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Correia de Carvalho M, Azevedo P, Pires C, Machado JP, Laranjeira M, Nunes de Azevedo J. Integrating Acupuncture into a Dialysis Center. Healthcare (Basel) 2023; 11:healthcare11101463. [PMID: 37239749 DOI: 10.3390/healthcare11101463] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/07/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
A growing interest in integrating traditional Chinese medicine (TCM) and conventional medicine (CM) to create a more comprehensive approach to healthcare has been verified. Scientific evidence supports acupuncture as an integrative treatment for specific health conditions. The aim of this study was to assess the acceptance and feasibility by patients and healthcare professionals of integrating acupuncture in a dialysis center. Individuals undergoing hemodialysis (HD) who participated in a patient-assessor-blinded randomized controlled trial that evaluated the effect of acupuncture on functional capacity and quality of life were included. Acceptance was measured by adherence (percentage of patients who completed treatments and dropouts) and patients' and healthcare professionals' opinions toward acupuncture (pre- and pro-intervention questionnaires). Feasibility was measured by safety (number of reported adverse events) and effectiveness (changes in functional capacity, peripheral muscle strength, and health-related quality of life scores after treatment). Forty-eight patients were included, and forty-five (93.8%) were analyzed. No adverse events were reported. All patients completed the treatment, and only three patients (6.2%) were lost to the 12-week post-treatment follow-up. The attitudes of patients and health professionals were favorable to acupuncture, namely in relation to its use, degree of discomfort, recommendation to others, and interference with routine care and clinical setting. Integrating acupuncture into a dialysis center seems viable and well-accepted by patients with kidney failure on maintenance HD, doctors and nurses.
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Affiliation(s)
| | - Pedro Azevedo
- TECSAM-Tecnologia e Serviços Médicos SA, 5370-530 Mirandela, Portugal
| | - Carlos Pires
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, 3000-115 Coimbra, Portugal
| | - Jorge Pereira Machado
- ICBAS-School of Medicine and Biomedical Sciences, University of Porto, 4050-313 Porto, Portugal
- CBSin-Center of BioSciences in Integrative Health, 4000-105 Porto, Portugal
| | - Manuel Laranjeira
- ICBAS-School of Medicine and Biomedical Sciences, University of Porto, 4050-313 Porto, Portugal
- INC-Instituto de Neurociências, 4100-141 Porto, Portugal
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Dynamic Pain-Related Changes in Pulse-Graph Measurements in Patients with Primary Dysmenorrhea before and after Electroacupuncture Intervention and Its Correlation with TCM Pattern. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:3518179. [PMID: 35126597 PMCID: PMC8813248 DOI: 10.1155/2022/3518179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 01/04/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To explore the dynamic changes recorded in pulse graph related to the changes in the severity of pain before and after electroacupuncture (EA) intervention among young women suffering from primary dysmenorrhea (PD). METHODS A total of 147 female college students were recruited in this study. Based on participants' symptoms associated with menstruation, they were divided into the PD group and the healthy control group. In addition, participants in the PD group were further sorted into the Cold Coagulation and Blood Stasis Pattern (CCBSP) and Qi Stagnation and Blood Stasis Pattern (QSBSP) based on TCM diagnoses and their pulses differences. Participants in the PD group received EA at maximal pain during menstruation. The primary acupuncture points selected were SP 6 and RN 3, additional RN 4 for CCBSP, and LR 3 for QSBSP. Four observation time points were 7-10 days before menstruation (T 0), maximal pain during menstruation (T 1), immediately after EA (T 2), and 30 mins after EA (T 3). The severity of pain was assessed by a visual analog scale (VAS) along with a pulse analyzer to record the variations of the pulse graph throughout the changes of pain level. RESULTS (1) The average VAS score in the PD group decreased from 5.44 ± 1.46 at T 1 to 1.72 ± 1.27 at T 2 and 1.59 ± 1.30 at T 3. The average VAS score in participants of CCBSP at T 1, T 2, and T 3 was higher than that of QSBSP. (2) At T 1, h 2, h 3, h 4, and w 1/t were all significantly increased, compared with those at T 0. At T 2, t and t 5 were both significantly increased, and w 1/t, t 1, and t 1/t were all significantly decreased, compared with those at T 1. At T 3, w 1/t, t 1, and t 1/t were all significantly increased, and t and t 5 were both significantly decreased, compared with those at T 2. (3) Comparing the pulse graphs between the healthy control and the PD groups, h 1 was significantly lower at T 0; w 1/t was significantly higher at T 1; t was significantly higher at T 2; and t 1 and t 1/t were both significantly higher at T 3 in PD group. (4) When comparing the pulse graphs between QSBSP and CCBSP, t 4/t 5 was significantly higher at T 0 and t 1 was significantly higher at T 1 in the CCBSP group. CONCLUSION EA is effective in relieving primary dysmenorrhea. Our results showed the opposite changing of the pulse graph recorded before the onset of pain to the maximum pain and that from maximum pain to pain relief. Indeed, there were differences in the recorded pulse graphs between CCBSP and QSBSP (two patterns of PD) as described in traditional Chinese pulses diagnosis. The study has been registered in the Chinese Clinical Trial Registry (registered number: ChiCTR2000040065; registered date: 2020/11/19).
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Miller DW, Roseen EJ, Stone JA, Gardiner P, Olson J, Rosen S, Wayne P, Davis R, Coeytaux R. Incorporating Acupuncture Into American Healthcare: Initiating a Discussion on Implementation Science, the Status of the Field, and Stakeholder Considerations. Glob Adv Health Med 2021; 10:21649561211042574. [PMID: 34471570 PMCID: PMC8404666 DOI: 10.1177/21649561211042574] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/21/2021] [Accepted: 08/10/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The field of implementation science is the study of methods that promote the uptake of evidence-based interventions into healthcare policy and practice. While acupuncture has gained significant traction in the American healthcare landscape, its journey has been somewhat haphazard and non-linear. METHODS In June 2019, a group of thirty diverse stakeholders was convened by the Society for Acupuncture Research with the support of a Patient Centered Outcomes Research Institute, Eugene Washington Engagement Award. This group of stakeholders represented a diverse mix of patients, providers, academicians, researchers, funders, allied health professionals, insurers, association leaders, certification experts, and military program developers. The collective engaged in discussion that explored acupuncture's status in healthcare, including reflections on its safety, effectiveness, best practices, and the actual implementation of acupuncture as seen from diverse stakeholder viewpoints. OBJECTIVES A primary goal was to consider how to utilize knowledge from the field of implementation science more systematically and intentionally to disseminate information about acupuncture and its research base, through application of methods known to implementation science. The group also considered novel challenges that acupuncture may present to known implementation processes. FINDINGS This article summarizes the initial findings of this in-person meeting of stakeholders and the ongoing discussion among the subject matter experts who authored this report. The goal of this report is to catalyze greater conversation about how the field of implementation science might intersect with practice, access, research, and policymaking pertaining to acupuncture. Core concepts of implementation science and its relationship to acupuncture are introduced, and the case for acupuncture as an Evidence Based Practice (EBP) is established. The status of the field and current environment of acupuncture is examined, and the perspectives of four stakeholder groups--patients, two types of professional practitioners, and researchers--are explored in more detail.
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Affiliation(s)
- David W. Miller
- University Hospitals, Connor Integrative Health Network, Rainbow Babies and Children’s Hospital, Cleveland, Ohio
| | - Eric J. Roseen
- Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Jennifer A.M. Stone
- Department of Anesthesia, Indiana University School of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Paula Gardiner
- Department of Family Medicine, University of Massachusetts Medical School, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Juli Olson
- U.S. Department of Veterans Affairs, Washington, District of Columbia
| | | | - Peter Wayne
- Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston, Massachusetts
| | - Robert Davis
- Society for Acupuncture Research, Burlington, Vermont
| | - Remy Coeytaux
- Center for Integrative Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - on behalf of the PCORI-SAR Stakeholder Group
- University Hospitals, Connor Integrative Health Network, Rainbow Babies and Children’s Hospital, Cleveland, Ohio
- Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
- Department of Anesthesia, Indiana University School of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
- Department of Family Medicine, University of Massachusetts Medical School, University of Massachusetts Medical School, Worcester, Massachusetts
- U.S. Department of Veterans Affairs, Washington, District of Columbia
- Crane Herbs, Austin, Texas
- Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston, Massachusetts
- Society for Acupuncture Research, Burlington, Vermont
- Center for Integrative Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Zhang NM, Vesty G, Zheng Z. Healthcare Professionals' Attitudes to Integration of Acupuncture in Western Medicine: A Mixed-Method Systematic Review. Pain Manag Nurs 2021; 22:684-693. [PMID: 33962872 DOI: 10.1016/j.pmn.2021.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/13/2020] [Accepted: 03/29/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Acupuncture is practiced in many Western countries with increasing evidence supporting its use across the healthcare system. However, this nonpharmacological intervention is yet to be widely integrated into hospitals. Fundamental to the integration of any innovation into healthcare systems is the attitudes of healthcare professionals. AIMS To explore healthcare professionals' attitudes towards acupuncture and identify the enablers and barriers to integration in the hospital setting. DESIGN This review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines; we conducted a mixed-method systematic review following Joanna Briggs Institute Reviewer's Manual 2017. DATA SOURCES PubMed, CINAHL, AMED, EMBASE, Cochrane Library, and SCOPUS were searched from their inception to December 2019 using different combination of keywords. METHODS Attitude and perception data were extracted from the articles and constructs were categorized as barriers and enablers. A convergent integrated approach was adopted whereby qualitative data themes were integrated with quantitative data constructs to generate descriptive codes around enablers and barriers at intrapersonal, interpersonal, and environmental levels according to the framework proposed by Manias et al. (2014). RESULTS Twenty-six studies comprising 19 survey and seven interview studies were identified, with 24 articles (92%) reporting positive attitudes, supporting the integration of acupuncture into Western medicine. Enablers identified were prior positive experience, belief in the treatment's efficacy, and patient demand. Barriers were lack of evidentiary knowledge or experience; lack of resources such as time, providers, and funding; and paradigm differences. Twenty studies (77%) focused on medical doctors or medical student perceptions. A conceptual framework for implementing and integrating acupuncture into Western medicine is proposed. CONCLUSION Healthcare professionals' attitudes to acupuncture are positive. Barriers to integrating acupuncture into the hospital system exist at intrapersonal, interpersonal, and external levels, with lack of resources being the key barrier. Nurses' role in facilitating integration into Western medical pain management practice provides an avenue for future research. The proposed conceptual framework provides guidance for nursing researchers interested in the role of acupuncture and integrated medicine in patient-centric, value-based healthcare.
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Affiliation(s)
- Nancy Ming Zhang
- School of Health and Biomedical Sciences, RMIT University, Bundoora West Campus, Australia; School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Fitzroy, Australia.
| | - Gillian Vesty
- School of Accounting, Information Systems and Supply Chain, RMIT University, Melbourne, Australia
| | - Zhen Zheng
- School of Health and Biomedical Sciences, RMIT University, Bundoora West Campus, Australia
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Roth I, Wells R, Highfield L, Cuccaro P, Misra S, Engebretson J. Implementing an inpatient integrative medicine consult service for children with pain: A qualitative analysis. Complement Ther Med 2021; 58:102698. [PMID: 33639250 PMCID: PMC8504152 DOI: 10.1016/j.ctim.2021.102698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 12/26/2020] [Accepted: 02/22/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Complementary and integrative medicine (CIM) therapies show clinical benefits with minimal side effects, yet challenges to effective integration in hospital settings remain. The current study aimed to better understand the process of integration of CIM therapies at a large urban pediatric hospital from the perspectives of providers, parents, and administrators. DESIGN The study employed an applied medical ethnography. SETTING The ethnography was conducted before, during, and after an Integrative Medicine Pain Consult Service (IM Pilot) was implemented at a large urban pediatric hospital during the spring of 2017. MAIN OUTCOME MEASURES Fieldwork interviews, participant observations, and document review captured aspects of the integration of CIM over a 6-month study period. Ethnographic analysis included thematic content analysis. Participants included providers (n = 10), administrators (n = 5), and parents of patients (n = 11). RESULTS Emergent themes from analysis of the interviews and field notes were organized according to the socio-ecological model. Themes included facilitating factors for CIM pain management at the intrapersonal and community levels (Alignment with Parental Perceptions of Child Needs and Provider Desire to Offer Care, Alignment of CIM with Spiritual Beliefs and Community Norms) and barriers at the interpersonal, organizational, and political levels (Inter-professional Challenges, Lack of Logistics in Place for Referrals and Triaging Patients with Pain, Lack of Remuneration/Insurance Reimbursement for Care). CONCLUSIONS To address barriers, future efforts to implement integrative pain management programs in pediatric hospital settings may consider testing implementation strategies, including engaging program champions and family advocates, providing education on CIM professions and therapies to hospital staff, and billing for provider time rather than individual CIM therapies.
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Affiliation(s)
- Isabel Roth
- Department of Management, Policy, and Community Health, University of Texas Health Science Center School of Public Health (UTHealth), Houston, TX, USA.
| | - Rebecca Wells
- Department of Management, Policy, and Community Health, University of Texas Health Science Center School of Public Health (UTHealth), Houston, TX, USA.
| | - Linda Highfield
- Department of Management, Policy, and Community Health, University of Texas Health Science Center School of Public Health (UTHealth), Houston, TX, USA.
| | - Paula Cuccaro
- Department of Health Promotion and Behavioral Science, UTHealth School of Public Health, Houston, TX, USA.
| | - Sanghamitra Misra
- Department of Academic General Pediatrics, Baylor College of Medicine, Houston, TX, USA.
| | - Joan Engebretson
- Department of Research, UTHealth Cizik School of Nursing, Houston, TX, USA.
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Ho EY, Thompson-Lastad A, Lam R, Zhang X, Thompson N, Chao MT. Adaptations to Acupuncture and Pain Counseling Implementation in a Multisite Pragmatic Randomized Clinical Trial. J Altern Complement Med 2021; 27:398-406. [PMID: 33902333 DOI: 10.1089/acm.2020.0387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objectives: As part of a pragmatic effectiveness trial of integrative pain management among inpatients with cancer, the authors sought to understand the clinical context and adaptations to implementation of two study interventions, acupuncture and pain counseling (i.e., pain education and coping skills). Design: The larger study uses a 2 × 2 factorial design with inpatients randomized to: (1) usual care (UC), (2) UC with acupuncture, (3) UC with pain counseling, and (4) UC with acupuncture and pain counseling. The study is being conducted in two hospitals (one academic and one public) and three languages (Cantonese, English, and Spanish). The authors conducted a process evaluation by interviewing study interventionists. Analysis included deductive coding to describe context, intervention, implementation, and inductive thematic coding related to intervention delivery. Results: Interviewees included seven acupuncturists and four pain counselors. Qualitative themes covered adaptations and recognizing site-specific differences that affected implementation. Interventionists adhered closely to protocols and made patient-centered adaptations that were then standardized in broader implementation (e.g., including caregivers in pain counseling sessions; working in culturally nuanced ways with non-English-speaking patients). The public hospital included more patients with recent diagnoses and advanced disease, more ethnically and linguistically diverse patients, less continuity of staffing, and shared patient rooms. At the academic medical center, more patients were familiar with integrative therapies and all were located in single rooms. Providing acupuncture to hospital staff was a key strategy to establish trust, experientially explain the intervention, and create camaraderie and staff buy-in. Conclusions: Providing nonpharmacologic interventions for a pragmatic trial requires adapting to a range of clinical factors. Site-specific factors included greater coordination and resources needed for successful implementation in the public hospital. The authors conclude that adaptation to context and individual patient needs can be done without compromising intervention fidelity and that intervention design should apply principles such as centering at the margins to reduce participation barriers for diverse patient populations.
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Affiliation(s)
- Evelyn Y Ho
- Department of Communication Studies, University of San Francisco, San Francisco, CA, USA.,Asian American Research Center on Health and University of California, San Francisco, San Francisco, CA, USA
| | - Ariana Thompson-Lastad
- Osher Center for Integrative Medicine, University of California, San Francisco, San Francisco, CA, USA.,Department of Family and Community Medicine and Division of General Internal Medicine at Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, CA, USA
| | - Rachele Lam
- Osher Center for Integrative Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Xiaoyu Zhang
- Osher Center for Integrative Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Nicole Thompson
- Osher Center for Integrative Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Maria T Chao
- Osher Center for Integrative Medicine, University of California, San Francisco, San Francisco, CA, USA.,Department of Medicine, Division of General Internal Medicine at Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, CA, USA
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Dusek JA, Rivard RL, Griffin KH, Finch MD. Significant Pain Reduction in Hospitalized Patients Receiving Integrative Medicine Interventions by Clinical Population and Accounting for Pain Medication. J Altern Complement Med 2021; 27:S28-S36. [PMID: 33788611 DOI: 10.1089/acm.2021.0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Prior research has reported that integrative medicine (IM) therapies reduce pain in inpatients, but without controlling for important variables. Here, the authors extend prior research by assessing pain reduction while accounting for each patient's pain medication status and clinical population. Methods: The initial data set consisted of 7,106 inpatient admissions, aged ≥18 years, between July 16, 2012, and December 15, 2014. Patients' electronic health records were used to obtain data on demographic, clinical measures, and pain medication status during IM. Results: The final data set included first IM therapies delivered during 3,635 admissions. Unadjusted average pre-IM pain was 5.33 (95% confidence interval [CI]: 5.26 to 5.41) and post-IM pain was 3.31 (95% CI: 3.23 to 3.40) on a 0-10 scale. Pain change adjusted for severity of illness, clinical population, sex, treatment, and pain medication status during IM was significant and clinically meaningful with an average reduction of -1.97 points (95% CI: -2.06 to -1.86) following IM. Adjusted average pain was reduced in all clinical populations, with largest and smallest pain reductions in maternity care (-2.34 points [95% CI: -2.56 to -2.14]) and orthopedic (-1.71 points [95% CI: -1.98 to -1.44]) populations. Pain medication status did not have a statistically significant association on pain change. Decreases were observed regardless of whether patients were taking narcotic medications and/or nonsteroidal anti-inflammatory drugs versus no pain medications. Conclusions: For the first time, inpatients receiving IM reported significant and clinically meaningful pain reductions during a first IM session while accounting for pain medications and across clinical populations. Future implementation research should be conducted to optimize identification/referral/delivery of IM therapies within hospitals. Clinical Trials.gov #NCT02190240.
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Affiliation(s)
- Jeffery A Dusek
- UH Connor Integrative Health Network, University Hospitals, Cleveland, OH, USA.,Department of Family Medicine and Community Health, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Rachael L Rivard
- UH Connor Integrative Health Network, University Hospitals, Cleveland, OH, USA.,Center for Evaluation and Survey Research, HealthPartners Institute, Minneapolis, MN, USA
| | - Kristen H Griffin
- Children's Minnesota Research Institute, Children's Minnesota, Minneapolis, MN, USA
| | - Michael D Finch
- Children's Minnesota Research Institute, Children's Minnesota, Minneapolis, MN, USA
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Chung VCH, Ho LTF, Leung TH, Wong CHL. Designing delivery models of traditional and complementary medicine services: a review of international experiences. Br Med Bull 2021; 137:70-81. [PMID: 33681965 DOI: 10.1093/bmb/ldaa046] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/10/2020] [Accepted: 12/07/2020] [Indexed: 11/13/2022]
Abstract
BACKGROUND The World Health Organization advocates integration of traditional and complementary medicine (T&CM) into the conventional health services delivery system. Integrating quality services in a patient-centred manner faces substantial challenges when T&CM is delivered within a health system dominated by conventional medicine. This review has synthesized international experiences of integration strategies across different contexts. SOURCES OF DATA Publications describing international experiences of delivering T&CM service in conventional healthcare settings were searched. Backward and forward citation chasing was also conducted. AREAS OF AGREEMENT Capable leaders are crucial in seeking endorsement from stakeholders within the conventional medicine hierarchy and regulatory bodies. However, patient demands for integrative care can be successful as demonstrated by cases included in this review, as can the promotion of the use of T&CM for filling effectiveness gaps in conventional medicine. Safeguarding quality and safety of the services is a priority. AREAS OF CONTROVERSY Different referral mechanisms between conventional and T&CM practitioners suit different contexts, but at a minimum, general guideline on responsibilities across the two professionals is required. Evidence-based condition-specific referral protocols with detailed integrative treatment planning are gaining in popularity. GROWING POINTS Interprofessional education is critical to establishing mutual trust and understanding between conventional clinicians and T&CM practitioners. Interprofessional communication is key to a successful collaboration, which can be strengthened by patient chart sharing, instant information exchange, and dedicated time for face-to-face interactions. AREAS TIMELY FOR DEVELOPING RESEARCH Research is needed on the optimal methods for financing integrated care to ensure equitable access, as well as in remuneration of T&CM practitioners working in integrative healthcare.
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Affiliation(s)
- Vincent C H Chung
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong.,School of Chinese Medicine, The Chinese University of Hong Kong
| | - Leonard T F Ho
- School of Chinese Medicine, The Chinese University of Hong Kong
| | - Ting Hung Leung
- School of Chinese Medicine, The Chinese University of Hong Kong
| | - Charlene H L Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong
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Bergström A, Ehrenberg A, Eldh AC, Graham ID, Gustafsson K, Harvey G, Hunter S, Kitson A, Rycroft-Malone J, Wallin L. The use of the PARIHS framework in implementation research and practice-a citation analysis of the literature. Implement Sci 2020; 15:68. [PMID: 32854718 PMCID: PMC7450685 DOI: 10.1186/s13012-020-01003-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 05/20/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The Promoting Action on Research Implementation in Health Services (PARIHS) framework was developed two decades ago and conceptualizes successful implementation (SI) as a function (f) of the evidence (E) nature and type, context (C) quality, and the facilitation (F), [SI = f (E,C,F)]. Despite a growing number of citations of theoretical frameworks including PARIHS, details of how theoretical frameworks are used remains largely unknown. This review aimed to enhance the understanding of the breadth and depth of the use of the PARIHS framework. METHODS This citation analysis commenced from four core articles representing the key stages of the framework's development. The citation search was performed in Web of Science and Scopus. After exclusion, we undertook an initial assessment aimed to identify articles using PARIHS and not only referencing any of the core articles. To assess this, all articles were read in full. Further data extraction included capturing information about where (country/countries and setting/s) PARIHS had been used, as well as categorizing how the framework was applied. Also, strengths and weaknesses, as well as efforts to validate the framework, were explored in detail. RESULTS The citation search yielded 1613 articles. After applying exclusion criteria, 1475 articles were read in full, and the initial assessment yielded a total of 367 articles reported to have used the PARIHS framework. These articles were included for data extraction. The framework had been used in a variety of settings and in both high-, middle-, and low-income countries. With regard to types of use, 32% used PARIHS in planning and delivering an intervention, 50% in data analysis, 55% in the evaluation of study findings, and/or 37% in any other way. Further analysis showed that its actual application was frequently partial and generally not well elaborated. CONCLUSIONS In line with previous citation analysis of the use of theoretical frameworks in implementation science, we also found a rather superficial description of the use of PARIHS. Thus, we propose the development and adoption of reporting guidelines on how framework(s) are used in implementation studies, with the expectation that this will enhance the maturity of implementation science.
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Affiliation(s)
- Anna Bergström
- Department of Women’s and Children’s health, Uppsala Global Health Research on Implementation and Sustainability (UGHRIS), Uppsala, Sweden
- Institute for Global Health, University College London, London, UK
| | - Anna Ehrenberg
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
- Adelaide Nursing School, University of Adelaide, Adelaide, Australia
| | - Ann Catrine Eldh
- Department of Medicine and Health, Linköping University, Linköping, Sweden
- Department of Public Health and Caring Science, Uppsala University, Uppsala, Sweden
| | - Ian D. Graham
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Kazuko Gustafsson
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
- University Library, Uppsala University, Uppsala, Sweden
| | - Gillian Harvey
- Adelaide Nursing School, University of Adelaide, Adelaide, Australia
| | - Sarah Hunter
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Alison Kitson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
- Green Templeton College, University of Oxford, Oxford, UK
| | - Jo Rycroft-Malone
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancashire, UK
| | - Lars Wallin
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
- Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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