• Pain Med · Nov 2024

    Randomized Controlled Trial Multicenter Study Pragmatic Clinical Trial

    The implementation of a pain navigator program in the department of Veterans Affairs' (VA) health care systems: a cluster randomized pragmatic clinical trial.

    • Courtni France, Chad E Cook, Cynthia J Coffman, Christa Tumminello, Ashley Choate, Steven Z George, Trevor A Lentz, and Susan N Hastings.
    • Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veteran Affairs Medical Center, Durham, NC 27701, United States.
    • Pain Med. 2024 Nov 1; 25 (Supplement_1): S83S90S83-S90.

    ObjectiveThis manuscript describes the uptake of the AIM-Back Pain Navigator Pathway (PNP) designed to encourage use of non-pharmacologic care options within the Veterans Health Administration (VHA).DesignThis manuscript describes the implementation of a telehealth intervention from one arm of a multisite, embedded, cluster-randomized pragmatic trial comparing the effectiveness of two novel clinical care pathways that provide access to non-pharmacologic care for Veterans with low back pain (LBP).SettingTen VHA clinics.Subjects19 pain navigators, >200 primary care physicians, and over 1000 Veterans were involved in the PNP implementation.MethodsData were generated within the VHA electronic health record (EHR) for the ongoing AIM-Back trial to describe PNP implementation for system-level findings in terms of number of visits, and type of care received.ResultsOver a 3-year period, 9 of 10 clinics implemented the PNP within the context of the AIM-Back trial. The most frequent care recommended in the PNP included physical therapy, chiropractic, acupuncture, and yoga/tai chi. During follow-up at six-weeks, ∼50% of Veterans elected to receive a different care choice than what was initially prescribed. Notable variation across clinics was documented for PNP based on time to initiation of care and follow-up rates.ConclusionsImplementation of the telehealth delivered PNP provides a nuanced understanding of the introduction of novel care programs within diverse clinical settings. These findings are most applicable to care programs that are delivered remotely and involve facilitation of existing care options.© The Author(s) 2024. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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