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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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Incollingo Rodriguez AC, Nephew BC, Polcari JJ, Melican V, King JA, Gardiner P. Race-Based Differences in the Response to a Mindfulness Based Integrative Medical Group Visit Intervention for Chronic Pain. GLOBAL ADVANCES IN INTEGRATIVE MEDICINE AND HEALTH 2024; 13:27536130241254793. [PMID: 38765807 PMCID: PMC11100402 DOI: 10.1177/27536130241254793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 04/22/2024] [Accepted: 04/26/2024] [Indexed: 05/22/2024]
Abstract
Background Chronic pain is one of the most common drivers of healthcare utilization and a marked domain for health disparities, as African American/Black populations experience high rates of chronic pain. Integrative Medical Group Visits (IMGV) combine mindfulness techniques, evidence-based integrative medicine, and medical group visits. In a parent randomized controlled trial, this approach was tested as an adjunct treatment in a diverse, medically underserved population with chronic pain and depression. Objective To determine race-based heterogeneity in the effects of a mindfulness based treatment for chronic pain. Methods This secondary analysis of the parent trial assessed heterogeneity of treatment effects along racialized identity in terms of primary patient-reported pain outcomes in a racially diverse sample suffering from chronic pain and depression. The analytic approach examined comorbidities and sociodemographics between racialized groups. RMANOVAs examined trajectories in pain outcomes (average pain, pain severity, and pain interference) over three timepoints (baseline, 9, and 21 weeks) between participants identifying as African American/Black (n = 90) vs White (n = 29) across both intervention and control conditions. Results At baseline, African American/Black participants had higher pain severity and had significantly different age, work status, and comorbidity profiles. RMANOVA models also identified significant race-based differences in the response to the parent IMGV intervention. There was reduced pain severity in African American/Black subjects in the IMGV condition from baseline to 9 weeks. This change was not observed in White participants over this time period. However, there was a reduction in pain severity in White participants over the subsequent interval from 9 to 21 week where IMGV had no significant effect in African American/Black subjects during this latter time period. Conclusion Interactions between pain and racialization require further investigation to understand how race-based heterogeneity in the response to integrative medicine treatments for chronic pain contribute to the broader landscape of health inequity.
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Affiliation(s)
| | - Benjamin C. Nephew
- Department of Biology and Biotechnology, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Justin J. Polcari
- Department of Biology and Biotechnology, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Veronica Melican
- Department of Biology and Biotechnology, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Jean A. King
- Department of Biology and Biotechnology, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Paula Gardiner
- Center for Mindfulness and Compassion, Cambridge Health Alliance, Cambridge MA, USA
- Department. of Family Medicine, University of Massachusetts Chan Medical School, Worcester, MA, 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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Malika N, Herman PM, Whitley M, Coulter I, Maiers M, Chesney M, Rogers R. Qualitative Assessment CIH Institutions' Engagement With Underserved Communities to Enhance Healthcare Access and Utilization. GLOBAL ADVANCES IN INTEGRATIVE MEDICINE AND HEALTH 2024; 13:27536130241244759. [PMID: 38545335 PMCID: PMC10966973 DOI: 10.1177/27536130241244759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/07/2024] [Accepted: 03/13/2024] [Indexed: 05/26/2024]
Abstract
Background In North America, there is a notable underutilization of complementary and integrative health approaches (CIH) among non-White and marginalized communities. Objectives This study sought to understand how CIH educational instutitions are proactively working to redress this disparity in access and utilization among these communities. Methods We conducted interviews with 26 key informants, including presidents, clinicians, and research deans across 13 CIH educational institutions across the US and Canada. Thematic analysis included deductive codes based on the interview guide during interview scripts review. Results Six themes were identified: (1) CIH institutions often had a long and varied history of community engaged care through partnerships to increase access and utilization; (2) CIH institutions' long-standing community outreach had been intentionally designed; (3) CIH institutions provided an array of services to a wide range of demographics and communities; (4) addressing healthcare access and utilization through community partnerships had a strong positive impact; (5) funding, staffing and COVID-19 were significant challenges that impeded efforts to increase CIH access through community engaged work; (6) identified gaps in community partnerships and services to increase access and utilization were recognized. Conclusion These findings underscore significant efforts made to enhance healthcare access and utilization among marginalized, underserved, and racial and ethnic communities. However, barriers such as funding constraints, resource allocation, and the need for proper measurement and accountability hinder proactive initiatives aimed at redressing disparities in CIH utilization within these communities.
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Affiliation(s)
| | | | | | | | - Michele Maiers
- Northwestern Health Sciences University, Bloomington, MN, USA
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Kiefer D, Eby K, Zaborek J, Goldstein E. Integrative Group Visits for Sleep Disturbance: A Brief Report. GLOBAL ADVANCES IN INTEGRATIVE MEDICINE AND HEALTH 2024; 13:27536130241260016. [PMID: 38846754 PMCID: PMC11155354 DOI: 10.1177/27536130241260016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/14/2024] [Accepted: 05/20/2024] [Indexed: 06/09/2024]
Abstract
Background There is limited research on the efficacy of group visits using integrative treatment modalities and for people whose chief concern is sleep disturbance. This quality improvement project delivered integrative health content in group visits for people with self-reported sleep disturbance. Objective To describe an integrative group visit for sleep disturbance, explore the evaluation process for several outcomes, and report on lessons learned. Methods A group visit series involved 4 sessions over the course of 1 month, covering integrative health topics such as acupuncture, mind-body therapies, and herbal medicine. Participants were administered 2 validated surveys (PSQI and PROMIS-29) at baseline and 1- and 3-months post-intervention. Results In 4 4 week GV series,18 people participated in-person pre-pandemic, and 5 people participated virtually during the pandemic. The mean age for the entire cohort was 63.2 years. Of the 23 participants, 18 (78%) attended all 4 GV sessions within their series. Conclusion Preliminary findings from this study suggest that an integrative group visit approach to sleep disturbance is feasible yet would benefit from a more rigorous investigation.
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Affiliation(s)
- David Kiefer
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Katherine Eby
- Department of Family Medicine and Community Health, Center for Wellness, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Jennifer Zaborek
- Department of Biostatistics and Medical Informatics, University of Wisconsin Health University Hospital, Madison, WI, USA
| | - Ellen Goldstein
- Department of Population Health Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL, USA
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McDermott K, Levey N, Brewer J, Ehmann M, Hooker JE, Pasinski R, Yousif N, Raju V, Gholston M, Greenberg J, Ritchie CS, Vranceanu AM. Improving Health for Older Adults With Pain Through Engagement: Protocol for Tailoring and Open Pilot Testing of a Mind-Body Activity Program Delivered Within Shared Medical Visits in an Underserved Community Clinic. JMIR Res Protoc 2023; 12:e52117. [PMID: 38157234 PMCID: PMC10787331 DOI: 10.2196/52117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Chronic musculoskeletal pain is prevalent and disabling among older adults in underserved communities. Psychosocial pain management is more effective than pharmacological treatment in older adults. However, underserved community clinics often lack psychosocial treatments, in part because of a lack of trained providers. Shared medical appointments, in which patients undergo brief medical evaluation, monitoring, counseling, and group support, are an efficacious and cost-effective method for chronic disease management in underserved clinics, reducing the need for specialized providers. However, shared medical visits are often ineffective for chronic pain, possibly owing to lack of inclusion of skills most relevant for older adults (eg, pacing to increase engagement in daily activities). OBJECTIVE We have described the protocol for the development and initial pilot effectiveness testing of the GetActive+ mind-body activity intervention for older adults with chronic pain. GetActive+ was adapted from GetActive, an evidence-based intervention that improved pain outcomes among mostly affluent White adults. We aim to establish the initial feasibility, acceptability, fidelity, and effectiveness of GetActive+ when delivered as part of shared medical appointments in a community clinic. METHODS We conducted qualitative focus groups and individual interviews with providers (n=25) and English-speaking older adults (aged ≥55 y; n=18) with chronic pain to understand the pain experience in this population, perceptions about intervention content, and barriers to and facilitators of intervention participation and implementation in this setting. Qualitative interviews with Spanish-speaking older adults are in progress and will inform a future open pilot of the intervention in Spanish. We are currently conducting an open pilot study with exit interviews in English (n=30 individuals in total). Primary outcomes are feasibility (≥75% of patients who are approached agree to participate), acceptability (≥75% of patients who enrolled complete 8 out of 10 sessions; qualitative), and fidelity (≥75% of session components are delivered as intended). Secondary outcomes include physical function-self-reported, performance based (6-minute walk test), and objective (step count)-and emotional function (depression and anxiety). Other assessments include putative mechanisms (eg, mindfulness and pain catastrophizing). RESULTS We began enrolling participants for the qualitative phase in November 2022 and the open pilot phase in May 2023. We completed the qualitative phase with providers and English-speaking patients, and the results are being analyzed using a hybrid, inductive-deductive approach. We conducted rapid analysis of these data to develop GetActive+ before the open pilot in English, including increasing readability and clarity of language, reducing the number of skills taught to increase time for individual check-ins and group participation, and increasing experiential exercises for skill uptake. CONCLUSIONS We provide a blueprint for the refinement of a mind-body activity intervention for older adults with chronic pain in underserved community clinics and for incorporation within shared medical visits. It will inform a future, fully powered, effectiveness-implementation trial of GetActive+ to help address the chronic pain epidemic among older adults. TRIAL REGISTRATION ClinicalTrials.gov NCT05782231; https://clinicaltrials.gov/study/NCT05782231. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52117.
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Affiliation(s)
- Katherine McDermott
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Nadine Levey
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Julie Brewer
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Madison Ehmann
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Julia E Hooker
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Roger Pasinski
- Massachusetts General Hospital Revere HealthCare Center, Revere, MA, United States
| | - Neda Yousif
- Massachusetts General Hospital Revere HealthCare Center, Revere, MA, United States
| | - Vidya Raju
- Massachusetts General Hospital Revere HealthCare Center, Revere, MA, United States
| | - Milton Gholston
- Massachusetts General Hospital Revere HealthCare Center, Revere, MA, United States
| | - Jonathan Greenberg
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Christine S Ritchie
- Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, MA, United States
| | - Ana-Maria Vranceanu
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
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Hunter J, Harnett JE, Chan WJJ, Pirotta M. What is integrative medicine? Establishing the decision criteria for an operational definition of integrative medicine for general practice health services research in Australia. Integr Med Res 2023; 12:100995. [PMID: 37915439 PMCID: PMC10616154 DOI: 10.1016/j.imr.2023.100995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 11/03/2023] Open
Abstract
Background Operational definitions outline how a conceptual definition will be measured for consistent, reproducible data collection and analysis. This article reports the decision criteria that will be used for an operational definition of integrative medicine (IM) in a secondary analysis of an Australian national survey of general practitioner activity. Methods A multidisciplinary team applied an iterative approach, informed by expert knowledge and literature reviews to establish decision criteria for categorizing the terms in the Australian clinical interface terminology of the International Classification of Primary Care, second edition (ICPC-2 PLUS) and the Coding Atlas for Pharmaceutical Substances, according to whether they reflected IM, conventional/mainstream medicine (MM), or both IM and MM (IM/MM). Results The final decision criteria categorized all terms for examinations, investigations, advice/counselling, and drugs with synthetic ingredients, and terms for referrals to secondary care services and healthcare practitioners that are not a traditional or complementary medicine practitioner as MM. Terms that could apply to both styles of clinical practice (e.g., preventive health, lifestyle medicine, psychosocial and some drugs with natural ingredients) were categorised as IM/MM. The remaining terms, that mostly reflected the World Health Organization's theoretical definitions of traditional and complementary medicine, were categorized as IM. Conclusion Differentiating between integrative and conventional/mainstream medicine in general practice is context specific and not always possible. The category IM/MM proposes integrative medicine as an extension, rather than an alternative. The rationale for the integrative medicine operational definition has relevance for researchers and health services in Australia, and internationally.
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Affiliation(s)
- Jennifer Hunter
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Australia
- Health Research Group Pty. Limited, Sydney, Australia
| | - Joanna E. Harnett
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Wai-Jo Jocelin Chan
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Marie Pirotta
- Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia
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Liou KT, Ashare R, Worster B, Jones KF, Yeager KA, Acevedo AM, Ferrer R, Meghani SH. SIO-ASCO guideline on integrative medicine for cancer pain management: implications for racial and ethnic pain disparities. JNCI Cancer Spectr 2023; 7:pkad042. [PMID: 37307074 PMCID: PMC10336300 DOI: 10.1093/jncics/pkad042] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/02/2023] [Indexed: 06/13/2023] Open
Abstract
Racial and ethnic disparities in pain management pose major challenges to equitable cancer care delivery. These disparities are driven by complex interactions between patient-, provider-, and system-related factors that resist reductionistic solutions and require innovative, holistic approaches. On September 19, 2022, the Society for Integrative Oncology and the American Society of Clinical Oncology published a joint guideline to provide evidence-based recommendations on integrative medicine for cancer pain management. Integrative medicine, which combines conventional treatments with complementary modalities from cultures and traditions around the world, are uniquely equipped to resonate with diverse cancer populations and fill existing gaps in pain management. Although some complementary modalities, such as music therapy and yoga, lack sufficient evidence to make a specific recommendation, other modalities, such as acupuncture, massage, and hypnosis, demonstrated an intermediate level of evidence, resulting in moderate strength recommendations for their use in cancer pain management. However, several factors may hinder real-world implementation of the Society for Integrative Oncology and the American Society of Clinical Oncology guideline and must be addressed to ensure equitable pain management for all communities. These barriers include, but are not limited to, the lack of insurance coverage for many complementary therapies, the limited diversity and availability of complementary therapy providers, the negative social norms surrounding complementary therapies, the underrepresentation of racial and ethnic subgroups in the clinical research of complementary therapies, and the paucity of culturally attuned interventions tailored to diverse individuals. This commentary examines both the challenges and the opportunities for addressing racial and ethnic disparities in cancer pain management through integrative medicine.
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Affiliation(s)
- Kevin T Liou
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rebecca Ashare
- Department of Psychology, State University of New York at Buffalo, Buffalo, NY, USA
| | - Brooke Worster
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Katie F Jones
- Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, MA, USA
| | - Katherine A Yeager
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Amanda M Acevedo
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Rebecca Ferrer
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Salimah H Meghani
- Department of Biobehavioral Health Science, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
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Mata R, Bankole AO, Barnhill J, Roth I. A descriptive exploration of younger and older adults' experiences of Integrative Medical Group Visits for Long COVID. AGING AND HEALTH RESEARCH 2023; 3:100137. [PMID: 37799164 PMCID: PMC10554753 DOI: 10.1016/j.ahr.2023.100137] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Introduction Long COVID disproportionately affects older adults. Individuals with Long COVID (LC) often experience symptoms that severely impact quality of life, and treatment approaches are still evolving. The Integrative Medical Group Visit (IMGV) model is an evidence-based approach that may be useful to treat patients with LC; however, there is limited evidence describing the experience and/or feasibility of using IMGV for LC treatment, especially among the older adult population. The purpose of this study is to describe older and younger adults' experiences of both having LC and participating in a virtually delivered IMGV for LC. Methods This is a secondary analysis of qualitative data from a parent study examining the experiences of participants in a virtually delivered IMGV for patients with LC. Patients participated in semi-structured interviews before and after 8 weekly IMGV sessions. Thematic analysis was used to analyze interview data. Results Overall, 21 pre-interviews and 17 post-interviews were collected. Thematic analysis of patient interviews by age group resulted in three themes that each contained similarities and differences between the younger and older adult participants. These themes included: (1) experiences of LC (2) feelings about the future (3) experiences of the pilot IMGV on LC. Conclusion This study provides critical context for clinicians who treat older adults with LC. Results support virtually delivered IMGVs as a potentially feasible option for both older and younger adults who want to apply an integrative approach to their LC treatment. Findings from this study will inform future research on IMGV for LC treatment.
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Affiliation(s)
- Raveena Mata
- The Ohio State University, College of Medicine, USA
- University of North Carolina, Chapel Hill, USA
| | | | | | - Isabel Roth
- University of North Carolina, Chapel Hill, USA
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10
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Gerontakos S, Leach M, Steel A, Wardle J. Feasibility and efficacy of implementing group visits for women's health conditions: a systematic review. BMC Health Serv Res 2023; 23:549. [PMID: 37237255 DOI: 10.1186/s12913-023-09582-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 05/18/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Shared medical appointments, also known as group visits, are a feasible and well-accepted approach for women receiving antenatal care, yet the feasibility and efficacy of this approach for female-specific reproductive conditions is uncertain. OBJECTIVE The aim of this systematic review was to (a) determine the feasibility of group visits in adults with any female-specific reproductive condition, and (b) identify whether delivering group care for these conditions impacts clinical outcomes. METHOD Six databases and two clinical trials registries were searched from inception through to 26 January 2022 for original research examining group medical visits or group consultation interventions for adults with female reproductive conditions or pathologic conditions specific to the female reproductive system. RESULTS The search yielded 2584 studies, of which four met the inclusion criteria. Included studies sampled women with breast cancer, chronic pelvic pain, polycystic ovary syndrome and gynaecological cancers. Studies reported high levels of patient satisfaction, with participants indicating their expectations had been met or exceeded. The impact of group visits on clinical outcomes was inconclusive however. DISCUSSION/CONCLUSIONS The studies in this review indicate delivery of female-specific healthcare via a group model maybe feasible and well-accepted. The review provides a solid basis for proposing larger and longer studies on group visits for female reproductive conditions. TRIAL REGISTRATION The review protocol was registered with PROSPERO (CRD42020196995).
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Affiliation(s)
- Sophia Gerontakos
- National Centre for Naturopathic Medicine, Southern Cross University, A Block, Military Road, Lismore, NSW, 2480, Australia.
| | - Matthew Leach
- National Centre for Naturopathic Medicine, Southern Cross University, A Block, Military Road, Lismore, NSW, 2480, Australia
| | - Amie Steel
- Faculty of Health, University of Technology Sydney, Australian Research Centre in Complementary and Integrative Medicine, Broadway, NSW, Australia
| | - Jon Wardle
- National Centre for Naturopathic Medicine, Southern Cross University, A Block, Military Road, Lismore, NSW, 2480, Australia
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Tiedt MK, Kavalakatt BM, Chilcoat A, Barnhill JL, Roth IJ. Aligning Preprofessional Student Experiences in Integrative Group Medical Visits with Integrative Medicine Core Competencies. INTEGRATIVE MEDICINE REPORTS 2022; 1:186-189. [PMID: 36561147 PMCID: PMC9756384 DOI: 10.1089/imr.2022.0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/31/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Malik K. Tiedt
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,*Address correspondence to: Malik K. Tiedt, Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, School of Medicine, CB #7200, Chapel Hill, NC 27599-9500, USA.
| | - Bethany M. Kavalakatt
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Aisha Chilcoat
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jessica L. Barnhill
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Isabel J. Roth
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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12
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Binda DD, Weinberg JM, Nguyen T, Morone NE. Characterizing Interprofessional Collaboration and Referral to Mindfulness-Based Stress Reduction Programs. Glob Adv Health Med 2022; 11:2164957X221126484. [PMID: 36118601 PMCID: PMC9478712 DOI: 10.1177/2164957x221126484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background In 2017, the American College of Physicians (ACP) designated Mindfulness-Based Stress
Reduction (MBSR), an eight-week group program, as first-line non-pharmacological
treatment for chronic low back pain. However, interprofessional collaboration between
mindfulness instructors and Primary Care Providers (PCP) remains largely unknown. Objective We developed a survey to assess communication between mindfulness instructors and PCPs,
identify predictors of referral to MBSR, and determine areas where interventions could
increase patient access to MBSR. Methods The 25-question survey was sent via email to PCPs at the Division of General Internal
Medicine, University of Pittsburgh, PA, the Piedmont Health Services Family Medicine
Section, Chapel Hill, NC, the Boston Medical Center General Internal Medicine and Family
Medicine Sections, Boston, MA, and the UMass Memorial Medical Center Family Medicine
Section, Worcester, MA. We used descriptive statistics and logistic regression to
analyze the data. Results Among 118 eligible respondents, 85 (72.0%) were female PCPs, mean age was approximately
41.5±10.1, and the majority (65.2%) had been in medical practice ≤10 years. Of these
PCPs, 83 (70.1%) reported familiarity with MBSR (95% CI: 62.1, 78.5), and 49 (59.0%) of
them referred patients at least yearly. Of those who referred, 8 (16.3%) reported
collaboration with mindfulness instructors. PCPs who were quite a bit or very much
familiar with MBSR had 5.10 (1.10, 22.50) times the odds (P=.03), and those who were 50
years or younger had 3.30 times the odds (P=.04) of referring patients to MBSR.
Frequency of PCPs’ personal practice of mindfulness was not significantly associated
with referrals (P=.30). Conclusion This is the first study to assess interprofessional collaboration between mindfulness
instructors and PCPs. Suggestions for a potential integrative health care model are
included; further studies on methods to augment communication and education are
warranted to improve the referral process and ultimately increase accessibility and
utilization of mindfulness-based programs.
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Affiliation(s)
- Dhanesh D Binda
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.,Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Janice M Weinberg
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Tra Nguyen
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.,Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Natalia E Morone
- Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
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13
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Nephew BC, Incollingo Rodriguez AC, Melican V, Polcari JJ, Nippert KE, Rashkovskii M, Linnell LB, Hu R, Ruiz C, King JA, Gardiner P. Depression predicts chronic pain interference in racially diverse, income-disadvantaged patients. PAIN MEDICINE 2021; 23:1239-1248. [PMID: 34908146 DOI: 10.1093/pm/pnab342] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 11/15/2021] [Accepted: 11/19/2021] [Indexed: 11/14/2022]
Abstract
BACKGROUND Chronic pain is one of the most common reasons adults seek medical care in the US, with prevalence estimates ranging from 11% to 40%. Mindfulness meditation has been associated with significant improvements in pain, depression, physical and mental health, sleep, and overall quality of life. Group medical visits are increasingly common and are effective at treating myriad illnesses, including chronic pain. Integrative Medical Group Visits (IMGV) combine mindfulness techniques, evidence based integrative medicine, and medical group visits and can be used as adjuncts to medications, particularly in diverse underserved populations with limited access to non-pharmacological therapies. OBJECTIVE AND DESIGN The objective of the present study was to use a blended analytical approach of machine learning and regression analyses to evaluate the potential relationship between depression and chronic pain in data from a randomized clinical trial of IMGV in diverse, income disadvantaged patients suffering from chronic pain and depression. METHODS The analytical approach used machine learning to assess the predictive relationship between depression and pain and identify and select key mediators, which were then assessed with regression analyses. It was hypothesized that depression would predict the pain outcomes of average pain, pain severity, and pain interference. RESULTS Our analyses identified and characterized a predictive relationship between depression and chronic pain interference. This prediction was mediated by high perceived stress, low pain self-efficacy, and poor sleep quality, potential targets for attenuating the adverse effects of depression on functional outcomes. CONCLUSIONS In the context of the associated clinical trial and similar interventions, these insights may inform future treatment optimization, targeting, and application efforts in racialized, income disadvantaged populations, demographics often neglected in studies of chronic pain. TRIAL REGISTRATION NCT from clinicaltrials.gov: 02262377.
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Affiliation(s)
- Benjamin C Nephew
- Dept. of Biology and Biotechnology, Worcester Polytechnic Institute, Worcester, Massachusetts
| | | | - Veronica Melican
- Dept. of Biology and Biotechnology, Worcester Polytechnic Institute, Worcester, Massachusetts
| | - Justin J Polcari
- Dept. of Biology and Biotechnology, Worcester Polytechnic Institute, Worcester, Massachusetts
| | - Kathryn E Nippert
- Dept. of Social Science and Policy Studies, Worcester Polytechnic Institute, Worcester, Massachusetts
| | - Mikhail Rashkovskii
- Dept. of Biology and Biotechnology, Worcester Polytechnic Institute, Worcester, Massachusetts
| | - Lilly-Beth Linnell
- Dept. of Biology and Biotechnology, Worcester Polytechnic Institute, Worcester, Massachusetts
| | - Ruofan Hu
- Computer Science Dept., Worcester Polytechnic Institute, Worcester, Massachusetts
| | - Carolina Ruiz
- Computer Science Dept., Worcester Polytechnic Institute, Worcester, Massachusetts
| | - Jean A King
- Dept. of Biology and Biotechnology, Worcester Polytechnic Institute, Worcester, Massachusetts
| | - Paula Gardiner
- Dept. of Family Medicine and Community Health, UMass Medical School, Worcester, Massachusetts
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14
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Sommers E, Vinjamury SP, Noborikawa J. Pain and Opioid Use: Evidence for Integrating Acupuncture Into Treatment Planning. Glob Adv Health Med 2021; 10:21649561211042571. [PMID: 34458014 PMCID: PMC8392795 DOI: 10.1177/21649561211042571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/03/2021] [Accepted: 08/10/2021] [Indexed: 11/18/2022] Open
Abstract
The epidemics of pain and opioid use pose unique challenges. Comprehensive approaches are required to address minds, bodies and spirits of individuals who live with pain and/or opioid use. The lack of an effective “quick fix” for either condition necessitates developing effective, innovative and multi-disciplinary avenues for treatment. This analytic article reviews epidemiological and demographic factors associated with pain and with opioid use and additional challenges posed by the Covid-19 epidemic. Several large-scale studies and meta-analyses have examined the role of acupuncture as a nonpharmacological approach to pain management as well as a component of comprehensive strategies to address opioid use disorder. We review and describe these in the context of safety, effectiveness, access and cost-related factors. With one in four U.S. hospitals as well as 88% of Veterans Health Administration facilities incorporating acupuncture, the feasibility of mobilizing and scaling up these treatment resources is being developed and demonstrated. We also identify potential facilitators and barriers to implementing acupuncture treatment. As part of a multi-disciplinary approach to pain management and/or opioid use disorder, we suggest that integrating acupuncture into treatment protocols may represent a viable strategy that is based on and consistent with public health principles.
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Affiliation(s)
- Elizabeth Sommers
- Integrative Medicine and Health Disparities Program, Family Medicine Department, Boston Medical Center, Boston, Massachusetts.,Family Medicine Department, Boston University School of Medicine, Boston, Massachusetts
| | - Sivarama Prasad Vinjamury
- Eastern Medicine Department, Southern California University of Health Sciences, Whittier, California
| | - Jennifer Noborikawa
- Eastern Medicine Department, Southern California University of Health Sciences, Whittier, California
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15
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Lloyd I, Gerontakos S, Cardozo V. Naturopathic community clinics: an international cross-sectional survey. BMC Health Serv Res 2021; 21:815. [PMID: 34391427 PMCID: PMC8364026 DOI: 10.1186/s12913-021-06806-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 07/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally, naturopathic practitioners offer services in 98 countries, reaching every world region and providing care to diverse populations for a range of acute and chronic health conditions. Community clinics provide free or low-cost healthcare services and play a key role in providing necessary primary healthcare for underprivileged or marginalized populations. However, the reach and impact of naturopathic community clinics (NCCs) has not yet been examined. The aim of this study was to identify the characteristics of NCCs around the world, determine the types of services they offer and provide insight into the populations being served. METHODS Two online cross-sectional surveys were administered using purposive and snowball sampling. A 6-item screening survey was administered first to identify clinics and institutions who fit the criteria for NCC services, followed by a 40-item follow-up survey. Descriptive analysis was conducted using frequencies and means. RESULTS The screening survey returned a total of 37 responses from six world regions. Of those respondents who indicated involvement in NCCs, 74% went on to complete the follow-up survey. The majority of the responding NCCs were located in North America (50%), followed by Western Pacific (17%), Europe (10%), Asia (13%), Latin America (7%) and Africa (3%). The vast majority (71%) of the NCCs that have been in operation for more than 10 years are located in North America, while 43% of the NCCs that have been operational less than 5 years are in the Western Pacific Region. 80% of the responding NCCs were affiliated with a naturopathic school. The majority of respondents (76%) mentioned that they aim to serve underserved and/or marginalized populations, with 34% indicating that their target population is low-income families, 21% focusing on serving immigrants and refugees, 21% on serving people experiencing homelessness, 14% on serving Indigenous peoples, 14% on serving those with specific gender differences, 10% on serving seniors and 10% on serving drug users. CONCLUSION The naturopathic profession offers free or significantly low-cost naturopathic services through community clinics around the world. The findings of this survey provide insight into the important role of the naturopathic profession in primary health care and provide rationale for exploring this topic in greater detail.
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Affiliation(s)
- Iva Lloyd
- World Naturopathic Federation, 20 Holly Street, Toronto, Canada
| | - Sophia Gerontakos
- NCNM, Southern Cross University, Military Rd, Lismore, NSW, Australia.
| | - Valentina Cardozo
- Canadian College of Naturopathic Medicine, 1255 Sheppard Ave East, Toronto, Canada
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16
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Roth IJ, Tiedt MK, Barnhill JL, Karvelas KR, Faurot KR, Gaylord S, Gardiner P, Miller VE, Leeman J. Feasibility of Implementation Mapping for Integrative Medical Group Visits. J Altern Complement Med 2021; 27:S71-S80. [PMID: 33788606 DOI: 10.1089/acm.2020.0393] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Objectives: Implementation science is key to translating complementary and integrative health intervention research into practice as it can increase accessibility and affordability while maximizing patient health outcomes. The authors describe using implementation mapping to (1) identify barriers and facilitators impacting the implementation of an Integrative Medical Group Visit (IMGV) intervention in an outpatient setting with a high burden of patients with chronic pain and (2) select and develop implementation strategies utilizing theory and stakeholder input to address those barriers and facilitators. Design: The authors selected a packaged, evidence-based, integrative pain management intervention, the IMGV, to implement in an outpatient clinic with a high burden of patients with chronic pain. The authors used implementation mapping to identify implementation strategies for IMGV, considering theory and stakeholder input. Stakeholder interviews with clinic staff, faculty, and administrators (n = 15) were guided by the Consolidated Framework for Implementation Research. Results: Based on interview data, the authors identified administrators, physicians, nursing staff, and scheduling staff as key stakeholders involved in implementation. Barriers and facilitators focused on knowledge, buy-in, and operational procedures needed to successfully implement IMGV. The implementation team identified three cognitive influences on behavior that would impact performance: knowledge, outcome expectations, and self-efficacy; and three theoretical change methods: cue to participate, communication, and mobilization. Implementation strategies identified included identifying and preparing champions, participation in ongoing training, developing and distributing educational materials, and organizing clinician implementation team meetings. Conclusions: This study provides an example of the application of implementation mapping to identify theory-driven implementation strategies for IMGV. Implementation mapping is a feasible method that may be useful in providing a guiding structure for implementation teams as they employ implementation frameworks and select implementation strategies for integrative health interventions.
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Affiliation(s)
- Isabel J Roth
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Malik K Tiedt
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jessica L Barnhill
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kristopher R Karvelas
- Department of Physical Medicine and Rehabilitation, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Keturah R Faurot
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Susan Gaylord
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Paula Gardiner
- Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA, USA
| | - Vanessa E Miller
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer Leeman
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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17
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Roth I, Thompson-Lastad A, Thomas AU. The Quadruple Aim as a Framework for Integrative Group Medical Visits. J Altern Complement Med 2020; 26:261-264. [PMID: 31971813 PMCID: PMC7153643 DOI: 10.1089/acm.2019.0425] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Isabel Roth
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Ariana Thompson-Lastad
- Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, CA
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18
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Kirk JK, Boyd CT, Spangler JG, Strickland CG. Group Medical Visits: experiences with patient and resident implementation. Expert Rev Endocrinol Metab 2020; 15:51-57. [PMID: 31990589 DOI: 10.1080/17446651.2020.1717946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 01/15/2020] [Indexed: 10/25/2022]
Abstract
Objective: Patients with diabetes must navigate multiple components of care to self-manage their disease. Group Medical Visits (GMVs) are a forum for patients to see a provider as well as actively participate in education and care management with other patients with diabetes. The objective is to describe GMV implementation and resident involvement in a primary care setting.Methods: We adapted and implemented a GMV model into a primary care practice with a residency program. Residents attend GMV sessions that provide a continuity experience in addition to their regular clinic schedules. A cohort of patients enroll in a series of eight GMVs occurring over of 4 months. Each patient and resident complete surveys evaluating the visits.Results: There have been 14 GMV groups totaling 70 participants. GMV groups (N = 67) mean A1C for reduction was 0.53 ± 1.60 from baseline to 3- to 6-month post-GMV follow-up. Resident and patient feedback show an overall positive experience.Conclusion: The GMV model offers patients the setting to interact and exchange experiences with each other as well as to receive feedback from providers and the health-care team. The incorporation of the GMV program into residency training provides a continuity group care experience and an alternative practice model.
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Affiliation(s)
- Julienne K Kirk
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Charlotte T Boyd
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - John G Spangler
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Carmen G Strickland
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston Salem, NC, USA
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19
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Geller JS. Group Medical Visits: Introducing the "Group Inclusion Effect" and Key Principles for Maximization. J Altern Complement Med 2019; 25:673-674. [PMID: 31314563 DOI: 10.1089/acm.2019.0012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jeffrey S Geller
- Integrative Medicine and Group Medical Visits-Kronos Health, Integrated Center for Group Medical Visits, Lawrence, MA
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20
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Bruns EB, Befus D, Wismer B, Knight K, Adler SR, Leonoudakis-Watts K, Thompson-Lastad A, Chao MT. Vulnerable Patients' Psychosocial Experiences in a Group-Based, Integrative Pain Management Program. J Altern Complement Med 2019; 25:719-726. [PMID: 31314560 PMCID: PMC6648209 DOI: 10.1089/acm.2019.0074] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objectives: To use a psychosocial framework to examine the pain experiences of low-income, ethnically diverse patients before and after an Integrative Pain Management Program (IPMP). Design and methods: IPMP is a 12-week, multimodal pain group incorporating mindfulness, acupuncture, massage, education, movement, and health coaching. The authors conducted semistructured interviews at the beginning, end, and 3 months following completion of IPMP. Interviews were digitally recorded and transcribed and analyzed using inductive coding methods. Setting: A primary care clinic in San Francisco, CA, serving low-income, ethnically diverse patients, many of whom are marginally housed and living with disabilities. Subjects: Forty-one patients with a diagnosis of chronic pain, currently receiving prescription opioids and referred by their primary care provider, who participated in IPMP. Results: Authors thematically analyzed 104 individual interviews with 41 IPMP participants, including 41 baseline, 35 three-month follow-up, and 28 six-month follow-up. Before IPMP, participants described a psychologic "vicious cycle" of pain symptoms that worsened with movement and anxiety, while increasing their sense of disempowerment and social isolation. Following IPMP, patients reported using new strategies to manage pain, including lowering medication use, resulting in an emerging sense of psychologic resilience, and more social connections. Conclusions: IPMP offers an accessible model for addressing psychosocial aspects of chronic pain. Vulnerable patients engaged with integrative medicine groups and developed new perspectives and tools for managing their pain; they emerged feeling hopeful and resilient. These results support the use of integrative medicine groups for targeting psychosocial aspects of chronic pain within primary care.
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Affiliation(s)
- Elizabeth B. Bruns
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA
| | - Deanna Befus
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| | - Barbara Wismer
- San Francisco Department of Public Health, San Francisco, CA
- Department of Family & Community Medicine, History, and Social Medicine, University of California, San Francisco, San Francisco, CA
| | - Kelly Knight
- Department of Anthropology, History, and Social Medicine, University of California, San Francisco, San Francisco, CA
| | - Shelley R. Adler
- Department of Family & Community Medicine, History, and Social Medicine, University of California, San Francisco, San Francisco, CA
- Osher Center for Integrative Medicine, University of California, San Francisco, San Francisco, CA
| | | | - Ariana Thompson-Lastad
- Osher Center for Integrative Medicine, University of California, San Francisco, San Francisco, CA
| | - Maria T. Chao
- Osher Center for Integrative Medicine, University of California, San Francisco, San Francisco, CA
- Division of General Internal Medicine at Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA
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