Tailored to Fit: How an Implementation Framework Can Support Pragmatic Pain Care Trial Adaptation for Diverse Veterans Affairs Clinical Settings

Overview

Journal Med Care

Specialty Health Services

Date 2020 Aug 23

PMID 32826776

Citations 3

Authors

Natalie Purcell

William C Becker

Kara A Zamora

Sarah L McGrath

Hildi J Hagedorn

Eva R Fabian

Nicole McCamish

Karen H Seal

Affiliations

Soon will be listed here.

Abstract

Background: Veterans Affairs (VA) has rolled out a holistic, multicomponent Whole Health care model nationwide, yet no pragmatic trials have been conducted in real-world clinical settings to compare its effectiveness against other evidence-based approaches for chronic pain management in veterans.

Objectives: We describe the adaptation of the first large pragmatic randomized controlled trial of the Whole Health model for chronic pain care for diverse VA clinical settings.

Research Design: Informed by the Promoting Action on Research Implementation in Health Systems implementation framework, we conducted qualitative semistructured interviews to obtain feedback on trial design from VA leadership, frontline clinicians, and veterans with chronic pain at 5 VA enrollment sites. Next, we convened in-person evidence-based quality improvement (EBQI) meetings with study stakeholders (including frontline clinicians and administrators) at each site to discuss study design; review interview themes; and identify site-specific barriers, facilitators, and approaches to implementation. Ethnographic observations from EBQI meetings provided additional insight into implementation strategies.

Subjects: Seventy-four veteran and VA staff stakeholders were interviewed; 71 stakeholders participated in EBQI meetings.

Results: At each site, unique clinical contexts and varying resources for Whole Health and pain care delivery affected plans for trial implementation. We present examples of local adaptations that emerged through the formative evaluation process to facilitate implementation and yield a more pragmatic trial design.

Conclusions: A systematic formative evaluation can facilitate engagement and buy-in of study stakeholders. Locally tailored pragmatic implementation strategies may improve the likelihood of successful trial execution as well as future implementation of evidence-based pain care approaches in real-world clinical settings.

Citing Articles

Natural Product Use Among Veterans with Chronic Pain: A Qualitative Study of Attitudes and Communication with Healthcare Providers.

Moore L, Woodruff N, Seal K, Feinberg T, Purcell N J Gen Intern Med. 2024; 39(12):2206-2214.

PMID: 38689119 PMC: 11347536. DOI: 10.1007/s11606-024-08746-2.

"Then COVID happened…": Veterans' Health, Wellbeing, and Engagement in Whole Health Care During the COVID-19 Pandemic.

Purcell N, Sells J, McGrath S, Mehlman H, Bertenthal D, Seal K Glob Adv Health Med. 2022; 10:21649561211053828.

PMID: 35174002 PMC: 8842446. DOI: 10.1177/21649561211053828.

Whole Health Options and Pain Education (wHOPE): A Pragmatic Trial Comparing Whole Health Team vs Primary Care Group Education to Promote Nonpharmacological Strategies to Improve Pain, Functioning, and Quality of Life in Veterans-Rationale, Methods,....

Seal K, Becker W, Murphy J, Purcell N, Denneson L, Morasco B Pain Med. 2020; 21(Suppl 2):S91-S99.

PMID: 33313734 PMC: 7825011. DOI: 10.1093/pm/pnaa366.

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