Patient Perspectives on Opioids: Views of Inpatient Veterans with Chronic Pain.

Objective: To elucidate perspectives on opioids and opioid use from hospitalized veterans with comorbid chronic pain using qualitative methods.

Design: This was an analysis of individual qualitative interviews. The semistructured interview guide was developed by a hospitalist with clinical expertise in pain treatment with guidance from a medical anthropologist.

Development of a Discrete Choice Experiment (DCE) Questionnaire to Understand Veterans' Preferences for Tobacco Treatment in Primary Care.

Background: Providers often prescribe counseling and/or medications for tobacco cessation without considering patients' treatment preferences.

Objective: The primary aims of this study are to describe (1) the development of a discrete choice experiment (DCE) questionnaire designed to identify the attributes and levels of tobacco treatment that are most important to veterans; and (2) the decision-making process in choosing between hypothetical tobacco treatments.

Methods: We recruited current smokers who were already scheduled for a primary care appointment within a single Veterans Affairs (VA) healthcare system.

Mixed-Methods Study of Uptake of the Extension for Community Health Outcomes (ECHO) Telemedicine Model for Rural Veterans With HIV.

Purpose: Extension for Community Health Outcomes (ECHO) is a provider-level telemedicine model successfully applied to hepatitis C care, but little is known about its application to Human Immunodeficiency Virus (HIV) care. We performed a mixed-methods evaluation of 3 HIV ECHO programs in the Veterans Health Administration, focusing on uptake by primary care clinics and veterans.

Methods: Administrative data were used to assess program uptake, including adoption (ie, proportion of primary care clinics participating) and reach (ie, proportion of eligible veterans participating).

"Let Me Get You a Nicotine Patch": Nurses' Perceptions of Implementing Smoking Cessation Guidelines for Hospitalized Veterans.

Many hospitalized smokers do not receive guideline-recommended tobacco treatment, but little is known about the perceptions of inpatient nurses with regard to tobacco treatment. We used a sequential explanatory mixed methods design to help explain the findings of an academic detailing intervention trial on the inpatient medicine units of four Veterans Affairs (VA) hospitals. We surveyed 164 nurses and conducted semistructured interviews in a purposeful sample of 33 nurses with different attitudes toward cessation counseling.

Gatekeepers as Care Providers: The Care Work of Patient-centered Medical Home Clerical Staff.

International implementation of the patient-centered medical home (PCMH) model for delivering primary care has dramatically increased in the last decade. A majority of research on PCMH's impact has emphasized the care provided by clinically trained staff. In this article, we report our ethnographic analysis of data collected from Department of Veterans Affairs staff implementing PACT, the VA version of PCMH.

Implications of the Patient-Centered Medical Home for Nursing Practice.

Objective: The experiences of RNs and licensed practical nurses (LPNs) implementing a patient-centered medical home (PCMH) in the Department of Veterans Affairs (VA) primary care clinics were examined to understand model implications for nursing practice and professional identity.

Background: National implementation of the PCMH model, called patient-aligned care teams (PACTs) in VA, emphasizes areas of nursing expertise, yet little is known about the effect of medical homes on the day-to-day work of nurses.

Methods: As part of a formative evaluation to identify barriers and facilitators to PACT implementation, we interviewed 18 nurses implementing PACT.

Implementing a patient centered medical home in the Veterans health administration: Perspectives of primary care providers.

Implementation of a patient centered medical home challenges primary care providers to change their scheduling practices to enhance patient access to care as well as to learn how to use performance metrics as part of a self-reflective practice redesign culture. As medical homes become more commonplace, health care administrators and primary care providers alike are eager to identify barriers to implementation. The objective of this study was to identify non-technological barriers to medical home implementation from the perspective of primary care providers.

Treating Dual-Use Patients Across Two Health Care Systems: A Qualitative Study.

Improved communication and increased education may enhance the experience and outcomes for veterans using multiple health care systems, according to this qualitative assessment of health care provider views.

Non-VA primary care providers' perspectives on comanagement for rural veterans.

Background: Many veterans utilize health care services within and outside of the Department of Veterans Affairs (VA). There are limited VA care coordination resources for non-VA primary care providers (PCPs), and the non-VA provider perspective on caring for veterans is underrepresented. The VA requires Patient Aligned Care Teams to coordinate care for veterans across health systems.

Unclaimed health care benefits: a mixed-method analysis of rural veterans.

Purpose: Rural areas contribute a disproportionate number of US military recruits compared to urban areas. However, few studies have examined why many rural veterans do not enroll in the Veterans Health Administration (VHA) for health care. Our objective was to elicit reasons rural veterans chose not to use VHA.

Perceptions of pharmacists' integration into patient-centered medical home teams.

Background: Patient-centered medical homes (PCMHs) are a newer paradigm of health care service delivery. Team-based care that includes pharmacists has been implemented in several countries. Subsequently studies have successfully identified challenges and barriers with team-based care.

Implementing smoking cessation guidelines for hospitalized veterans: effects on nurse attitudes and performance.

Background: A minority of hospitalized smokers actually receives assistance in quitting during hospitalization or cessation counseling following discharge. This study aims to determine the impact of a guideline-based intervention on 1) nurses' delivery of the 5A's (Ask-Advise-Assess-Assist-Arrange follow-up) in hospitalized smokers, and 2) nurses' attitudes toward the intervention.

Methods: We conducted a pre-post guideline implementation trial involving 205 hospitalized smokers on the inpatient medicine units at one US Department of Veterans Affairs (VA) medical center.