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4 MHCE News VHA Office of Communications. As the whole health program manager at VA Roseburg VA Medical Center (VAMC) in Oregon, registered nurse Fletcher Watson believes engaging in complementary and whole health programs is a game changer for Veterans’ well-being. Since 2014, Watson has been working to expand complementary and whole health programs. These programs support Veterans experiencing chronic health issues. They also help improve mental health and general wellness. These programs include meditation, yoga, tai chi, mindfulness practice, acupuncture and other complementary therapies. Many of the classes are led by practitioners specially trained to support Veterans’ unique needs. “The magic that happens with our program is possible because the Veteran directs us as to what he or she is ready for rather than us deciding what they should do,” Watson says. “We lock in on that motivation and get behind them. All of a sudden they are more successful and that success often leads them to want to do more.” Whole health programs put Veterans at the center of their success Over the last six years, Watson has seen these programs dramatically improve Veterans’ lives. They help Veterans manage anxiety, post-traumatic stress disorder, weight, diabetes, chronic pain and other chronic health issues. “Evidence shows that partnering with Veterans through this whole health approach – finding out what matters most to them and meeting them there – leads to more sustained behavior, lasting lifestyle change. The success they experience in a particular area often empowers and encourages them to also transform their lives in other areas as well.” This was the case for a Veteran who lived with Post-Traumatic Stress Disorder and anxiety. Those issues prevented her from being able to travel by car, train or plane. She isolated herself in her home and had not seen her family in years. Three months after joining the yoga program she was able to visit her family for the first time. therapeutic movement modalities such as yoga encourage Veterans to simply notice what is happening in their experience and gently stay as present as they are able in the supportive environment. This ability to simply notice and stay present gets strengthened and seems to translate powerfully into everyday life for many of our Veterans such as this particular woman Veteran.” Here is another example of one of the many Veterans who have changed their lives after participating in one of Watson’s programs. “Another Veteran who began attending battlefield acupuncture mentioned to me that he had come off his opioids. He had not taken them in over a week. Two weeks went by and he approached me. He was excited to share that he was working with his provider to come off his sleeping medication. “About a month later he SEPTEMBER 2020 EDITION NURSES EMPOWER VETERANS WITH YOGA AND GUIDED MEDITATION returned with news of more progress. Because he was no longer in so much pain he was able to sleep better. He also no longer needed one of his mood stabilizers. He said he just felt so much better, even happy again. His progress in such a short time was remarkable.” Facing your fears and addressing personal pain and trauma can be difficult, but Watson guarantees the process is worth it. Whole health at your VA In 2014, VHA established Translates powerfully the Integrative into everyday life Health Coordinating Center (IHCC) to identify “For some Veterans, talkbased therapies can generate and address barriers to providing integrated anxiety. However, health across the VHA system. IHCC continues to serve as a resource for clinical practices and education for Veterans, clinicians, leadership and staff. The center is critical in ensuring Veterans receive the same positive outcomes despite each program being run and organized differently from medical center to medical center. When asked what he would say to Veterans on the fence about joining one of VA’s Whole Health programs, Watson simply asks, “What do you want your health for? Take a leap and give it a try.” Veterans who are interested in beginning their Whole Health journey can talk to their health team about their needs and priorities. Some of the popular group programs are available online through video sessions Veterans can follow along at home. WWW.MHCE.US
WWW.MHCE.US MHCE News 5 Elective PCI Done Outside the VA System Riskier for US Veterans By Caitlin E. Cox More than half of US veterans undergoing elective PCI now choose to do so at a community hospital rather than through the healthcare system of the Department of Veterans Affairs (VA), researchers have found. But these patients are at higher risk of dying—especially within the first month—than those treated at a VA medical center. Policy changes have driven the shift toward community care, lead author Stephen W. Waldo, MD, Aurora, CO), explained to TCTMD. First, the Veterans Choice Act of 2014 “enabled veterans to seek care outside of the VA if they were unable to get care within the VA in a reasonable period of time or they lived a significant distance away from a tertiary care facility that could provide those sources,” he said. With the 2018 MISSION Act, which aims to further streamline access, “they now have the opportunity to seek access to care much closer to their homes.” Morton Kern, MD (University of California, Irvine, and VA Long Beach Healthcare System), said that for those working in the VA it’s “kind of common knowledge that you don’t know what you get when you send somebody to the community—we don’t have any control over it, we don’t have any tracking of it, they don’t have any responsibility for the quality of care they perform, and we don’t know what it costs. . . . We may or may not even get the records back.” Thus, it’s no surprise that the level of care might be quite variable, with some hospitals performing better than others, he told TCTMD. This phenomenon, though, “has not been well looked at and this is a study that says, yes, that’s true.” It’s a warning, Kern said, that something needs to happen in order to change course—outcomes aren’t being tracked and there are no penalties for poor performance. Waldo et al looked at 8,913 patients who were actively enrolled in the VA healthcare system and underwent elective PCI for stable angina between October 2015 and December 2018. Two-thirds had their procedures done within the VA and one-third in community facilities—over the course of the study, the proportion done at non-VA hospitals rose from 38.9% to 51.8%. Using a Cox proportional hazards model, there was a 33% increase in death risk for elective PCI patients treated at community hospitals versus within the VA (HR 1.33; 95% CI 1.09-1.62), with an absolute risk difference of 1.4%. Restricting the analysis to just the first month showed an even sharper increase in relative risk—143%, with an absolute difference of 0.7%— for the community-hospital setting (HR 2.43; 95% CI 1.50-3.94). Administrative billing data were used to determine outcomes in the community, Waldo pointed out. There were no details captured for procedural complexity or complications. “We don’t have access to the same level of quality information for patients that are treated outside the VA as we do within the VA,” he said. “And that’s something, I think, going forward that can be taken away from this: an opportunity to improve, to ensure that patients treated outside the VA have the same level of quality assessment and quality assurance that those treated within the VA have.” Perhaps it would make sense, he suggested, to partner with existing programs, such as the National Cardiovascular Data Registry, or to use the resources of the MISSION Act to obtain the same information on veterans regardless of whether they are treated at a VA facility or elsewhere. Kern, too, called for broader quality initiatives and for clinicians to strive for high standards. Payment structures might be able to encourage better performance, if the VA mandated that referral centers meet certain criteria. As for what individual physicians can do, Waldo said they should follow best practices for PCI, using radial access and intravascular imaging as much as possible, and also make sure that patients are discharged on guideline-directed medical therapy. “Those are the foundational blocks for improved interventional care, within the VA and outside the VA,” he observed.
