A5001173690- Mental Health Treatment and Access
- Primary Care and Health Outcomes
- Opioid Use Disorder Treatment
- Pain Management and Opioid Use
- Mental Health and Patient Involvement
- Geriatric Care and Nursing Homes
- Musculoskeletal pain and rehabilitation
- Health Systems, Economic Evaluations, Quality of Life
- Health Policy Implementation Science
- Frailty in Older Adults
- Mobile Health and mHealth Applications
- Health, psychology, and well-being
- Technology Use by Older Adults
- Patient Satisfaction in Healthcare
- Emergency and Acute Care Studies
- Substance Abuse Treatment and Outcomes
- Digital Mental Health Interventions
- Posttraumatic Stress Disorder Research
- Health Sciences Research and Education
- Intensive Care Unit Cognitive Disorders
- Empathy and Medical Education
- Pediatric Pain Management Techniques
- Cognitive Functions and Memory
- Adolescent and Pediatric Healthcare
- Aging and Gerontology Research
San Francisco VA Health Care System
2016-2025
University of California, San Francisco
2015-2025
San Francisco VA Medical Center
2016-2025
San Francisco General Hospital
2019
Santa Clara University
2019
University of California, Berkeley
2019
United States Department of Veterans Affairs
2017
Some veterans face multiple barriers to VA mental healthcare service use. However, there is limited understanding of how veterans' experiences and meaning systems shape their perceptions health In 2015, a participatory, mixed-methods project was initiated elicit veteran-centered using services among diverse sample US rural urban veterans. We sought identify veteran-centric increase initial engagement continuation with services. Cultural Domain Analysis, incorporated in mixed methods...
Mental health smartphone apps provide support, skills, and symptom tracking on demand come at minimal to no additional cost patients. Although the Department of Veterans Affairs has established itself as a national leader in creation mental apps, veterans' attitudes regarding use these innovations are largely unknown, particularly among rural aging populations who may benefit from increased access care.The objective our study was examine toward assess whether openness this technology varies...
Abstract Purpose Telephone motivational coaching has been shown to increase urban veteran mental health treatment initiation. However, no studies have tested telephone delivered by peers facilitate initiation and engagement. This study describes pre‐implementation strategies with 8 Veterans Affairs (VA) community‐based outpatient clinics in the West Mid‐South United States adapt implement a multisite pragmatic randomized controlled trial of peer for rural veterans. Methods We used 2...
Background: Patients with a history of substance use are more likely than those without to experience chronic noncancer pain (CNCP), be prescribed opioids, and opioid misuse or overdose. Primary care practitioners (PCPs) in safety-net settings for low-income patients CNCP use, usually specialist consultation. To inform communication related risk, we explored PCPs’ patients’ perceptions the risks therapy. Methods: We conducted semistructured interviews 23 PCPs 46 their patients, who had use....
To examine the impact of a pilot VA Whole Health Coaching program, including whether and how program helps veterans improve their health quality life.Whole is structured to support in making healthy behavior changes promote holistic well-being.This mixed-methods quality-improvement evaluation combined surveys (pre- post-coaching) with follow-up qualitative interviews.The setting was large healthcare system, encompassing medical center six community-based clinics Northern California.65...
In the United States, spouses provide 17% of in-home care for people living with dementia. Negative impacts dementia on spouses/partners are well-documented, but we lack information about holistic experience spouses/partners. We conducted a secondary thematic analysis data from two observational studies everyday music engagement and at home. this paper, report experiences perspectives Participants included 15 (20% women, 20% color); (73% 27% color). Individual varied, underlying patterns...
The Housing and Urban Development-Veterans Affairs Supported (HUD-VASH) program provides rental subsidies, case management, supportive services to Veterans who are currently or formerly homeless, 77% of whom ages ≥50. Few interventions have been developed address the needs older in HUD-VASH. We conducted a 2-stage study inform development an intervention promote aging place First, we completed qualitative interviews with 21 HUD-VASH focus groups 13 staff members identify unmet for supporting...
Abstract Background Maintaining functional status, defined as the ability to perform daily activities such bathing, dressing, and preparing meals, is central older adults’ quality of life, health, remain independent. Identifying impairments – having difficulty or needing help performing these essential for clinicians provide optimal care adults, on a population level, understanding function can anticipate service needs. Yet uptake standardized measurement status into routine patient has been...
To evaluate the impact of Integrated Pain Team (IPT)-an interdisciplinary chronic pain care intervention embedded in primary at a large Veterans Affairs health system. Outcomes evaluated included IPT's on perceived effectiveness care; provider self-confidence; and team satisfaction, stress, burnout.This mixed-methods quality-improvement study employed: 1) qualitative semistructured interviews 61 providers, other members, organizational stakeholders; 2) supplementary quantitative survey 65...
Military veterans who could benefit from mental health services often do not access them. Research has revealed a range of barriers associated with initiating United States Department Veterans Affairs (VA) care, including those specific to accessing care (e.g., fear stigmatization). More work is needed streamline VA health-care for veterans. In the current study, we interviewed 80 9 clinics across about initiation identify access. Results suggested that five predominant factors influenced...
<h3>Purpose:</h3> This study sought to understand clinicians9 and patients9 experience managing chronic noncancer pain (CNCP) opioids in safety-net primary care settings. article explores the time requirements of safer opioid prescribing for medically socially complex patients context care. <h3>Methods:</h3> We qualitatively interviewed 23 clinicians 46 their with concurrent CNCP substance use disorder (past or current). also conducted observations clinical interactions between patients....
Background Guideline recommendations to reduce prescription opioid misuse among patients with chronic noncancer pain include the routine use of urine toxicology tests for high-risk patients. Yet little is known about how implementation co-occurring and substance impacts primary care providers’ management misuse. Clinicians’ perspectives on benefits challenges implementing in monitoring safety net health settings are presented this paper. Methods Twenty-three providers from 6 whose had a...
The NIH-DOD-VA Pain Management Collaboratory (PMC) supports 11 pragmatic clinical trials (PCTs) on nonpharmacological approaches to management of pain and co-occurring conditions in U.S. military veteran health organizations. Stakeholder Engagement Work Group is supported by a separately funded Coordinating Center was formed with the goal developing respectful productive partnerships that will maximize ability generate trustworthy, internally valid findings directly relevant veterans service...
Mounting concern about the risks and limited effectiveness of opioid therapy for chronic pain has spurred implementation novel integrated biopsychosocial care models in health-care systems like Department Veterans Affairs (VA). However, little is known patient experiences with these new models.We conducted a qualitative study to examine model currently being disseminated at VA: interdisciplinary, teams (IPTs) embedded primary care.We interviewed 41 veterans who received from VA's first IPT...
Biopsychosocial integrated pain team (IPT) care models are being implemented in Veterans Health Administration (VA) and other health systems to address chronic reduce risks related long-term opioid therapy, with little evaluation of effectiveness date. We examined whether IPT improves self-reported pain-related outcomes misuse.Single-group quality improvement study.Large VA system.Veterans (N = 99, 84% male, mean age [SD] 60 [13] years).Using paired t tests Wilcoxon matched-pairs...
According to recent Congressional testimony by the Secretary for Veterans Affairs (VA), improving timeliness of services is one five current priorities VA. A comprehensive access measure, grounded in veterans' experience, essential support VA's efforts improve access. In this article, authors describe process they used develop Perceived Access Inventory (PAI), a veteran-centered measure perceived mental health services. They multiphase, mixed-methods approach PAI. Each phase built on and was...
Abstract Introduction Access to high-quality healthcare, including mental is a high priority for the Department of Veterans Affairs (VA). Meaningful monitoring progress will require patient-centered measures access. To that end, we developed Perceived Inventory focused on access VA health services (PAI-VA). However, purchasing increasing amounts from community providers. In this paper, describe development PAI users VA-funded healthcare incorporates barriers unique care service use and...
Background: In the United States and internationally, providers have adopted guidelines on management of prescription opioids for chronic noncancer pain (CNCP). For "high-risk" patients with co-occurring CNCP a history substance use, advise that monitor using urine toxicology screening tests, develop opioid plans, refer to use treatment. Objective: We report primary care provider experiences in safety net interpreting implementing guideline recommendations use. Methods: interviewed who work...
To determine the effectiveness of telephone motivational coaching delivered by veteran peers to improve mental health (MH) treatment engagement among veterans.Veterans receiving primary care from primarily rural VA community-based outpatient clinics were enrolled. Veterans not engaged in MH screening positive for ≥1 problem(s) randomized receive peer-delivered feedback on screen results and referrals plus 4 sessions (intervention) versus without (control). Blinded assessments conducted at...
Functional status, or the ability to perform activities of daily living, is central older adults’ health and quality life. However, systems have been slow incorporate routine measurement function into patient care. We used multiple qualitative methods develop a patient-centered, interprofessional intervention improve functional status for veterans in primary care settings. conducted semi-structured interviews with patients, clinicians, operations staff (n = 123) from 7 Veterans Health...
Background: Veterans Affairs (VA) has rolled out a holistic, multicomponent Whole Health care model nationwide, yet no pragmatic trials have been conducted in real-world clinical settings to compare its effectiveness against other evidence-based approaches for chronic pain management veterans. Objectives: We describe the adaptation of first large randomized controlled trial diverse VA settings. Research Design: Informed by Promoting Action on Implementation Systems implementation framework,...
Access to high-quality health care, including mental remains a high priority for the Department of Veterans Affairs and civilian care systems. Increased access is associated with improved outcomes, decreased suicidal behavior. Multiple policy changes interventions are being developed implemented improve care. The Perceived Inventory (PAI) patient-centered questionnaire understand veteran perspective about services. PAI self-report measure that includes 43 items across 5 domains: Logistics (6...
Biopsychosocial, integrated pain care models are increasingly implemented in the Veterans Health Administration to improve chronic and reduce opioid-related risks, but little is known about how well these address women veterans' needs.Qualitative, interview-based study.San Francisco VA Care System Integrated Pain Team (IPT), an interdisciplinary team that provides short-term, personalized emphasizing functional goals active self-management.Women with who completed ≥3 IPT...