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Roth I, Tiedt M, Brintz C, Thompson-Lastad A, Ferguson G, Agha E, Holcomb J, Gardiner P, Leeman J. Determinants of implementation for group medical visits for patients with chronic pain: a systematic review. Implement Sci Commun 2024; 5:59. [PMID: 38783388 PMCID: PMC11112917 DOI: 10.1186/s43058-024-00595-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Despite the critical need for comprehensive and effective chronic pain care, delivery of such care remains challenging. Group medical visits (GMVs) offer an innovative and efficient model for providing comprehensive care for patients with chronic pain. The purpose of this systematic review was to identify barriers and facilitators (determinants) to implementing GMVs for adult patients with chronic pain. METHODS The review included peer-reviewed studies reporting findings on implementation of GMVs for chronic pain, inclusive of all study designs. Pubmed, EMBASE, Web of Science, and Cochrane Library were searched. Studies of individual appointments or group therapy were excluded. The Mixed Methods Appraisal Tool was used to determine risk of bias. Data related to implementation determinants were extracted independently by two reviewers. Data synthesis was guided by the updated Consolidated Framework for Implementation Research. RESULTS Thirty-three articles reporting on 25 studies met criteria for inclusion and included qualitative observational (n = 8), randomized controlled trial (n = 6), quantitative non-randomized (n = 9), quantitative descriptive (n = 3), and mixed methods designs (n = 7). The studies included in this review included a total of 2364 participants. Quality ratings were mixed, with qualitative articles receiving the highest quality ratings. Common multi-level determinants included the relative advantage of GMVs for chronic pain over other available models, the capability and motivation of clinicians, the cost of GMVs to patients and the health system, the need and opportunity of patients, the availability of resources and relational connections supporting recruitment and referral to GMVs within the clinic setting, and financing and policies within the outer setting. CONCLUSIONS Multi-level factors determine the implementation of GMVs for chronic pain. Future research is needed to investigate these determinants more thoroughly and to develop and test implementation strategies addressing these determinants to promote the scale-up of GMVs for patients with chronic pain. TRIAL REGISTRATION This systematic review was registered with PROSPERO 2021 CRD42021231310 .
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Affiliation(s)
- Isabel Roth
- Department of Physical Medicine and Rehabilitation, Program on Integrative Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
| | - Malik Tiedt
- Department of Physical Medicine and Rehabilitation, Program on Integrative Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
- Department of Health Studies and Applied Educational Psychology, Program in Nutrition, Teachers College, Columbia University, New York, NY, USA
| | - Carrie Brintz
- Department of Anesthesiology, Division of Pain Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Osher Center for Integrative Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ariana Thompson-Lastad
- Department of Family and Community Medicine, Osher Center for Integrative Health, University of California San Francisco, San Francisco, CA, USA
| | - Gayla Ferguson
- Department of Management, Policy, and Community Health, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Erum Agha
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | | | - Paula Gardiner
- Department of Family Medicine, Cambridge Health Alliance, University of Massachusetts Medical School, Boston, MA, USA
| | - Jennifer Leeman
- University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, NC, USA
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Loy MH, Prisco L, Parikh C. Implementation of Virtual Integrative Oncology Shared Medical Appointment Series (VIOSMAS) Within Mixed Diagnosis Population. Integr Cancer Ther 2024; 23:15347354231223969. [PMID: 38243739 PMCID: PMC10799580 DOI: 10.1177/15347354231223969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 11/09/2023] [Accepted: 12/15/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Integrative oncology [IO] is sought-after by patients, endorsed by clinical guidelines, and valued within National Cancer Institute Centers. Shared Medical Appointments [SMA] leverage health education and social connection to deliver enhanced patient experience, population health, cost-reduction, and clinician well-being. Integrative Oncology Shared Medical Appointments increase access to integrative medicine but delivering these services via telehealth have not been evaluated. OBJECTIVE We created, and pilot tested a Virtual Integrative Oncology Shared Medical Appointment Series (VIOSMAS) to assess its feasibility, acceptability, and efficacy at an urban academic teaching hospital. METHODS The 7-session hour-long Living Well with and after Cancer series included didactics, multi-disciplinary experiential sessions, and group discussion. Topics included (1) Introduction, (2) Herbs/Botanicals/Fungi, (3) Mindful Movement, (4) Acupuncture, (5) Narratives and Nature, (6) Diet and Culinary Medicine, and (7) Vitamins/Supplements. Virtual visits via telehealth were offered to enhance patient participation during the pandemic. Outcome measures included recruitment, retention, pre/post-series patient survey and qualitative clinician feedback. RESULTS Between 9/2021 and 4/2023, 72 unique patients were recruited to 5 cohorts and had a total of 332 VIOSMAS visits. A total of 50 patients (69%) attended 4 or more of the 7-session series; 60 (83% were women); patients ranged in age from 28 to 93 years (median 66); 36 (50%) lived outside the city center; the most common cancer diagnoses were breast, lymphoma, and lung cancer. Patients were from diverse demographics. Pre-program, patients reported desiring assistance in addressing diverse symptoms including fatigue, insomnia, pain, gastrointestinal (GI) symptoms, anxiety, and depression. Post-series, patients reported that the VIOSMAS addressed their goals and symptoms; they also reported incorporating recommended lifestyle changes in diet, exercise, sleep, and stress management; they were satisfied with the number of sessions and telehealth format. The participating clinicians reported high levels of satisfaction with VIOSMAS. Revenue to the institution from VIOSMAS exceeded the revenue potential of equivalent time spent for individual visits while supporting extended physician-patient contact. CONCLUSION VIOSMAS is feasible for patients and clinicians, addresses patients' symptoms and questions about lifestyle and complementary therapies, and generates more revenue than individual visits. Larger implementation trials with appropriate comparison groups are recommended.
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Affiliation(s)
- Michelle H. Loy
- Cornell University, New York, NY, USA
- Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA
| | | | - Chiti Parikh
- Cornell University, New York, NY, USA
- Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA
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Edwards MT. Patient-reported outcomes of ayurveda consultation in relation to clinical practice data. Explore (NY) 2023; 19:721-729. [PMID: 36822960 DOI: 10.1016/j.explore.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 02/05/2023] [Accepted: 02/18/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND Clinical practice characteristics and patient-reported outcomes for Ayurveda have not been adequately studied. METHODS From January 2 thru February 28, 2022, all clients first seen during the 9-year period ending December 31, 2021, were solicited to respond to a web-based 34-item questionnaire containing 5 items targeting their general experience, 7 focusing on specific results, and 22 examining the implementation and impact of common Ayurvedic recommendations. These data were combined with practice data to develop linear regression models for the main outcome variables to assess improvement and the drivers of change. RESULTS 170 responses were received from 252 eligible clients: an overall response rate of 67%. Test-retest data for 57 respondents gave a reliability coefficient of 0.83 [0.69-0.91]. The outcomes of consultation were independent of the mode of interaction (in-person vs. telehealth) and whether pulse diagnosis information was available. 85% were at least Satisfied with their overall consultation experience. The mean difference in health from before consultation to the survey was 1.2 [1.0-1.4] on a 7-point scale. 61% reported Much to Exceptional benefit. On average, 63% rated themselves as at least Somewhat Better in terms of physical well-being, emotional well-being, sleep, digestion, bowel function, fitness and energy. These findings were buttressed by clinically significant changes on 4 clinical assessment questionnaires among 60 clients. Engaging in follow-up and adopting recommendations were associated with better outcomes. CONCLUSIONS Consultation with a practitioner of Ayurveda may provide substantial probability of durable holistic health benefit and improvement in chronic conditions with minimal risk of harm.
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Affiliation(s)
- Marc T Edwards
- School of Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina, Chapel Hill, NC, United States; Physiology and Health, Maharishi International University, Fairfield, IA, United States.
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Savaş BB, Märtens B, Cramer H, Voiss P, Longolius J, Weiser A, Ziert Y, Christiansen H, Steinmann D. Effects of an Interdisciplinary Integrative Oncology Group-Based Program to Strengthen Resilience and Improve Quality of Life in Cancer Patients: Results of a Prospective Longitudinal Single-Center Study. Integr Cancer Ther 2022; 21:15347354221081770. [PMID: 35225054 PMCID: PMC8891834 DOI: 10.1177/15347354221081770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Patients with cancer receiving oncological treatment often suffer from a reduced quality of life (QoL) and resilience. Objectives: The aim of this study was to evaluate the effect of an interdisciplinary integrative oncology group-based program on resilience and quality of life in patients with cancer during or after conventional oncological therapy. Methods: This prospective longitudinal single-center study evaluated the resilience (Resilience Scale), quality of life (EORTC-QLQ C30), anxiety, depression (Hospital Anxiety and Depression Scale), and distress levels (Distress Thermometer) of 60 patients with cancer who participated in a 10-week interdisciplinary integrative oncology group-based program during or after cancer treatment in outpatient clinics. An average of 12 (range 11-13) patients participated in each 10-week group. The program included recommendations for diet, stress management, relaxation, and exercise, as well as naturopathic self-help strategies and psychosocial support. Results: There were slight increases in global quality of life scores (week 0: 58.05 ± 20.05 vs week 10: 63.13 ± 18.51, n = 59, P = .063, d = −.25) and resilience scores (week 0: 63.50 ± 13.14 vs week 10: 66.15 ± 10.17, n = 52, P = .222, d = −.17) after the group program compared to before; however, these changes were not statistically significant and had small effect sizes. Patients with at least moderate anxiety symptoms (P = .022, d = .42) and low resilience (P = .006, d = −.54) benefited most from the program. The patients reported no relevant side effects or adverse events from the program. Conclusions: No significant effects on global quality of life or resilience were found in the general sample; notably, patients with anxiety and low initial resilience benefited the most from the program.
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Affiliation(s)
- Burcu Babadağ Savaş
- Department of Radiation Therapy and Special Oncology, Medical School Hannover, Hannover, Germany
| | - Bettina Märtens
- Department of Radiation Therapy and Special Oncology, Medical School Hannover, Hannover, Germany
| | | | - Petra Voiss
- University of Duisburg-Essen, Essen, Germany
| | - Julia Longolius
- Department of Radiation Therapy and Special Oncology, Medical School Hannover, Hannover, Germany
| | - Axel Weiser
- Department of Organisation, Innovation and Quality of Management, Medical School Hannover, Hannover, Germany
| | - Yvonne Ziert
- Institute of Biometrics, Medical School Hannover, Hannover, Germany
| | - Hans Christiansen
- Department of Radiation Therapy and Special Oncology, Medical School Hannover, Hannover, Germany
| | - Diana Steinmann
- Department of Radiation Therapy and Special Oncology, Medical School Hannover, Hannover, Germany
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Haun JN, Paykel J, Fowler CA, Lapcevic WA, Panaite V, Alman AC, Melillo C, Venkatachalam HH, French DD. Preliminary Evidence on the Association of Complementary and Integrative Health Care Program Participation and Medical Cost in Veterans. Mil Med 2022; 188:usab567. [PMID: 35064265 DOI: 10.1093/milmed/usab567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 10/27/2021] [Accepted: 01/13/2022] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Transforming Health and Resilience through Integration of Values-based Experiences (THRIVE) is a complimentary and integrative health program. THRIVE is delivered through shared medical appointments where participants engage in provider-led education and group discussion on wellness-related topics. THRIVE has been associated with improved patient-reported outcomes in a female veteran cohort. This quality improvement study evaluated the association between THRIVE participation and Veterans Health Administration (VHA) healthcare costs across a 1 year period. MATERIALS AND METHODS A cohort study design (n = 184) used VHA administrative data to estimate the cost difference between 1 year pre- and post-THRIVE participation. The 1 year post-cost of the THRIVE cohort was then compared to the 1 year cost of a quasi-experimental waitlist control group (n = 156). Data sources included VHA administrative and electronic health records. RESULTS Patients were roughly 51 years old, were typically White/Caucasian, and had a service priority level representing catastrophic disability. The adjusted post-THRIVE cost was $26,291 [95% confidence interval (CI): $23,014-29,015]; $1,720 higher than the previous year's cost but was not statistically significant (P = 0.289). However, a comparison between the THRIVE cohort and a group of waitlist THRIVE patients (n = 156) the intervention group on average was $8,108 more than the waitlist group (95% CI: $3,194-14,005; P < 0.01). CONCLUSIONS In summary, data analysis of veterans' annual healthcare cost trajectories were inconclusive. This preliminary study produced mixed results requiring more research with larger samples and randomized control trial methodology. Evidence of whether the THRIVE intervention can maintain cost effectiveness while maintaining its supported evidence of healthcare quality is needed.
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Greco CM, Gaylord SA, Faurot K, Weinberg JM, Gardiner P, Roth I, Barnhill JL, Thomas HN, Dhamne SC, Lathren C, Baez JE, Lawrence S, Neogi T, Lasser KE, Castro MG, White AM, Simmons SJ, Ferrao C, Binda DD, Elhadidy N, Eason KM, McTigue KM, Morone NE. The design and methods of the OPTIMUM study: A multisite pragmatic randomized clinical trial of a telehealth group mindfulness program for persons with chronic low back pain. Contemp Clin Trials 2021; 109:106545. [PMID: 34455111 PMCID: PMC8691659 DOI: 10.1016/j.cct.2021.106545] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 01/04/2023]
Abstract
Mindfulness-based stress reduction (MBSR) is an evidence-based non-pharmacological approach for chronic low back pain (cLBP), yet it is not readily available or reimbursable within primary care clinics. Primary care providers (PCPs) who wish to avoid prescribing opioids and other medications typically have few options for their cLBP patients. We present the protocol of a pragmatic clinical trial entitled OPTIMUM (Optimizing Pain Treatment In Medical settings Using Mindfulness). OPTIMUM is offered online via telehealth and includes medical group visits (MGV) with a PCP and a mindfulness meditation intervention modeled on MBSR for persons with cLBP. In diverse health-care settings in the US, such as a safety net hospital, federally qualified health centers, and a large academic health system, 450 patients will be assigned randomly to the MGV + MBSR or to usual PCP care alone. Participants will complete self-report surveys at baseline, following the 8-week program, and at 6- and 12-month follow-up. Health care utilization data will be obtained through electronic health records and via brief monthly surveys completed by participants. The primary outcome measure is the PEG (Pain, enjoyment, and general activity) at the 6-month follow-up. Additionally, we will assess psychological function, healthcare resource use, and opioid prescriptions. This trial, which is part of the NIH HEAL Initiative, has the potential to enhance primary care treatment of cLBP by combining PCP visits with a non-pharmacological treatment modeled on MBSR. Because it is offered online and integrated into primary care, it is expected to be scalable and accessible to underserved patients. Clinical Trials.gov: NCT04129450.
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Affiliation(s)
- Carol M Greco
- Department of Psychiatry and Physical Therapy, University of Pittsburgh School of Medicine and School of Health and Rehabilitation Sciences, PA, United States of America
| | - Susan A Gaylord
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, North Carolina, United States of America
| | - Kim Faurot
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, North Carolina, United States of America
| | - Janice M Weinberg
- Department of Biostatistics, Boston University School of Public Health, MA, United States of America
| | - Paula Gardiner
- Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Isabel Roth
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, North Carolina, United States of America
| | - Jessica L Barnhill
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, North Carolina, United States of America
| | - Holly N Thomas
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, PA, United States of America
| | - Sayali C Dhamne
- Boston University School of Public Health, Boston Medical Center, MA, United States of America
| | - Christine Lathren
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, North Carolina, United States of America
| | - Jose E Baez
- General Internal Medicine, Boston Medical Center, MA, United States of America
| | - Suzanne Lawrence
- Department of Psychiatry, University of Pittsburgh, PA, United States of America
| | - Tuhina Neogi
- Section of Rheumatology, Department of Medicine, Boston University School of Medicine, United States of America
| | - Karen E Lasser
- Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States of America
| | - Maria Gabriela Castro
- Siler City Community Health Center, Piedmont Health Services, Department of Family Medicine, University of North Carolina at Chapel Hill, NC, United States of America
| | - Anna Marie White
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, PA, United States of America
| | | | - Cleopatra Ferrao
- General Internal Medicine, Boston Medical Center, MA, United States of America
| | - Dhanesh D Binda
- Boston University School of Medicine, Boston, MA, United States of America
| | - Nandie Elhadidy
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, North Carolina, United States of America
| | - Kelly M Eason
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, North Carolina, United States of America
| | - Kathleen M McTigue
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, PA, United States of America
| | - Natalia E Morone
- Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States of America.
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