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Implementing Complementary and Integrative Health in the VA

Taylor SL, Bolton R, Huynh AK, Dvorin K. Implementing Complementary and Integrative Health in the VA. Poster session presented at: National Institutes of Health / AcademyHealth Conference on the Science of Dissemination and Implementation; 2015 Dec 14; Washington, DC.


Background: Complementary and integrative health (CIH, formerly "CAM") refers to things such as yoga, meditation, and acupuncture. Patients use CIH to supplement or replace standard medical treatment for pain, mental health issues, or other conditions. Providing CIH is a recent national priority at the Veterans Administration (VA), the nation's largest healthcare system. However, little is known about the facilitators and challenges the VA faces with CIH implementation, information that is necessary to spread CIH throughout the VA and potentially useful to other healthcare organizations offering CIH. Methods: We conducted in-person semi-structured interviews with 122 stakeholders at 8 VA medical centers during two-day site visits between February-August 2015. We selected sites based on their having implemented 3+ types of CIH at least a year prior. Sites varied in their geographic location, rural/urban status, and facility size. Stakeholders included executive leadership, CIH-relevant department chairs and their providers, CIH practitioners, and CIH program leaders. We based the interview guide on Greenhalgh's Model of Diffusion in Service Organizations and our prior knowledge of VA CIH implementation issues. Findings: Common organizational-level implementation facilitators included: framing CIH as being an alternative to opioids; aligning CIH with primary care; organizing the individual types of CIH into one program instead of individually integrating them into departments; and having funding, supportive leadership, and an organizational culture receptive to CIH. Common challenges included excessive fear of CIH-related liability, and lack of appropriate space to deliver CIH. Staff-level facilitators included having CIH program managers who were MDs (to counter CIH skepticism faced by medical leadership and department chairs), and hiring staff with scopes of practice that include movement therapy (e.g. recreational therapists). Challenges include provider skepticism toward CIH, CIH practitioners' lack of time and lack of a CIH program coordinator/planner. Patient-level facilitators included patient demand and CIH-users talking with other patients, while challenges included patient skepticism. Implications for DandI Research: We identified implementation challenges and facilitators that other healthcare settings might face in implementing CIH, some of which are more commonly seen in implementation studies while others seemed particular to novel practices having a mixed evidence base, such as CIH.

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