Perceptions of Providers and Administrators in the Veterans Health Administration Regarding Complementary and Alternative Medicine

Abstract

Background The integration of complementary and alternative medicine (CAM) therapies into a large organization such as the Veterans Health Administration (VHA) requires cultural change and deliberate planning to ensure feasibility and buy-in from staff and patients. Currently, there is limited knowledge of VHA patient care providers’ and administrators’ viewpoints regarding CAM therapies and their implementation. Objectives Our purpose was to qualitatively examine knowledge, attitudes, perceived value and perceived barriers and/or facilitators to CAM program implementation among VHA providers and administrators at a large VHA facility. Research design We are reporting the qualitative interview portion of a mixed-methods study. Subjects Twenty-eight participants (patient care providers or administrators) were purposely chosen to represent a spectrum of positions and services. Participants’ experience with and exposure to CAM therapies varied. Measures Individual interviews were conducted using a semi-structured format and were digitally recorded, transcribed, and coded for themes. Results Recurrent themes included: a range of knowledge about CAM; benefits for patients and staff; and factors that can be facilitators or barriers including evidence based practice or perceived lack thereof, prevailing culture, leadership at all levels, and lack of position descriptions for CAM therapists. Participants rated massage, meditation, acupuncture, and yoga as priorities for promotion across the VHA. Conclusions Despite perceived challenges, providers and administrators recognized the value of CAM and potential for expansion of CAM within the VHA. Interview results could inform the process of incorporating CAM into a plan for meeting VHA Strategic Goal One of personalized, proactive, patient-driven healthcare across the VHA.

Providers' and Administrators' Perceptions of Complementary and Integrative Health Practices Across the Veterans Health Administration

“…Therapies most often mentioned included massage, meditation, acupuncture, and yoga. 8 All of these findings were confirmed and extended by the second multisite phase of the study. Although some sites are functioning at a much higher level and providing many more CIH therapies than others, respondents from even the highperforming sites cited challenges involving limited time, space, funding, and staff training.…”

“…However, they are consistent with the findings from the first portion of the study at the authors' local site. 8 In addition, the sites in the currently reported portion of the study represent a variety of geographic locations and approaches to the use of CIH therapies within the VA. While these preliminary findings cannot be generalized, they suggest that there are significant barriers to the implementation of CIH therapies in VA settings.…”

“…The local respondents listed multiple facilitators of and barriers to the promotion of CIH. 8 Thus, the subsequent aim was to fill a gap in the literature by investigating whether the varying levels of familiarity with and biases concerning CIH therapies were unique to the authors' local institution or are found in providers and administrators throughout the VA. The findings from the interviews with personnel from the additional VAs are reported in this paper.…”

Pilot Study of Massage in Veterans with Knee Osteoarthritis

“…In one large-scale study (n = 401) conducted across five VA primary care clinics, 202 participants reported having sought massage for their chronic pain, and 387 participants (97%) reported willingness to try massage therapy; thus, massage was the most preferred of the complementary and alternative medicine modalities studied (massage therapy, chiropractic care, herbal medicines, and acupuncture). 18,19 A recent qualitative study of 28 patient care providers and administrators at a large VA facility rated massage as the top priority for promotion within the VA over 18 other modalities. 19 In this same study, although many participants saw lack of funding as a barrier to providing massage within the VA, others thought funding was available in response to a well-planned request.…”

“…18,19 A recent qualitative study of 28 patient care providers and administrators at a large VA facility rated massage as the top priority for promotion within the VA over 18 other modalities. 19 In this same study, although many participants saw lack of funding as a barrier to providing massage within the VA, others thought funding was available in response to a well-planned request.…”