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Browsing by Author "Becker, William C."
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Item Mixed methods formative evaluation of a collaborative care program to decrease risky opioid prescribing and increase non-pharmacologic approaches to pain management(Elsevier, 2018) Becker, William C.; Mattocks, Kristin M.; Frank, Joseph W.; Bair, Matthew J.; Jankowski, Rebecca L.; Kerns, Robert D.; Painter, Jacob T.; Fenton, Brenda T.; Midboe, Amanda M.; Martino, Steve; Medicine, School of MedicineIntroduction Opioid prescribing and subsequent rates of serious harms have dramatically increased in the past two decades, yet there are still significant barriers to reduction of risky opioid regimens. This formative evaluation utilized a mixed-methods approach to identify barriers and factors that may facilitate the successful implementation of Primary Care-Integrated Pain Support (PIPS), a clinical program designed to support the reduction of risky opioid regimens while increasing the uptake of non-pharmacologic treatment modalities. Methods Eighteen Department of Veterans Affairs (VA) employees across three sites completed a survey consisting of the Organizational Readiness for Implementing Change (ORIC) scale; a subset of these individuals (n = 9) then completed a semi-structured qualitative phone interview regarding implementing PIPS within the VA. ORIC results were analyzed using descriptive statistics while interview transcripts were coded and sorted according to qualitative themes. Results Quantitative analysis based on ORIC indicated high levels of organizational readiness to implement PIPS. Interview analysis revealed several salient themes: system-level barriers such as tension among various pain management providers; patient-level barriers such as perception of support and tension between patient and provider; and facilitating factors of PIPS, such as the importance of the clinical pharmacist role. Conclusions While organizational readiness for implementing PIPS appears high, modifications to our implementation facilitation strategy (e.g., establishing clinical pharmacists as champions; marketing PIPS to leadership as a way to improve VA opioid safety metrics) may improve capacity of the sites to implement PIPS successfully.Item Pain Management for Primary Care Providers: A Narrative Review of High-Impact Studies, 2014-2016(Oxford University Press, 2018-01-01) Becker, William C.; Bair, Matthew J.; Picchioni, Michael; Starrels, Joanna L.; Frank, Joseph W.; Medicine, School of MedicineObjective: This manuscript reviews high-impact, peer-reviewed studies published from January 2014 to March 2016 that are relevant to pain management in primary care. Given the recent release of the US Centers for Disease Control and Prevention's "Guideline for Prescribing Opioids for Chronic Pain" emphasizing the primacy of nonopioid treatment, we focused our review on nonopioid pain management. Design: Narrative review of peer-reviewed literature. Methods: We searched three article summary services and queried expert contacts for high-impact, English-language studies related to the management of pain in adults in primary care. All authors reviewed 142 study titles to arrive at group consensus on article content domains. Within article domains, individual authors selected studies approved by the larger group according to their impact on primary care clinical practice, policy, and research, as well as quality of the study methods. Through iterative discussion, 12 articles were selected for detailed review, discussion, and presentation in this narrative review. Results: We present key articles addressing each of six domains of pain management: pharmacotherapy for acute pain; interventional treatments; medical cannabis; complementary and integrative medicine; care management in chronic pain; and prevention. Within each section, we conclude with implications for pain management in primary care. Conclusions: There is growing evidence for multiple nonopioid treatment modalities available to clinicians for the management of pain in primary care. The dissemination and implementation of these studies, including innovative care management interventions, warrant additional study and support from clinicians, educators, and policy-makers.Item Racial and Ethnic Differences in Total Knee Arthroplasty in the Veterans Affairs Health Care System, 2001-2013(Wiley, 2017-08) Hausmann, Leslie R.M.; Brandt, Cynthia A.; Carroll, Constance M.; Fenton, Brenda T.; Ibrahim, Said A.; Becker, William C.; Burgess, Diana J.; Wandner, Laura D.; Bair, Matthew J.; Goulet, Joseph L.; Medicine, School of MedicineOBJECTIVE: To examine black-white and Hispanic-white differences in total knee arthroplasty from 2001 to 2013 in a large cohort of patients diagnosed with osteoarthritis (OA) in the Veterans Affairs (VA) health care system. METHODS: Data were from the VA Musculoskeletal Disorders cohort, which includes data from electronic health records of more than 5.4 million veterans with musculoskeletal disorders diagnoses. We included white (non-Hispanic), black (non-Hispanic), and Hispanic (any race) veterans, age ≥50 years, with an OA diagnosis from 2001-2011 (n = 539,841). Veterans were followed from their first OA diagnosis until September 30, 2013. As a proxy for increased clinical severity, analyses were also conducted for a subsample restricted to those who saw an orthopedic or rheumatology specialist (n = 148,844). We used Cox proportional hazards regression to examine racial and ethnic differences in total knee arthroplasty by year of OA diagnosis, adjusting for age, sex, body mass index, physical and mental diagnoses, and pain intensity scores. RESULTS: We identified 12,087 total knee arthroplasty procedures in a sample of 473,170 white, 50,172 black, and 16,499 Hispanic veterans. In adjusted models examining black-white and Hispanic-white differences by year of OA diagnosis, total knee arthroplasty rates were lower for black than for white veterans diagnosed in all but 2 years. There were no Hispanic-white differences regardless of when diagnosis occurred. These patterns held in the specialty clinic subsample. CONCLUSION: Black-white differences in total knee arthroplasty appear to be persistent in the VA, even after controlling for potential clinical confounders.Item The Relationship Between Body Mass Index and Pain Intensity Among Veterans with Musculoskeletal Disorders: Findings from the MSD Cohort Study(Oxford University Press, 2020-10-01) Higgins, Diana M.; Buta, Eugenia; Heapy, Alicia A.; Driscoll, Mary A.; Kerns, Robert D.; Masheb, Robin; Becker, William C.; Hausmann, Leslie R.M.; Bair, Matthew J.; Wandner, Laura; Janke, E. Amy; Brandt, Cynthia A.; Goulet, Joseph L.; Medicine, School of MedicineObjective: To examine the relationship between body mass index (BMI) and pain intensity among veterans with musculoskeletal disorder diagnoses (MSDs; nontraumatic joint disorder; osteoarthritis; low back, back, and neck pain). Setting: Administrative and electronic health record data from the Veterans Health Administration (VHA). Subjects: A national cohort of US military veterans with MSDs in VHA care during 2001-2012 (N = 1,759,338). Methods: These cross-sectional data were analyzed using hurdle negative binomial models of pain intensity as a function of BMI, adjusted for comorbidities and demographics. Results: The sample had a mean age of 59.4, 95% were male, 77% were white/Non-Hispanic, 79% were overweight or obese, and 42% reported no pain at index MSD diagnosis. Overall, there was a J-shaped relationship between BMI and pain (nadir = 27 kg/m2), with the severely obese (BMI ≥ 40 kg/m2) being most likely to report any pain (OR vs normal weight = 1.23, 95% confidence interval = 1.21-1.26). The association between BMI and pain varied by MSD, with a stronger relationship in the osteoarthritis group and a less pronounced relationship in the back and low back pain groups. Conclusions: There was a high prevalence of overweight/obesity among veterans with MSD. High levels of BMI (>27 kg/m2) were associated with increased odds of pain, most markedly among veterans with osteoarthritis.