Background/Purpose: Chronic pain is epidemic, impacting one fifth of the U.S. adult population. The opioid crisis has raised awareness of the limitations of opioid pain management. While clinical guidelines now recommend Integrative Pain Management (IPM) as first-line pain treatment, insurance typically does not cover IPM interventions. IPM interventions have therefore been minimally implemented in biomedical healthcare systems, and the lack of staffing, training, and remuneration have been noted obstacles to implementation.

The Integrative Medical Group Visit (IMGV) is an innovative approach to IPM that offers mindfulness-based stress reduction, pain education, acupressure, self-massage, and chair yoga to patients with chronic pain in a billable model. IMGV has been successfully tested; however data is needed to inform future efforts to implement IMGV at scale. Our overall objective is to develop implementation strategies and measures for a future hybrid implementation-effectiveness trial of IMGV. To do this, we are assessing feasibility of methods in an outpatient clinical context with a high burden of patients with chronic pain, specifically, the University of North Carolina Health Center for Rehabilitation Care (CRC).

Methods: In our first aim, we used Implementation Mapping to systematically develop implementation strategies using theory and stakeholder input. To accomplish this, we conducted semi-structured, recorded interviews with clinic employees, including faculty, staff, and administrators. We asked questions to assess potential barriers and facilitators to implementation of IPM broadly, and the IMGV specifically. Interviews were transcribed and uploaded into ATLAS.ti Cloud, a qualitative analysis data management software. Data were double-coded by two experienced qualitative researchers using thematic content analysis, and guided by the Consolidated Framework for Implementation Research. Themes will be matched to implementation strategies to implement the IMGV.

In our second aim, patients who agree to participate in the IMGV will be interviewed before and after participation in the IMGV. Interviews will assess IMGV feasibility, acceptability, and health outcomes. Feasibility of extracting patient health data from the electronic health record pre and post participation will also be assessed.

In our third aim, to assess feasibility of conducting the IMGV at the CRC, we will collect data on patient recruitment, attendance, and retention. We will assess fidelity to the IMGV through participant observation using the IMGV Fidelity Checklist, a tool created by the intervention developers. Finally, provider perspectives of acceptability, appropriateness, and feasibility will be assessed through field notes, informal interviews, and periodic reflections.

Results/Outcomes: Qualitative interviews were conducted via zoom videoconference with fifteen administrators, faculty, and staff at the CRC. Preliminary themes include a shift to virtual care/telehealth given the COVID-19 pandemic, tension for change, a welcoming implementation climate, and limited resources of patients with chronic pain. Data collection and analysis is ongoing.

Conclusions: To increase access to clinical-guideline concordant pain management, and to mitigate the risks associated with opioids, implementation of IPM interventions is needed. Implementation science methods and frameworks can be employed to assess implementation of IPM interventions, with potential to improve uptake and sustainability.