Barriers to and Facilitators of Multimodal Chronic Pain Care for Veterans: A National Qualitative Study.
OBJECTIVE
Chronic pain is more common among veterans than among the general population. Expert guidelines recommend multimodal chronic pain care. However, there is substantial variation in the availability and utilization of treatment modalities in the Veterans Health Administration. We explored health care providers' and administrators' perspectives on the barriers to and facilitators of multimodal chronic pain care in the Veterans Health Administration to understand variation in the use of multimodal pain treatment modalities.


METHODS
We conducted semi-structured qualitative interviews with health care providers and administrators at a national sample of Veterans Health Administration facilities that were classified as either early or late adopters of multimodal chronic pain care according to their utilization of nine pain-related treatments. Interviews were conducted by telephone, recorded, and transcribed verbatim. Transcripts were coded and analyzed through the use of team-based inductive and deductive content analysis.


RESULTS
We interviewed 49 participants from 25 facilities from April through September of 2017. We identified three themes. First, the Veterans Health Administration's integrated health care system is both an asset and a challenge for multimodal chronic pain care. Second, participants discussed a temporal shift from managing chronic pain with opioids to multimodal treatment. Third, primary care teams face competing pressures from expert guidelines, facility leadership, and patients. Early- and late-adopting sites differed in perceived resource availability.


CONCLUSIONS
Health care providers often perceive inadequate support and resources to provide multimodal chronic pain management. Efforts to improve chronic pain management should address both organizational and patient-level challenges, including primary care provider panel sizes, accessibility of training for primary care teams, leadership support for multimodal pain care, and availability of multidisciplinary pain management resources.
['Leonard|Chelsea|C|', 'Ayele|Roman|R|', 'Ladebue|Amy|A|', 'McCreight|Marina|M|', 'Nolan|Charlotte|C|', 'Sandbrink|Friedhelm|F|', 'Frank|Joseph W|JW|']
D059350:Chronic Pain D006801:Humans D036301:Qualitative Research D014481:United States D014493:United States Department of Veterans Affairs D014728:Veterans D058014:Veterans Health
Chronic Pain Veterans Health Administration Medical Decision-Making Patient-Centered Care Qualitative Research