Tinnitus is the most prevalent service-connected disability for Veterans; it is also strongly associated with traumatic brain injury (TBI) and polytrauma. The Veterans Health Administration (VHA) is committed to providing access to tinnitus services to improve patient engagement in self management and health outcomes. We have developed Progressive Tinnitus Management (PTM), a cross-disciplinary (Mental Health and Audiology) counseling/self-management program that has been shown in controlled studies to reduce symptoms and improve life satisfaction for tinnitus sufferers. VA Audiology and Speech Pathology (ASP) Service has endorsed PTM as an effective intervention for tinnitus and has recommended its use at VA medical centers (VAMCs). However, PTM is not routinely offered to Veterans suffering from tinnitus. In partnership with VA Program Offices (Mental Health Services and ASP Service) and the Polytrauma and Blast- Related Injuries (PT/BRI) QUERI, we plan to examine provider- and systems-level contributors to this gap between evidence-based VA recommendations and provider practices. This 1-year mixed-methods study will be conducted in three phases: (1) conduct an online survey to describe current tinnitus management practices in VA Audiology and Mental Health (MH) programs nationwide; (2) conduct interviews to determine barriers and facilitators to providing PTM in selected VA clinics nationwide; and (3) conduct interviews to determine readiness of clinics in VISN 20 to conduct an implementation study of PTM. The goal is to better understand provider and systems factors associated with implementation of PTM services in VA outpatient Audiology and MH clinics. Of interest are both providers' experiences and the context in which they occur in VA environments that both facilitate and impede the ability to implement PTM services. The study directly addresses all three PT/BRI QUERI priority goals: (1) Support and enhance implementation of evidence-based, integrated, patient-centered care for patients with TBI/polytrauma. (2) Improve patients' ability to manage their persistent TBI/polytrauma-related symptoms, impairments, and functional difficulties. (3) Optimize Veterans' support systems, including family, peers, VA, and community resources. Through team collaboration with the VA Program Offices and the PT/BRI QUERI, the dissemination of these study results will be widespread. Data findings from this research will inform the development of a program of research that will evaluate the dissemination and implementation of VA tinnitus management programs nationally, with focus on PTM. Following successful completion of the Rapid Response Project, we intend to conduct a point of care study to evaluate three modalities for delivering PTM in VISN 20: (1) in the clinic; (2) using Clinical Video Telehealth at VA sites of care; and (3) Home Telehealth for Veterans who cannot otherwise access VA tinnitus services. We are currently completing two randomized clinical studies evaluating two of the three modalities for delivering the PTM intervention: In-Clinic Care and In-Home Telehealth. Preliminary analyses, both quantitative and qualitative, reveal that both modalities provide efficacious intervention (see Appendices 1 and 2). Long-term, implementation of PTM can provide access to effective tinnitus services for Veterans everywhere. The two telehealth modalities could be delivered from major VAMCs and/or from a centralized location. A centralized program could provide tinnitus telehealth services directly to Veterans, and could also support VA clinicians in their efforts to provide tinnitus services to their patients. A centralized tinnitus program would promote uniform tinnitus care on a national basis, and would result in a new standard of efficiency and improved outcomes for managing the needs of all Veterans suffering from tinnitus.
Veterans often experience tinnitus caused by high levels of noise in the military as well as traumatic brain injury. In Fiscal Year 2012, tinnitus was the most prevalent service-connected disability for Veterans. We have developed Progressive Tinnitus Management (PTM), an interdisciplinary program that has been shown in controlled studies to reduce symptoms and improve life satisfaction for tinnitus sufferers. However, PTM is not routinely accessible to Veterans suffering from tinnitus. In partnership with VA Program Offices (Mental Health Services and Audiology and Speech Pathology Service) and the Polytrauma and Blast-Related Injuries (PT/BRI) QUERI, the proposed study will describe current tinnitus-management practices in VA Audiology and Mental Health programs across the country. This information will be used to develop interventions that mitigate barriers to implementation of PTM and will support the development of implementation strategies for overcoming barriers to adoption of PTM services, leading to a planned implementation study of PTM.
