Implementing an Integrative Medicine Group Visit Facilitator Training Program to Improve Chronic Pain Management in the Safety-Net.

Abstract

Background: As the opioid epidemic claims over 200 lives per day, there is an urgent need to increase access to evidence-based, non-pharmacologic modalities for pain management.

Objective: To design, implement, and evaluate an integrative medicine group visit (IMGV) facilitator training program to support group visits incorporating mind-body therapies (eg, acupuncture, meditation, tai chi, yoga) for chronic musculoskeletal pain within the Los Angeles County Department of Health Services (LAC DHS).

Methods: Prospective cohort pre-post study with mixed methods formative evaluation. Fifty-nine clinical staff from 3 LAC DHS medical centers and associated clinics enrolled in a 40-hour curriculum including online modules, case discussions, and onsite skills workshops in 2020. We used the Self-Efficacy in Using Non-Drug Therapies for Common Symptoms (SEND) scale to measure change in trainees' self-efficacy to teach selected mind-body therapies for chronic pain management. We evaluated feasibility and acceptability with the course completion rate and obtained participant feedback through program evaluations and semi-structured interviews.

Results: 49% of staff members completed the course, primarily physicians (37%) and rehabilitation therapists (22%). Most participants (80%) were female and 28% more non-physicians completed the final exam than physicians (P = 0.040). SEND scores increased by 20.9 (P < 0.001). Trainees strongly valued the curriculum content, particularly the in-person tai chi and acupressure instruction, but recommended that the online modules be customizable to reduce time commitment. Disruptions from the COVID-19 pandemic affected course progress and completion rates.

Conclusion: Overall, the IMGV facilitator training program was acceptable, feasible with program modifications under pandemic conditions, and increased staff confidence to teach others nonpharmacologic chronic pain management.