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

2. 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

3. 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 ( 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

4. 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

5. 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

6. 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!

7. 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