The implementation of a pain navigator program in the department of Veterans Affairs' (VA) health care systems: a cluster randomized pragmatic clinical trial.

OBJECTIVE: This manuscript describes the uptake of the AIM-Back Pain Navigator Pathway (PNP) designed to encourage use of non-pharmacologic care options within the Veterans Health Administration (VHA). DESIGN: This manuscript describes the implementation of a telehealth intervention from one arm of a multisite, embedded, cluster-randomized pragmatic trial comparing the effectiveness of two novel clinical care pathways that provide access to non-pharmacologic care for Veterans with low back pain (LBP). SETTING: Ten VHA clinics. SUBJECTS: 19 pain navigators, >200 primary care physicians, and over 1000 Veterans were involved in the PNP implementation. METHODS: Data were generated within the VHA electronic health record (EHR) for the ongoing AIM-Back trial to describe PNP implementation for system-level findings in terms of number of visits, and type of care received. RESULTS: Over a 3-year period, 9 of 10 clinics implemented the PNP within the context of the AIM-Back trial. The most frequent care recommended in the PNP included physical therapy, chiropractic, acupuncture, and yoga/tai chi. During follow-up at six-weeks, ∼50% of Veterans elected to receive a different care choice than what was initially prescribed. Notable variation across clinics was documented for PNP based on time to initiation of care and follow-up rates. CONCLUSIONS: Implementation of the telehealth delivered PNP provides a nuanced understanding of the introduction of novel care programs within diverse clinical settings. These findings are most applicable to care programs that are delivered remotely and involve facilitation of existing care options.

Duke Scholars

Author Trevor A. Lentz Orthopaedic Surgery

Author Cynthia Jan Coffman Biostatistics & Bioinformatics, Division of Biostatistics

Author Chad E. Cook Orthopaedic Surgery, Physical Therapy

Author Steven Zachary George Orthopaedic Surgery

Author Susan Nicole Hastings Medicine, Geriatrics and Palliative Care