NADA for the future care for our Veterans Karen Williams, DNP, FNP-BC

Current Landscape of Central Texas VA System Central Texas Veterans Health Care System (CTVHCS) Includes Waco, Temple, Austin and surrounding Community Based Outpatient Clinics (CBOC’s) Temple VA is the main hospital for the area Serve over 100,000 veterans Ft Hood- the largest Army base is 30 miles from Temple VA Has both a head injury program and a headache clinic

Challenges Continual increase in local veteran population, due to retirement, medical discharge from FT Hood Majorities of head injuries in the military are suffered by Army personnel- (over 360,00 head injuries from 2000 to 2017) Headache is the one of the most common debilitating issues after a head injury ( 2017- over 390,000 veterans dx with headache) In the veterans with chronic headaches there is a high comorbidity of post traumatic stress, insomnia, chronic pain Medications are not working, not helping enough, causing more side effects Chronic Daily Headaches in the general population is about 3%, but is 20% or more in the post 9/11 combat vet with a hx of head injury. The population is those in age range from 20-39

Challenges Continued Space is limited Personnel is limited Funding is limited Chiropractic and Acupuncture services are limited Credentialing can take months Chronic pain/the need for on going therapies is great

Temple VA headache capability Integrative clinic utilizing: acupuncture, Botox, occipital blocks, relaxation techniques, aromatherapy, medication management and on going patient education Has one provider- NP Current case load 150 patients Neurology- 7 providers, 4 administer Botox, none use acupuncture Unknown case load number Current number of veterans seen in the CTVHCS with a diagnosis of some form of headache- 7,191 Botox must be repeated every 12 weeks

Acupuncture Acupuncture performed by CTVHCS providers for 2018 = 648 veterans (160 of these were by the headache clinic) Community Care Consults for acupuncture for 2018 = 1,522 (unknown cost, possibly over $4 million for the year) Battlefield Acupuncture (BFA) has been embraced by the VA to help with the chronic pain issues. Limitations on the ability of RN’s to administer this Recommended not to administer in pregnancy Could NADA be even more beneficial? -According to the Richmond VA pain program, the answer is YES!

NADA The future of NADA at CTVHCS Advantages of NADA Domiciliary- short term stay for those with substance abuse issues Inpatient and outpatient clinics, especially those dealing with pain/mental health issues Possibly Community Living Center (CLC)/skilled nursing facility Advantages of NADA Helpful for substance abuse Greater flexibility in who can be trained to administer this Appears to be very helpful for chronic pain Can be administered in pregnancy