1 Pain and Addiction Care: VA’S TRANSFORMATION & ITS IMPACT ON NON-VA CLINICIANS Charlotte Bailey, DPT Acknowledgements and Disclosures I do not have any financial relationships to disclose. I do not authorize commitments for government purchases. This presentation was prepared as an individual acting in a personal capacity. The opinions expressed in this continuing education session are the author's own and do not reflect the view of the Iowa City VA Health Care System, the Department of Veterans Affairs, or the United States government. Some graphs/graphics included here are elements provided through national VA resources including Pharmacy Benefits Management. One VA
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Pain and Addiction Care...pain-perpetuating comorbidities. Image of non-pharmacologic treatments from PBM Academic Detailing (2017)11 Understanding Complex Pain: Neurophysiology Education,
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Pain and Addiction Care: VA’S TRANSFORMATION & ITS IMPACT ON NON-VA
CLINICIANS
Charlotte Bailey, DPT
Acknowledgements and Disclosures
I do not have any financial relationships to disclose.
I do not authorize commitments for government purchases.
This presentation was prepared as an individual acting in a personal capacity. The opinions expressed in this continuing education session are the author's own and do not reflect the view of the Iowa City VA Health Care System, the Department of Veterans Affairs, or the United States government.
Some graphs/graphics included here are elements provided through national VA resources including Pharmacy Benefits Management.
One VA
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With Implementation of the Mission Act
High Risk Veterans have more options
to choose Care in the Community
Your Clinic/Health Care System may become their medical home.
You May Be Their Lifeline!
Veterans Crisis Line 1-800-273-8255 Press 1,
send a text message to 838255,
or chat online
Everything ChangedJune 2019
VHA Directive 2009-053
Stepped Care Update
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Supporting Primary CareWork as a team to address pain-perpetuating comorbidities.
Image of non-pharmacologic treatments from PBM Academic Detailing (2017)11
Understanding Complex Pain:Neurophysiology Education, Inter-professional Care Planning, and Multimodal Pain Treatments can help.
Paced rehabilitation activities to improve capacity for movement in the home and in the community.
Engaging in personal goal-setting, prioritizing and planning for a better quality of life.
Transition toward more effective and ACTIVE self-management of multiple health conditions including chronic pain.
Interdisciplinary Care:Complex Conditions rarely have Simple Solutions
Six Essential Elements of Good Pain Care
1. Educate Veterans/families to promote self-efficacy and shared decision
making; provide access to all relevant resources
2. Educate/train all team members to their discipline specific competencies,
including team based care
3. Develop and integrate non-pharmacological modalities into care plans
4. Institute evidence based medication prescribing, use of pain
procedures and safe opioid use (universal precautions)
5. Implement approaches for bringing the Veteran’s whole team together
such as virtual pain consulting (SCAN-ECHO, e-consults, tele-health,
clinical video tele-consultation and education) and for maintaining ongoing
communication between team members
6. Establish metrics to monitor pain care and outcomes at both the
individual level and the population level
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Explain Pain Supercharged
VA Whole Health
https://www.va.gov/patientcenteredcare/about.asp
US Military Model of Health
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It’s Complicated!
Treat Pain By (almost)Any Means Necessary
Image of non-pharmacologic treatments from PBM Academic Detailing (2017)
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Transforming VA Pain Care
• VA has taken strong steps to improve the quality of pain care for Veterans
• They have invested resources in moving toward multimodal evidence-based care– Expanded access to interdisciplinary care teams
– Increased availability of integrative health services and non-pharmacologic therapies
– Developed resources for clinicians with a major emphasis on opioid safety
• For Health Care Systems– To improve patient satisfaction
– Preventing harm with well-prepared teams
– Reduce unnecessary variation in care• Identify and treat patients with “red flags”
• Recognize and address “yellow flags”
• Better matched/stratified care reduces waste
• Standardizing best practices to improve outcomes
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Room To ImproveDistress is still driving prescribing & referralsImage from Seal (2012)
Transforming the Treatment of Chronic Pain: Moving Beyond Opioids;
VA Pharmacy Benefits Management
What’s NextCloser Looks at Suicide Risk, Addiction, and
Stepped Care for Opioid Use Disorder
• Almost 4 out of every 5 patients who died from overdose/suicide were prescribed doses < 90 MEDD• Almost 3 out of every 4 overdose/suicide deaths were among patients with MH/SUD diagnoses• More than 1 out of every 2 deaths were among patients with MH/SUD diagnoses prescribed < 90 MEDD
• VA REACH VET Initiative Helps Save Veterans Lives– Recovery Engagement and Coordination for Health –
Veterans Enhanced Treatment (REACH VET).
– Using a new predictive model, REACH VET analyzes existing data from Veterans’ health records to identify those at a statistically elevated risk for suicide, hospitalization, illness or other adverse outcomes.
• Veterans Crisis Line website: VeteransCrisisLine.net/BeThere