Preliminary Outcomes from an Intensive Multidisciplinary Pain Program in a Veteran’s Administration Hospital: A Pilot Study
Abstract: Chronic pain is a leading cause of lost productivity, disability payments, and health care utilization among the Veteran population. As such, there is interest in chronic pain treatments that address not only physical functioning and pain, but also psychological functioning and pain-related beliefs. One such treatment that has been explored is multidisciplinary team treatments. This pilot study aimed to determine whether a multidisciplinary treatment program for chronic pain would be effective in a sample of primarily rural-based Veterans. Seventy Veterans completed multidisciplinary chronic pain treatment, which consisted of 3–5 hours of pain related services per week for twelve weeks with providers from seven different disciplines. Veterans took standardized pre- and post-test measures of functioning, pain, pain-related beliefs, and mood. The program was highly acceptable and feasible to both Veterans and medical providers. Participants reported statistically significant improvements in average pain level following the intervention and improvements in pain related beliefs, pain-related catastrophizing, pain-related self-efficacy, mood symptoms and increased activity engagement. The program was highly acceptable to participants and feasible to a rural VA medical center, as evidenced by high completion rates. Future research is needed for cost-benefit analysis of the multidisciplinary program compared to less time-intensive pain related services (e.g. CBT-CP), post-intervention pain-related health care utilization, and the role of pain-related beliefs in treatment outcomes.
Abstract: Introduction: Persistent inequities exist in obstetric and neonatal outcomes in military families despite universal health care coverage. Though the exact underlying cause has not been identified, social determinants of health may uniquely impact military families. The purpose of this study was to qualitatively investigate the potential impact of social determinants of health and the lived experiences of military individuals seeking maternity care in the Military Health System. Materials and methods: This was an Institutional Review Board-approved protocol. Nine providers conducted 31 semi-structured interviews with individuals who delivered within the last 5 years in the direct or purchased care market. Participants were recruited through social media blasts and clinic flyers with both maximum variation and homogenous sampling to ensure participation of diverse individuals. Data were coded and themes were identified using inductive qualitative research methods. Results: Three main themes were identified: Requirements of Military Life (with subthemes of pregnancy notification and privacy during care, role of pregnancy instructions and policies, and role of command support), Sociocultural Aspects of the Military Experience (with subthemes of pregnancy as a burden on colleagues and a career detractor, postpartum adjustment, balancing personal and professional requirements, pregnancy timing and parenting challenges, and importance of friendship and camaraderie in pregnancy), and Navigating the Healthcare Experience (including subthemes of transfer between military and civilian care and TRICARE challenges, perception of military care as inferior to civilian, and remote duty stations and international care). Conclusions: The unique stressors of military life act synergistically with the existing health care challenges, presenting opportunities for improvements in care. Such opportunities may include increased consistency of policies across services and commands. Increased access to group prenatal care and support groups, and increased assistance with navigating the health care system to improve care transitions were frequently requested changes by participants.