title: Providers' and Administrators' Perceptions of Complementary and Integrative Health Practices Across the Veterans Health Administration.
abstract: OBJECTIVE
  Use of complementary and integrative health (CIH) therapies is being promoted by the Veterans Health Administration (VA), but promotion may not equate to adoption. The purpose of this study was to explore whether perceptions regarding CIH at one VA medical center (VAMC) were similar to perceptions from a sample of other VAMCs.
  
  
  METHODS
  This article reports a subset of qualitative findings from a mixed-methods study.
  
  
  METHODS
  Sites were recruited through a VA-wide CIH listserver. On the basis of site description (e.g., therapies offered, interest in CIH), sustained site interest, and geographic location, recorded interviews of 22 persons were conducted at 6 sites across the country.
  
  
  METHODS
  Interviewees were asked the same questions as the single-site VAMC study respondents.
  
  
  RESULTS
  Variable access to CIH services across the VA created the need for workarounds. Multiple barriers (e.g., limited space and challenging credentialing) and facilitators (e.g., strong champion and high veteran demand) were cited. Respondents described nonpharmacologic pain control, the usefulness in treating mental health and/or post-traumatic stress disorder issues, and improvement of staff morale as additional reasons to promote CIH. Findings confirmed those from the earlier single-site VAMC phase of the study. Even the highest-performing sites reported struggling to meet veterans' demands for delivery of CIH.
  
  
  CONCLUSIONS
  Almost half of active-duty military personnel report the use of at least one type of CIH therapy. As active-duty personnel transition to veteran status, both their physical and mental healthcare needs can potentially benefit from CIH therapies. The VA must actively support local enthusiastic CIH proponents and receive congressional support if it is to actually meet its stated goal of providing personalized, proactive, patient-driven healthcare through the promotion of comprehensive CIH services to veterans.
authors.affiliation: 1 VA Ann Arbor Medical Center , Ann Arbor, MI.
authors.forename: Carol E
authors.initials: CE
authors.lastname: Fletcher
authors.affiliation: 1 VA Ann Arbor Medical Center , Ann Arbor, MI.
authors.forename: Allison R
authors.initials: AR
authors.lastname: Mitchinson
authors.affiliation: 1 VA Ann Arbor Medical Center , Ann Arbor, MI.
authors.forename: Erika
authors.initials: E
authors.lastname: Trumble
authors.affiliation: 1 VA Ann Arbor Medical Center , Ann Arbor, MI.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Hinshaw
authors.affiliation: 2 Integrated Health Research Center , Penney George Institute for Health and Healing, Allina Health, Minneapolis, MN.
authors.forename: Jeffery A
authors.initials: JA
authors.lastname: Dusek
mesh_terms: D001291:Attitude of Health Personnel; D000529:Complementary Therapies / Q000706:statistics & numerical data*; D003695:Delivery of Health Care; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy; D059408:Pain Management; D018802:Patient-Centered Care; D010465:Perception; D036301:Qualitative Research; D013313:Stress Disorders, Post-Traumatic / Q000628:therapy; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans; D058014:Veterans Health
keywords: access; barriers and facilitators; complementary and alternative medicine (CAM); complementary and integrative health (CIH); patient-centered care; veterans