Profile of minority and under-served patients using acupuncture

Tackling health inequity: a commentary on the potential of acupuncture to improve health outcomes of marginalised populations

BACKGROUND

Health inequities or disparities challenge governments and public health systems, impacting health service delivery worldwide. Inherent disadvantage linked to the social determinants of health is intrinsic to the health outcomes among society's marginalised and most vulnerable members. It is acknowledged that marginalised individuals present with higher levels of chronic disease, multi-morbidities and adverse health behaviours than their non-disadvantaged peers. Marginalised individuals and communities present with complex health problems and often receive poor quality or inadequate health care that is unable to meet their needs, leading to stigmatisation and perpetuating the cycle of disadvantage.

DISCUSSION

Emerging research indicates that there may be a role for acupuncture in managing the health needs of marginalised populations and that when historical barriers to accessing acupuncture treatment (such as awareness, availability and affordability of this therapy) are removed, certain marginalised populations are open to engaging with acupuncture treatment. Acupuncture has been used by low-income, refugee, veteran and ethnic minority groups to manage chronic pain, substance use disorders, stress and the impacts of trauma in conventional health settings such as community clinics and hospitals. There is the suggestion that integrative health settings and group treatment models may improve access and uptake of acupuncture among marginalised groups.

CONCLUSION

Evidence suggests that the sociodemographic profile of acupuncture users is diverse and acupuncture therapy holds potential value in the treatment of marginalised populations. Further research that investigates reframing and expanding the scope of practice for acupuncture is timely and may contribute to tackling health inequity.

"It Gave Me Hope" Experiences of Diverse Safety Net Patients in a Group Acupuncture Intervention for Painful Diabetic Neuropathy

Purpose: To explore the experiences of living with painful diabetic neuropathy (PDN) and with a group acupuncture intervention in a sample of low-income, diverse patients.

Methods: We conducted a randomized clinical trial of a 12-week group acupuncture intervention for PDN. Data included validated measures of patient-reported outcomes, including pain and quality of life (QOL), as well as semistructured qualitative interviews about participants' experiences with PDN and the intervention. Interview transcripts were coded and analyzed using an inductive thematic framework.

Results: We recruited 40 participants from diverse racial/ethnic backgrounds from a public hospital and conducted in-depth qualitative interviews with a subset of 17 participants. Participants randomized to acupuncture experienced greater decreases in pain compared with usual care as well as improved QOL. In interviews, they described a myriad of socioeconomic and personal life stressors that compounded the significant suffering and disability brought on by PDN. Those who received acupuncture were able to decrease reliance on pain medication, improve their sleep and daily function, reduce stress, and engage more with their own self-care. They noted that the acupuncture intervention also gave them hope in the face of their chronic disease.

Conclusion: Acupuncture is a valuable adjunct treatment for low-income and marginalized populations with PDN. In addition to reducing pain and improving QOL, acupuncture may offer powerful benefits by increasing patient activation and hope.

Integrative Group Medical Visits: A National Scoping Survey of Safety-Net Clinics

Purpose: Integrative group medical visits (IGMVs) aim to increase access to complementary and integrative health care, which is particularly relevant for low-income people. We sought to describe IGMV programs in US safety-net clinics through a survey of providers. Methods: An online and paper survey was conducted to collect data on the use of complementary health approaches and characteristics of IGMV programs. We recruited a purposive sample of safety-net clinicians via national meetings and listservs. Results: Fifty-seven clinicians reported on group medical visits. Forty percent worked in federally qualified health centers, 57% in safety-net or teaching hospitals, 23% in other settings such as free clinics. Thirty-seven respondents in 11 states provided care in IGMVs, most commonly for chronic pain and diabetes. Nutrition (70%), mindfulness/meditation/breathing (59%), and tai chi/yoga/other movement practices (51%) were the most common treatment approaches in IGMVs. Conclusion: Safety-net institutions in 11 states offered IGMVs to treat a range of chronic conditions. IGMVs are an innovative model to improve access to non-pharmacologic approaches to chronic illness care and health promotion. They may advance health equity by serving patients negatively impacted by health and health care disparities.

Does Acupuncture Treatment Affect Utilization of Other Hospital Services at an Urban Safety-Net Hospital?

BACKGROUND

Little is known regarding the interaction between acupuncture and biomedical healthcare among vulnerable patient populations. In particular, the association between acupuncture and total cost of healthcare has not been characterized.

METHODS

Total hospital system visits and associated charges were retrospectively reviewed among patients who received acupuncture at a large safety-net hospital system from 2007 to 2014. Inclusion criteria were Medicare or Medicaid insurance coverage, older than age 18 years, and one or more on-site acupuncture appointments. Patients were stratified into five groups based on the number of acupuncture visits: 1-3, 4-6, 7-9, 10-12, or 13-15 treatments. The total number of biomedical hospital visits and total associated charges were compared 6 months before and 6 months after initiation of acupuncture.

RESULTS

A total of 329 patients met our inclusion criteria. Although not statistically significant, there appeared to be an association between acupuncture treatment and a decrease in total hospital charges. The group receiving 1-3 acupuncture treatments showed a per-patient average increase in total charges in the 6-month period after acupuncture ($1771.34; p = 0.38). The patients who received 7-9 treatments showed the largest average decrease in total charges ($8967.24; p = 0.17).

CONCLUSION

This study shows a previously unreported aggregate relationship between number of treatments and total healthcare charges in a single urban safety-net hospital. Given the sample size available and the heterogeneity of the patient population, no statistically significant associations could be established between initiation of acupuncture treatment and charges. However, some suggestive patterns were observed. Further prospective studies with a matched-group control are warranted to further explore this relationship. Additional study across wider locations is warranted to best guide practitioners and hospitals in designing efficacious, high-value integrative medicine programs.

Acupuncture Use in the United States: Who, Where, Why, and at What Price?

Despite the increase in acupuncture uses and greater than ever before interest of funding agencies to fund biomedical research in acupuncture, little is known about the profile of acupuncture users. We examined who these individuals are, where they reside, why they use acupuncture, and what price they pay. The increased use and high costs associated with each acupuncture visit poses questions to health care insurers regarding its coverage. Profiling will help conventional providers identify the segment of the population who are more likely to use acupuncture and educate them on the possible risks and benefits of using it with conventional medicine.

A preliminary comparison of primary care use by refugees before and after acupuncture

BACKGROUND

Limited research exits on utilization and cost-effectiveness of acupuncture among underserved communities, and virtually no evidence has been published with respect to refugee populations. In this study, we examined the relationship between acupuncture and the total utilization of primary care services in a cohort of refugee patients with chronic pain.

METHODS

We retrospectively reviewed the medical records of 16 refugee patients with chronic pain at Boston Medical Center (BMC). The research was IRB-approved. Demographics and total charges associated with primary care over 18 months were collected.

RESULTS

Total charges associated with primary care services decreased by 50.2% in our refugee cohort in the 12 months following acupuncture treatment, equivalent to a savings of $691 per patient per month.

CONCLUSIONS

This preliminary review demonstrated a statistically significant decrease in total charges associated with primary care following acupuncture treatment (p=0.0308). This study suggests the need for further investigation of the relation between acupuncture and refugees with chronic pain, as well as the financial implications of this relationship. It is unclear why refugees may seek fewer primary care services after acupuncture treatment. Additional study is needed to further explore whether this relationship is generalizable to other hospital services and to other patient populations.

Characteristics of Female and Male Visitors to Practitioners of Acupuncture in the HUNT3 Study

Characteristics of female and male visitors to practitioners of acupuncture were investigated in a large cross-sectional adult population in Central Norway. A total population health survey, HUNT3, conducted in 2008 with 50,827 respondents provided the data. Demographic variables, lifestyle, health, and use of conventional medicine were analyzed using multivariable logistic regression models. The one year prevalence of visiting a practitioner of acupuncture was 5.7% for females and 2.2% for males. Visitors of both genders were five times more likely to have had somatic complaints in the preceding year and were 2–3 times more likely to report poor global health than female or male non-visitors. Also, visitors of both genders were more likely to do hard physical activities every week, and they were less likely to live alone or be daily smokers. Further, female visitors were characterized by having higher education and were more likely to have a paid job than other females. Corresponding differences were not seen among males. Age showed limited associations with being a visitor, and for females only. Valid for both genders, our findings draw a picture of visitors to acupuncture treatment as persons who actively contribute to promoting their health through lifestyle choices of physical activity and non-smoking while simultaneously having worse global health and higher burdens of somatic complaints than other adults. In contrast to males, it is suggested that females may be more dependent on personal income, as indicated by higher education and being in a paid job, in choosing acupuncture treatment in addition to conventional medicine.