Table 2.
Quotations (supporting evidence) for findings
| Finding | Representative quotation (Q) |
|---|---|
| Program dissemination: critical to inform decision to adopt | Q1. it would really be nice if they would offer a training or something … I’m not real familiar with TelePain…what they do and what they offer and how they would best fit in with our practices and how we could work together (PRE-IMPLEMENTATION_14) |
| Q2. If we try to do something … that requires primary care to do a lot of clicking or entering of consults, it’s not going to do anything but cause more burnout” (PRE-IMPLEMENTATION_18) | |
| Q3. With a lot of veterans … they feel that they don’t get enough information upfront, … they’re not told a lot of detail about the treatment that they’re undergoing in terms of managing pain and so it’s not until later on or maybe from someone else like a psychologist versus the prescriber that they’re receiving more detailed information and so that would be very helpful. (PRE-IMPLEMENTATION_012) | |
| Q4. Yeah, just thinking about like a handout or a video or some kind of format like that would be would be useful for patients.I would say if there’s an electronic type format because of all our waiting rooms you know have uh, have the TVs in them.. (PRE-IMPLEMENTATION_15) | |
| Q5. I like YouTube videos for patient education …[for] the younger guys its very helpful. You know they like everything electronic, they don’t like paper. And so, you have to customize it, you have to be able to do all of the above. (PRE-IMPLEMENTATION_17) | |
| Q6. maybe mail the patient something eductational once they get referred to TelePain. (PRE-IMPLEMENTATION_18) | |
| Decision to adopt informed by patient needs and preferences | Q7. … if we could offer some sort of alternative here.. through the TelePain services, it would be beneficial cause then they don’t have to travel all the way to [X], which is again you know 80 miles away and it kind of negates the treatment they get when they’re there by the… time they’re back home. (PRE-IMPLEMENTATION_24) |
| Q8. veterans…in our Whole Health type clinic that actually want to get off the opioids … their complaints are more the fact that we don’t have as many complementary services as they would like to see. (PRE-IMPLEMENTATION_15) | |
| Q9. even though we try to address pain with the standards of care, you really have to look at that person individually and come up with a plan of care that fits them. (PRE-IMPLEMENTATION_11) | |
| Q6. the veteran herself had done a lot of that [yoga and tai-chi] in the past and that got her really excited about how people who are trained in pain management are doing things that she cares about and loves so it just gave her some hope that there might be something out there. (POST-IMPLEMENTATION_10) | |
| Decision to adopt informed by challenges to patient participation | Q10. I have quite a few that just don’t feel comfortable with anything that is not face to face. There are some that have hearing issues …. It tends to be the older, especially more remote rural veterans that are less comfortable with technology in general but some are middle age mental health veterans who really just are creeped out I guess by the video chatting experience. (POST-IMPLEMENTATION_03) |
| Q11. this guy [veteran] said where he’s from, he’s in the woods, … he has no access to, no internet, no technology…basically the infrastructure, right? (PRE-IMPLEMENTATION_17) | |
| Decision to adopt informed by needs of individual spoke sites | Q12. I just saw the flyer … so it sounds like a good way for somebody to … have the time to go through what might work for a veteran and give some recommendations…But I’ll tell you that our primary care providers are overworked and overburdened and burned out. So if we try to do something … that requires primary care to do a lot of clicking or entering of consults, it’s not going to do anything but cause more burnout. (PRE-IMPLEMENTATION_18) |
| Q13. for our veterans that do have pain, integrate at least one visit where the TelePain provider [is] on the screen as well as their primary care provider and the veteran so that everybody can kind of be on the same page as to what is our goal, what are we trying to do. (PRE-IMPLEMENTATION_15) | |
| Q14. We don’t have, currently have an interdisciplinary team, which I think would be beneficial to the patients. We kind of have each provider addressing their own piece of it but that always doesn’t interpret into a cohesive plan. (PRE-IMPLEMENTATION_21) | |
| Importance of communication with champion and leadership | Q15. It's a must to have somebody locally build that relationship … as a long-term strategy. I think anytime that you can have a meeting between a champion and the actual staff to troubleshoot issues, I think it’s useful. I have found over the years that when we don’t communicate things…items just don’t get done or there’s information that’s miscommunicated or misconstrued and it ends up making the team not as productive. (PRE-IMPLEMENTATION_19) |
| Q16. There definitely needs to be a way for us [spoke site] to communicate to you guys [hub site] if a veteran has a complaint or an issue…or if we have a follow up meeting every quarter or…like somebody we can have as a contact person like a clinical champion if I have a problem, that’s easier than having a meeting. I mean, we can have a meeting but most of the clinicians aren’t going to have blocked out time to have a meeting. (PRE-IMPLEMENTATION_18) | |
| Clarifying roles | Q17. my patient at least was misconstruing what your [hub site] role was, she had thought that you were going to be talking with her primary physician about other pain options and then it didn’t seem like that happened, so I think all of it just ended up being some miscommunication on my part as well. So, I think I could have been more direct in asking what this program is, what are you doing, how are you helping, that sort of thing. (POST-IMPLEMENTATION_10) |
| Q18. … sometimes it would help to have that second opinion or maybe there’s something that we haven’t thought about or a treatment that we're not aware about because we don’t have a specialist here that would perform that procedure. (PRE-IMPLEMENTATION_21) | |
| Q19. I would want to call on uh TelePain if I had reached capacity or if there was some sort of intervention that I thought the, the Vet would really benefit from that I didn’t have the expertise to offer myself. (PRE-IMPLEMENTATION_26) | |
| Q20. Some more like direct education from the providers in the TelePain clinic on what they have available, what they do and the rationale for that and how it’s to refer patients and maybe just more regular interfacing with like our local leadership or stakeholders like PCMHI or the pain team here to coordinate any particularly like complicated veteran cases and things like that. So increasing that collaboration instead of having more primarily like a treatment referral service. (POST-IMPLEMENTATION_08) | |
| Consult Process | Q21. “they let the veteran know at the end of the visit the recommendations, … the recommendations would go in, even at real time. [At] The time of the appointment we had enough information to kind of change the course of therapy and it was a good positive change.” (POST-IMPLEMENTATION_09) |
| Clarifying Communication | Q22. I’d probably say more routine or formal feedback on the patients and their progress and corroboration in that regard. Cause I’ve had some patients that they went like initial intake appointment, and they weren’t sure if they wanted to follow up and kind of left it there…. (POST-IMPLEMENTATION_08) |
| Q23. The medical provider has different information than I [mental health specialist] have and so more of the team approach at least especially with pain because it’s you know, it has so many different dynamics to it, kind of that holistic approach where everybody’s looped in. (POST-IMPLEMENTATION_05) | |
| Implementation Success: Improving Perceived Access to Pain Care | Q24. “[TelePain]’s definitely a benefit and I would personally, I think, my [clinic] and colleagues would benefit knowing more about the program, and maybe just [be] reminded that [it] exists and what you all are able to offer, having some kind of handout to be able to give to the patient. (POST-IMPLEMENTATION_07) |
| Q25: “It’s improved access because even here locally, non-VA wise, we really don’t have any pain specialist…like we only have very few psychologists in our community and none of them are “pain.” You know that’s not their forte…so it’s definitely, I think improved access to pain care. (POST-IMPLEMENTATION_03) | |
| Q26: Oh definitely it [TelePain] feels like it opened it up. I think that overall our pain services feel like they’re a lot more robust than they were when I first started here and I suspect the other providers are working more collaboratively with the TelePain services cause it’s opened a lot of different options and services here at our facility, too…I don’t know if it is a result of partnering with TelePain, but it’s definitely been a really helpful resource for veterans who are not thrilled about trying these other nonmedication option. I think they always look for someone to vent about it too which I know that’s not what therapy is, but the thought of having that external support to get through it, I think is really beneficial, so it’s been good. (POST-IMPLEMENTATION_04) |