characteristics of included studies are outlined in Additional file 3 .…”

How VA Whole Health Coaching Can Impact Veterans’ Health and Quality of Life: A Mixed-Methods Pilot Program Evaluation

“…Interviews were guided by a set of original questions informed by qualitative interview instruments previously used to evaluate local clinical program implementation and effectiveness for quality improvement. 25 , 26 Topics covered included program experience, impact, and satisfaction, with probes to elicit feedback on health goals, goal attainment progress, the coaching relationship, and program improvement suggestions. Interviews lasted 30–60 minutes.…”

Qualitative analysis of long-term chronic pain program management outcomes: Veterans and civilians

“…4 Studies identifed the beneft of interdisciplinary programs through qualitative analysis methods for patients with chronic pain in general and Veterans in particular. [5][6][7][8][9] Hapidou and Horst conducted an inductive thematic analysis of 50 patient comments collected from two measures at discharge from a fourweek interdisciplinary program: 5 Self-Evaluation Scale (SES) and Pain Program Satisfaction Questionnaire (PPSQ). 10,11 Six themes emerged: impact of a strong interdisciplinary team, learning to adapt to manage pain, the program as a stepping stone, positive efects of a group efort, improved mental health, and benefts of the program.…”