Incorporating Patient and Provider Voices into the Veterans Pain Care Organizational Improvement Comparative...

Area of Science:

• Health Services Research
• Implementation Science
• Comparative Effectiveness Research

Background:

• Limited evidence exists for managing pain while reducing opioid use.
• The Veterans Pain Care Organizational Improvement Comparative Effectiveness (VOICE) trial compared interdisciplinary pain teams (IPT) and pharmacist collaborative management (PCM).

Purpose of the Study:

• To conduct a qualitative process evaluation alongside the VOICE trial.
• To inform future implementation and sustainability efforts for pain management interventions.

Main Methods:

• Utilized ethnographic observations and semi-structured interviews.
• Included study staff, clinicians, clinical champions, and patients from 10 VHA facilities.
• Applied the Practical Implementation Sustainability Model (PRISM) and mapped themes to RE-AIM outcomes.

Main Results:

• Successful adoption depended on leadership support, environmental scanning, and clinical champions.
• Implementation success factors included training, patient involvement, team responsiveness, and intervention intensity.
• Maintenance was facilitated by sustained leadership, dedicated positions, and standardized procedures.

Conclusions:

• Identified strategies to support the successful implementation and sustainment of IPT and PCM interventions.
• Implementation considerations are crucial for VHA sites selecting interventions.
• Both interventions demonstrated similar effectiveness in improving pain and reducing opioid dosage in the VOICE trial.