Browsing by Subject "Veteran"

Now showing 1 - 6 of 6
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    Complementary and integrative medicine perspectives among veteran patients and VHA healthcare providers for the treatment of headache disorders: a qualitative study
    (Springer, 2022-01-25) Kuruvilla, Deena E.; Lindsey, Hayley; Grinberg, Amy S.; Goldman, Roberta E.; Riley, Samantha; Baird, Sean; Fenton, Brenda T.; Sico, Jason J.; Damush , Teresa M.; Medicine, School of Medicine
    Objective To evaluate veteran patient and provider perceptions and preferences on complementary and integrative medicine (CIM) for headache management. Background The Veterans Health Administration (VHA) has spearheaded a Whole Health system of care focusing on CIM-based care for veteran patients. Less is known about patients’ and providers’ CIM perceptions and preferences for chronic headache management. Methods We conducted semi-structured interviews with 20 veteran patients diagnosed with headache and 43 clinical providers, across 12 VHA Headache Centers of Excellence (HCoE), from January 2019 to March 2020. We conducted thematic and case comparative analyses. Results Veteran patients and VHA clinical providers viewed CIM favorably for the treatment of chronic headache. Specific barriers to CIM approaches included: (1) A lack of personnel specialized in specific CIM approaches for timely access, and (2) variation in patient perceptions and responses to CIM treatment efficacy for headache management. Conclusion Veteran patients and VHA clinical providers in this study viewed CIM favorably as a safe addition to mainstream headache treatments. Advantages to CIM include favorable adverse effect profiles and patient autonomy over the treatment. By adding more CIM providers and resources throughout the VHA, CIM modalities may be recommended more routinely in the management of veterans with headache.
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    Learning to Apply Mindfulness to Pain (LAMP): Design for a Pragmatic Clinical Trial of Two Mindfulness-Based Interventions for Chronic Pain
    (Oxford Academic, 2020-12) Burgess, Diana J.; Evans, Roni; Allen, Kelli D.; Bangerter, Ann; Bronfort, Gert; Cross, Lee J.; Ferguson, John E.; Haley, Alex; Hagel Campbell, Emily M.; Mahaffey, Mallory R.; Matthias, Marianne S.; Meis, Laura A.; Polusny, Melissa A.; Serpa, J. Greg; Taylor, Stephanie L.; Taylor, Brent C.; Medicine, School of Medicine
    Background: Mindfulness-based interventions (MBIs) are evidence-based nonpharmacological treatments for treating chronic pain. However, the predominant MBI, mindfulness-based stress reduction, has features that pose significant implementation barriers. Objectives: This study will test two approaches to delivering MBIs for improving Veterans' chronic pain and mental health comorbidities. These two approaches address key implementation barriers. Methods: We will conduct a four-site, three-arm pragmatic randomized controlled trial, Learning to Apply Mindfulness to Pain (LAMP), to test the effectiveness of two MBIs at improving pain and mental health comorbidities. Mobile+Group LAMP consists of prerecorded modules presented by a mindfulness instructor that are viewed in an online group setting and interspersed with discussions led by a facilitator. Mobile LAMP consists of the same prerecorded modules but does not include a group component. We will test whether either of these MBIs will be more effective than usual care at improving chronic pain and whether the Mobile+Group LAMP will be more effective than Mobile LAMP at improving chronic pain. Comparisons for the primary hypotheses will be conducted with continuous outcomes (Brief Pain Inventory interference score) repeated at 10 weeks, 6 months, and 12 months. The secondary hypotheses are that Mobile+Group LAMP and Mobile LAMP will be more effective than usual care at improving secondary outcomes (e.g., post-traumatic stress disorder, depression). We will also confirm the comparisons for the primary and secondary hypotheses in gender-specific strata. Implications: This trial is expected to result in two approaches for delivering MBIs that will optimize engagement, adherence, and sustainability and be able to reach large numbers of Veterans.
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    Long-Term Assessment of Weight Loss Medications in a Veteran Population
    (MDedge, 2024) Rodriguez, Allison D.; Ifeachor, Amanda P.; Moore, Emily A.; Otte, Cassandra F.; Schopper, M. Joseph; Liangpunsakul, Suthat; Lteif, Amale A.; Medicine, School of Medicine
    Background: Overweight and obesity are common in the veteran population. Medical management with semaglutide, orlistat, liraglutide, phentermine, phentermine/topiramate, and naltrexone/bupropion is increasingly common. This study expands on a 2021 study and evaluates medication effectiveness. Methods: This single-center retrospective study analyzed patients prescribed weight loss medications at Veteran Health Indiana. Primary outcomes included body weight loss and total weight loss with each medication at 3, 6, 12, 24, 36, and 48 months. Secondary outcomes were also used to determine the efficacy of the current weight loss medications. Results: Of 105 included patients, 66 were treated with liraglutide, 30 with phentermine/topiramate, 5 with naltrexone/bupropion, 3 with orlistat, and 1 with phentermine. The absolute weight loss for all medications was 10.6 kg over the patient-specific duration of weight management therapy. The mean body weight loss was 9.2%. There were no statistically significant differences in primary or secondary outcomes between liraglutide and phentermine/topiramate. The group sizes were too small to analyze the other medication groups. Conclusions: Patients in this study lost weight while using medications. However, there were no statistically significant differences among the medications. Patients did not receive uniformly consistent follow-up care, suggesting the need for more standardized processes that could lead to better weight loss outcomes.
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    Prevalence of Diagnosed Ocular Disease in Veterans with Serious Mental Illness
    (Elsevier, 2016) Osamah, Saeedi; Ashraf, Hasan; Malouf, Marc; Slade, Eric P.; Medoff, Deborah R.; Li, Lan; Kreyenbuhl, Julie; Medicine, School of Medicine
    Objective To compare the prevalence of diagnosed ocular disease and eye disease treatment between VA patients with and without serious mental illness (SMI). Methods Retrospective comparison of diagnosed ocular disease and treatment prevalence among patients with and without diagnosed SMI in fiscal year (FY) 2011 in the VA Capitol Health Care System (VISN 5). Results We identified 6,462 VA patients with SMI and 137,933 without SMI. The prevalence of diagnosed ocular disease was 22.7% in SMI patients and 35.4% in non-SMI patients (P <0.001). Those with serious mental illness had a higher prevalence of glaucoma (10.2% vs. 7.1% P < 0.0001), cataract (12.6% vs. 9.2% P < 0.0001), and dry eye (4.0% vs. 2.7% P < 0.0001). 34.3% of SMI subjects had been seen in ophthalmology or optometry vs. 23.0% of controls (P < 0.0001). Conclusion VA patients with SMI have a greater prevalence of diagnosed ocular disease, particularly cataract, glaucoma, and dry eye. While SMI patients utilize eye care services at a higher rate than the general VA population, the majority of subjects with serious mental illness do not get recommended annual eye examinations. More consistent annual ocular screening among VA patients with SMI may be indicated.
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    Supporting Veteran Mental Health Through Metacognitive Reflection and Insight Therapy for the Occupational Therapist (MERIT-OT): A Quality Improvement Doctoral Capstone Project Report
    (2023-05) Horsford, Caitlin; Wasmuth, Sally; Department of Occupational Therapy, School of Health and Human Sciences; Wellington, Miranda
    Background: Veterans are at over 50% higher risk of experiencing mental health crises compared to the general population, negatively impacting occupational engagement and quality of life. With roots in mental health practice, OT is primed to meet these uniquely complex healthcare needs. Research shows improving factors of metacognition through interventions like MERIT-OT can improve self-agency and recovery from mental health crises. However, OT at the IN VA has not yet been utilized within the mental health care teams. For MERIT-OT research to move forward at the IN VA, the barriers and facilitators to implementation at this site needed to be understood. Methods: A DCE student completed a 14-week quality improvement project to support the role of OT in mental health services within the IN VA, eliciting appropriate patient populations to implement MERIT-OT research in the future. Program implementation included OT staff training and advocacy, MERIT-OT resource building, and clinical skills building through mental health group interventions. Data was collected through activity analysis of staff workflow, informal discussion, staff survey, self-assessment journalling of MERIT-OT integration, and pre/post assessment of domiciliary groups. Results: Increased knowledge, access, and the likelihood of OT staff implementation of mental health resources. New OT integration into existing suicide prevention follow-up programs. Deeper understanding of MERIT-OT principles, barriers/ facilitators, and appropriate opportunities for future research. Conclusion: Integration of MERIT-OT within OT’s newly established and growing roles in mental health services at the IN VA healthcare system will improve the quality of care, meet the growing need for mental health professionals, and support rigor and fidelity within the field of mental health OT.
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    Veterans and non-veterans with schizophrenia : a grounded theory comparison of perceptions of self, illness, and treatment
    (2014-07-31) Firmin, Ruth L.; Salyers, Michelle P.; McGrew, John H., 1953-; Boyd, Elizabeth; Lysaker, Paul H.; Grahame, Nicholas J.
    This study investigates differences between Veterans and non-Veterans with severe mental illness (SMI) regarding perceptions of their illness, themselves, and treatment. I compare patient interviews (using the Indiana Psychiatric Illness Interview, IPII) of Veterans (N=20) and non-Veterans (N=26). Modified grounded theory and qualitative coding software Atlas-TI were used to develop codebooks for each group, and these were compared for differences. I examined differences in both code frequency and meaning. Statistically, more Veterans were male, employed, married, had higher income, and had higher education. Statistical differences in code frequency included: more Veterans discussing boredom, regret/guilt/loss, and wanting to be “normal.” More non-Veterans had codes of pessimism and religion/spirituality, wanting a different future, bringing up mental health, family, future: no change, life goals, and relapse. Key differences in narrative themes included: (1) Veterans’ “military mindset”/discussion of anger as part of mental illness, (2) non-Veterans’ focus on mental-illness, (3) differing attitudes regarding stigma, (4) active versus passive attitudes toward treatment, and (5) degree of optimism regarding the future. Differences are described and then potential relationships and interactions are proposed. Veterans appear to have several protective factors (i.e., finances, employment, marriage). Additionally, Veterans’ military-mindset seems to encourage greater stigma-resistance, and thereby also facilitate Veterans being more active and optimistic toward treatment and recovery. By contrast, non-Veteran focus on mental illness may be related to increased self-stigma, passive and pessimistic attitudes. I propose that Veteran identity can serve as an additional protective factor against stigma, pessimism, and passivity. Veteran-identity may also be a useful framework clinically, to help promote active approaches to treatment (e.g., “fighting symptoms”). Further, Veterans emphasized issues relating to anger as important and part of their mental health. It may be that Veterans are more comfortable discussing mental health in the language of “anger,” given stigma. Finally, findings suggest that helping individuals in both groups engage in meaningful, non-mental illness-related life activities may help shape self-perception, and thereby responses to stigma, attitudes toward treatment, and hope for the future.