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

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.