Pain Care in the Department of Veterans Affairs: Understanding How a Cultural Shift in Pain Care Impacts Provider Decisions and Collaboration.

摘要: Objective Over the past decade, Department of Veterans Affairs (VA) has experienced a sizeable shift in its approach to pain. The VA's 2009 Pain Management Directive introduced Stepped Care Model, which emphasizes an interdisciplinary pain management involving referrals and from primary specialty care providers. Additionally, Opioid Safety Initiative 2017 VA/Department Defense (DoD) clinical guidelines on opioid prescribing set new standard for reducing use VA. These shifts have led strategies that rely multidisciplinary teams nonpharmacologic treatments. goal this study was examine how cultural transformation impacted providers, degree VA providers are aware services at their facilities, perceptions collaboration across disciplines. Methods We conducted semistructured phone interviews with 39 clinicians care, mental health, pharmacy, physical therapy/rehabilitation eight Integrated Service Network medical centers New England. Results identified four major themes concerning approaches: 1) culture changed dramatically, greater focus approaches pain, though many "old school" continue prefer medication options; 2) most facilities sample no clear roadmap about treatment pathway follow, unaware what recommend when; 3) despite multiple options treatment, generally work together ensure veterans receive coordinated care; 4) veteran preferences may not align existing pathways. Conclusions shifted practices regarding management, emphasis options. proliferation requires stakeholders know choose among alternative