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Austin RR, Lu SC, Jantraporn R, Park S, Geiger-Simpson E, Koithan M, Kreitzer M, Delaney CW. Documentation of Complementary and Integrative Health Therapies in the Electronic Health Record: A Scoping Review. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2023; 29:483-491. [PMID: 36897742 DOI: 10.1089/jicm.2022.0748] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
Introduction: Complementary and integrative health (CIH) therapies refers to massage therapy, acupuncture, aromatherapy, and guided imagery. These therapies have gained increased attention in recent years, particularly for their potential to help manage chronic pain and other conditions. National organizations not only recommend the use of CIH therapies but also the documentation of these therapies within electronic health records (EHRs). Yet, how CIH therapies are documented in the EHR is not well understood. The purpose of this scoping review of the literature was to examine and describe research that focused on CIH therapy clinical documentation in the EHR. Methods: The authors conducted a literature search using six electronic databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), Ovid MEDLINE, Scopus, Google Scholar, Embase, and PubMed. Predefined search terms included "informatics," "documentation," "complementary and integrative health therapies," "non-pharmacological approaches," and "electronic health records" using AND/OR statements. No restrictions were placed on publication date. The inclusion criteria were as follows: (1) Original peer-reviewed full article in English, (2) focus on CIH therapies, and (3) CIH therapy documentation practice used in the research. Results: The authors identified 1684 articles, of which 33 met the criteria for a full review. A majority of the studies were conducted in the United States (20) and hospitals (19). The most common study design was retrospective (9), and 26 studies used EHR data as a data source for analysis. Documentation practices varied widely across all studies, ranging from the feasibility of documenting integrative therapies (i.e., homeopathy) to create changes in the EHR to support documentation (i.e., flowsheet). Discussion: This scoping review identified varying EHR clinical documentation trends for CIH therapies. Pain was the most frequent reason for use of CIH therapies across all included studies and a broad range of CIH therapies were used. Data standards and templates were suggested as informatics methods to support CIH documentation. A systems approach is needed to enhance and support the current technology infrastructure that will enable consistent CIH therapy documentation in EHRs.
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Affiliation(s)
- Robin R Austin
- School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA
- Earl E. Bakken Center for Spirituality and Healing, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sheng-Chieh Lu
- Department of Symptom Research, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Suhyun Park
- School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Mary Koithan
- College of Nursing, Washington State University, Spokane, Washington, USA
| | - MaryJo Kreitzer
- School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA
- Earl E. Bakken Center for Spirituality and Healing, University of Minnesota, Minneapolis, Minnesota, USA
| | - Connie W Delaney
- School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA
- Earl E. Bakken Center for Spirituality and Healing, University of Minnesota, Minneapolis, Minnesota, USA
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2
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Pintas S, Zhang A, James KJ, Lee RM, Shubov A. Effect of Inpatient Integrative Medicine Consultation on 30-Day Readmission Rates: A Retrospective Observational Study at a Major U.S. Academic Hospital. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2022; 28:241-249. [PMID: 35294299 DOI: 10.1089/jicm.2021.0155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives: The prevalence of inpatient integrative medicine (IM) consult services is increasing among academic health care institutions. The diversity of services between institutions, as well as the novel nature of such interventions, makes it challenging for health care administrators to determine the cost/benefit of adding such a program to their institution. The main purpose of this study was to examine the performance of the new University of California, Los Angeles (UCLA) East-West (EW) consult service as measured by 30-day readmission rates and lengths of stay. Design: This is a retrospective observational case-control study with participants matched to themselves. Setting: UCLA Santa Monica Hospital, a 281-bed academic tertiary care hospital near Los Angeles, California. Subjects: Patients who had received an EW consultation during the inaugural 20 months of the program (2018-2020), and who had been hospitalized in the prior 2 years from the date of their first EW consult. Intervention: Inpatient East-West consultation, which may include counseling, acupuncture and/or trigger point injections depending on medical necessity. Outcome Measures: Thirty-day readmission rates and lengths of hospital admission were compared between the hospitalization that included an EW consult (which included the use of acupuncture and/or trigger point injections when appropriate) and any prior admissions during the 2 years before that EW consult. Secondary outcomes included quantitative analysis of average number of treatments and qualitative assessment of integrative treatment(s) received, conditions treated, and reasons that EW treatment may have been deferred during a consult. Results: One hundred sixty-five unique patients met the study criteria. The EW consultation was associated with clinically relevant, statistically significant decreased 30-day readmission rates (33.0% vs. 4.6%, p < 0.001, odds ratio [OR] 0.10, 95% confidence interval [CI] 0.06-0.17). This effect was similar when limiting the analysis to pain-related admissions (32.3% vs. 3.4%, p < 0.001, OR = 0.07, 95% CI 0.03-0.16). Hospital admissions with EW consults were found to have a statistically significant increased length of stay (7.03 days vs. 5.40 days, p < 0.001). Conclusion: The EW medicine, an example of IM, correlates with a reduced risk of 30-day readmission and with modestly increased lengths of stay.
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Affiliation(s)
- Stephanie Pintas
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Annie Zhang
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.,Department of Medicine, UCLA Santa Monica Hospital, Santa Monica, California, USA.,Department of Medicine, UCLA Center for East West Medicine, Los Angeles, California, USA
| | - Kevin J James
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Roger M Lee
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.,Department of Medicine, UCLA Santa Monica Hospital, Santa Monica, California, USA
| | - Andrew Shubov
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.,Department of Medicine, UCLA Santa Monica Hospital, Santa Monica, California, USA.,Department of Medicine, UCLA Center for East West Medicine, Los Angeles, California, USA
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McSwan J, Gudin J, Song XJ, Grinberg Plapler P, Betteridge NJ, Kechemir H, Igracki-Turudic I, Pickering G. Self-Healing: A Concept for Musculoskeletal Body Pain Management - Scientific Evidence and Mode of Action. J Pain Res 2021; 14:2943-2958. [PMID: 34584448 PMCID: PMC8464648 DOI: 10.2147/jpr.s321037] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 08/21/2021] [Indexed: 12/16/2022] Open
Abstract
Traditionally, musculoskeletal pain management has focused on the use of conventional treatments to relieve pain. However, multi-modal integrative medicine including alternative/complementary treatments is becoming more widely used and integrated into treatment guidelines around the world. The uptake of this approach varies according to country, with generally a higher uptake in developed countries and in females aged more than 40 years. Integral to the concept described here, is that the body has an innate ability to self-heal, which can be optimized by the use of integrative medical strategies. Stress triggers for acute or recurring musculoskeletal pain are diverse and can range from physical to psychological. The mechanism by which the body responds to triggers and initiates the self-healing processes is complex, but five body networks or processes are thought to be integral: the nervous system, microcirculation/vasodilation, immune modulation, muscular relaxation/contraction and psychological balance. Multi-modal integrative medicine approaches include nutritional/dietary modification, postural/muscular training exercises, and cognitive behavioral mind/body techniques. This article will review the self-healing concept and provide plausible scientific evidence where available.
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Affiliation(s)
- Joyce McSwan
- GCPHN Persistent Pain Program, PainWISE, Gold Coast, QLD, Australia
| | - Jeffrey Gudin
- Department of Anesthesiology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Xue-Jun Song
- SUSTech Center of Pain Medicine, School of Medicine, Southern University of Science and Technology, Shenzhen, Guangdong, People’s Republic of China
| | - Perola Grinberg Plapler
- Division of Physical Medicine, Institute of Orthopedics and Traumatology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Hayet Kechemir
- Consumer Healthcare Medical Affairs Department, Sanofi CHC, Paris, France
| | - Iva Igracki-Turudic
- Consumer Healthcare Medical Affairs Department, Sanofi CHC, Frankfurt, Germany
| | - Gisele Pickering
- Clinical Investigation Center CIC Inserm 1405, University Hospital Clermont-Ferrand, Clermont-Ferrand, France
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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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5
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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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7
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Patients’ familiarity with, trust in and willingness to pay for traditional Chinese medicine in Chinese community health care centres. Eur J Integr Med 2020. [DOI: 10.1016/j.eujim.2020.101118] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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8
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Morse EF, Ross C, Clemensen S, Babbar S, Wisneski LA, Clune H, de Picciotto M, Xu S, Binswanger I. Exploring the Use of Complementary and Integrative Health Modalities in Urgent Care for Acute Pain. J Altern Complement Med 2020; 26:537-540. [PMID: 32167802 DOI: 10.1089/acm.2019.0452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Erica F Morse
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Colleen Ross
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Scott Clemensen
- Center for Complementary Medicine, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Shaweta Babbar
- Department of Chemical Dependency, Kaiser Permanente Colorado, Aurora, CO, USA
| | | | - Heidi Clune
- Urgent Care, Colorado Permanente Medical Group, Denver, CO, USA
| | | | - Stan Xu
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Ingrid Binswanger
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA.,Department of Chemical Dependency, Kaiser Permanente Colorado, Aurora, CO, USA.,Colorado Permanente Medical Group, Denver, CO, USA.,Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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9
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Roth I, Highfield L, Cuccaro P, Wells R, Misra S, Engebretson J. Employing Evidence in Evaluating Complementary Therapies: Findings from an Ethnography of Integrative Pain Management at a Large Urban Pediatric Hospital. J Altern Complement Med 2019; 25:S95-S105. [PMID: 30870018 PMCID: PMC6446163 DOI: 10.1089/acm.2018.0369] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Complementary and Integrative Medicine (CIM) shows positive clinical benefit with minimal side effects, yet, challenges to effective integration of CIM providers in biomedical health care settings remain. This study aimed to better understand the role evidence played in the process of integration of complementary therapies into a large urban pediatric hospital from the perspective of patients, caregivers, providers, and administrators through applied medical ethnography. METHODS An ethnography was conducted over the course of 6 months in a large urban pediatric hospital in the Southern United States. At the time, the hospital was piloting an integrative medicine (IM) pain consult service. Purposive sampling was used to select providers, patients, administrators, and caregivers to follow as they engaged with both the preexisting pain service and pilot IM pain services. Field observation and interviews were conducted with 34 participants. Thematic content analysis was used to analyze field notes, interview transcripts, and documents collected. FINDINGS Analysis of the data revealed five themes regarding the role of evidence in the process of integration: Anecdotal Evidence and Personal Experience Effecting CIM Use, Open to Trying Whatever Works, Resistance to the Unfamiliar, Patients and Parents Trusting Doctors as Experts, and Importance of Scientific Evidence to Biomedicine. All themes address the role of evidence in relationship to acceptance of complementary therapies and correspond with three thought processes: critical thinking, relying on others for evidence, and reactionary thinking. CONCLUSION Both scientific and anecdotal evidence informed CIM use in this context. Biomedical environments seeking to integrate CIM into pain treatment regimens will need to engage all relevant stakeholders in building education, clinical training, and research programs that are critically informed about the context and evidence for CIM.
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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
| | - Linda Highfield
- Department of Management, Policy, and Community Health, University of Texas Health Science Center School of Public Health (UTHealth), Houston, TX
| | - Paula Cuccaro
- Department of Health Promotion and Behavioral Science, University of Texas Health Science Center School of Public Health (UTHealth), Houston, TX
| | - Rebecca Wells
- Department of Management, Policy, and Community Health, University of Texas Health Science Center School of Public Health (UTHealth), Houston, TX
| | - Sanghamitra Misra
- Department of Academic General Pediatrics, Baylor College of Medicine, Houston, TX
| | - Joan Engebretson
- Department of Family Health, University of Texas Health Science Center Cizik School of Nursing (UTHealth), Houston, TX
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Abstract
With the support of colleagues and hospital management, the author, an RN with board certification in therapeutic massage and bodywork, developed and implemented the role of the integrative therapy nurse on the spinal cord injury and disorders unit at the Minneapolis Veterans Affairs Medical Center. The goal of this initiative was to provide patients with additional nonpharmacologic options for addressing their symptoms through the creation of an integrative therapy nurse role within the existing interdisciplinary team of physicians, NPs, psychologists, registered dieticians, physical therapists, occupational therapists, speech pathologists, and staff nurses. This article outlines the process of creating this role, discusses implications for practice, and reports the outcomes of three years of its implementation. The outcomes of decreased pain and increased relaxation among the veterans who participated in this initiative warrant its further expansion to additional clinical settings.
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Attias S, Sivan K, Avneri O, Sagee A, Ben-Arye E, Grinberg O, Sroka G, Matter I, Schiff E. Analgesic Effects of Reflexology in Patients Undergoing Surgical Procedures: A Randomized Controlled Trial. J Altern Complement Med 2018; 24:809-815. [DOI: 10.1089/acm.2017.0167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Samuel Attias
- Complementary and Integrative Surgery Service, and the Surgery Department, Bnai-Zion Medical Center, Haifa, Israel
- School of Public Health, University of Haifa, Haifa, Israel
| | - Keren Sivan
- Internal Medicine Department, Bnai Zion Medical Center, Haifa, Israel
| | - Ofri Avneri
- Complementary and Integrative Surgery Service, and the Surgery Department, Bnai-Zion Medical Center, Haifa, Israel
| | - Avigail Sagee
- Complementary and Integrative Surgery Service, and the Surgery Department, Bnai-Zion Medical Center, Haifa, Israel
| | - Eran Ben-Arye
- Integrative Oncology Program, The Oncology Service and Lin Medical Center, Clalit Health Services, Haifa, Israel
- Rappaport Faculty of Medicine, The Technion-Israel Institute of Technology, Haifa, Israel
| | - Ofra Grinberg
- Department of General Surgery, Bnai-Zion Medical Center, Haifa, Israel
| | - Gideon Sroka
- Rappaport Faculty of Medicine, The Technion-Israel Institute of Technology, Haifa, Israel
- Department of General Surgery, Bnai-Zion Medical Center, Haifa, Israel
| | - Ibrahim Matter
- Rappaport Faculty of Medicine, The Technion-Israel Institute of Technology, Haifa, Israel
- Department of General Surgery, Bnai-Zion Medical Center, Haifa, Israel
| | - Elad Schiff
- Complementary and Integrative Surgery Service, and the Surgery Department, Bnai-Zion Medical Center, Haifa, Israel
- Internal Medicine Department, Bnai Zion Medical Center, Haifa, Israel
- The International Center for Health, Law and Ethics, Haifa, Israel
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12
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Dusek JA, Griffin KH, Finch MD, Rivard RL, Watson D. Cost Savings from Reducing Pain Through the Delivery of Integrative Medicine Program to Hospitalized Patients. J Altern Complement Med 2018; 24:557-563. [PMID: 29474095 PMCID: PMC6006422 DOI: 10.1089/acm.2017.0203] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES An important task facing hospitals is improving pain management without raising costs. Integrative medicine (IM), a promising nonpharmacologic pain management strategy, is yet to be examined for its cost implications in an inpatient setting. This institution has had an inpatient IM department for over a decade. The purpose was to examine the relationship between changes in patients' pain, as a result of receiving IM therapy, and total cost of care during an inpatient hospital admission. DESIGN In this retrospective analysis, data from an EPIC-based electronic health record (EHR) patient demographics, length of stay (LOS), and All Patient Refined Diagnosis Related Groups (APR-DRG) severity of illness measures were utilized. IM practitioners collected and entered patient-reported pain scores into the EHR. The authors regressed the demographic, change in pain, LOS, and APR-DRG variables with changes in pain on total cost for the hospital admission. To estimate cost savings to the hospital, they computed the average reduction in cost associated with reduction in pain by multiplying the coefficient for change in pain by average total cost. SETTING/LOCATION A large, tertiary care hospital in Minneapolis, MN. SUBJECTS Adult inpatient admissions, 2730, during the study period where patients received IM for pain and met eligibility criteria. INTERVENTION IM services provided to inpatients. OUTCOME MEASURES Change in pain on an 11-point numeric rating scale before and after initial IM sessions; total costs for hospital admissions. RESULTS Both LOS and age were found to increase cost, as did being white, male, married, and having APR-DRG severity coded as extreme. For patients receiving IM therapies, pain was reduced by an average of 2.05 points and this pain reduction was associated with a cost savings of $898 per hospital admission. CONCLUSIONS For patients receiving IM therapies, pain was significantly reduced and costs were lowered by about 4%.
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Affiliation(s)
- Jeffery A Dusek
- 1 Allina Health, Integrative Health Research Center, Penny George Institute for Health and Healing , Minneapolis, MN
| | - Kristen H Griffin
- 1 Allina Health, Integrative Health Research Center, Penny George Institute for Health and Healing , Minneapolis, MN
| | - Michael D Finch
- 2 Children's Minnesota, Children's Minnesota Research Institute , Minneapolis, MN
| | - Rachael L Rivard
- 1 Allina Health, Integrative Health Research Center, Penny George Institute for Health and Healing , Minneapolis, MN
| | - David Watson
- 2 Children's Minnesota, Children's Minnesota Research Institute , Minneapolis, MN
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13
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Schiff E, Levy I, Arnon Z, Ben-Arye E, Attias S. First, keep it safe: Integration of a complementary medicine service within a hospital. Int J Clin Pract 2018; 72:e13082. [PMID: 29665222 DOI: 10.1111/ijcp.13082] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 03/08/2018] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES This paper sought to explore risk/safety considerations associated with the integration of a complementary medicine (CM) service within a public academic medical centre in Israel. METHODS We reviewed various sources pertaining to the CM service (interviews with CM staff, patients' electronic charts, service guidelines, correspondence with hospital administration) and conducted a thematic analysis to evaluate safety-related incidents during the 7 years of operation. In addition, we systematically assessed the charts for reports of treatment-associated adverse effects, which were documented in an obligatory field on treatment reports. RESULTS After reviewing transcripts of interviews with 12 CM practitioners and with the director and vice-director of the CM service as well as transcripts of 8560 consultations that included 7383 treatments, we categorised 3 major domains of CM safety management: (i) prevention of safety-related incidents by appropriate selection of CM practitioners and modalities, (ii) actual adverse incidents and (iii) prevention of their recurrence using both hospital and CM service safety protocols. CM staff reported 5 categories of adverse incidents, most of which were minor. Twenty-nine adverse incidents were documented in the 7383 treatment sessions (0.4%). CONCLUSIONS Safety management needs to be addressed both before introducing CM services in hospitals and throughout their integration. Important considerations for the safe integration of CM practices in the hospital include communication between CM and conventional practitioners, adherence to hospital safety rules, implementing a systematic approach for detecting and reporting safety-related incidents and continuous adaptation of the CM service safety protocols.
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Affiliation(s)
- Elad Schiff
- Internal Medicine B Department, Bnai Zion Medical Center, Haifa, Israel
- Complementary Medicine Service, Bnai Zion Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Ilana Levy
- Internal Medicine B Department, Bnai Zion Medical Center, Haifa, Israel
| | - Zahi Arnon
- Complementary Medicine Service, Bnai Zion Medical Center, Haifa, Israel
| | - Eran Ben-Arye
- Rappaport Faculty of Medicine, Technion, Haifa, Israel
- Integrative Oncology Program, Oncology Service, Lin Medical Center, Clalit Health Services, Haifa, Israel
| | - Samuel Attias
- Complementary Medicine Service, Bnai Zion Medical Center, Haifa, Israel
- School of Public Health, University of Haifa, Haifa, Israel
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Montross-Thomas LP, Meier EA, Reynolds-Norolahi K, Raskin EE, Slater D, Mills PJ, MacElhern L, Kallenberg G. Inpatients' Preferences, Beliefs, and Stated Willingness to Pay for Complementary and Alternative Medicine Treatments. J Altern Complement Med 2017; 23:259-263. [DOI: 10.1089/acm.2016.0288] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Lori P. Montross-Thomas
- Department of Psychiatry, University of California, San Diego, San Diego, CA
- Moores Cancer Center, Psychiatry and Psychosocial Services, Patient and Family Support Services, University of California, San Diego, San Diego, CA
- Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA
| | - Emily A. Meier
- Department of Psychiatry, University of California, San Diego, San Diego, CA
- Moores Cancer Center, Psychiatry and Psychosocial Services, Patient and Family Support Services, University of California, San Diego, San Diego, CA
| | - Kimberly Reynolds-Norolahi
- Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA
- True Wellness Acupuncture, San Diego, CA
| | - Erin E. Raskin
- Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA
- Center for Integrative Medicine, University of California, San Diego, San Diego, CA
| | - Daniel Slater
- Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA
| | - Paul J. Mills
- Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA
- Center for Integrative Medicine, University of California, San Diego, San Diego, CA
| | - Lauray MacElhern
- Center for Integrative Medicine, University of California, San Diego, San Diego, CA
| | - Gene Kallenberg
- Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA
- Center for Integrative Medicine, University of California, San Diego, San Diego, CA
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Kemper KJ, Hill E. Training in Integrative Therapies Increases Self-Efficacy in Providing Nondrug Therapies and Self-Confidence in Offering Compassionate Care. J Evid Based Complementary Altern Med 2017; 22:618-623. [PMID: 29228783 PMCID: PMC5871260 DOI: 10.1177/2156587216686463] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background. Patient demand and clinician interest have driven professional training in integrative therapies, but few rigorous evaluations have been published. Methods. This project evaluated the proof of concept of training in acupressure, guided imagery, massage, and Reiki on clinicians’ sense of self-efficacy in providing nondrug therapies, self-confidence in providing compassionate care, and engagement with work. Results. Three out of 4 topics met minimum enrollment numbers; 22 of 24 participants completed follow-up as well as pretraining surveys. All would recommend the training to others and planned changes in personal and professional care. There were significant improvements in self-efficacy in using nondrug therapies, confidence in providing compassionate care, and unplanned absenteeism (P < .05 for each). Conclusion. Training in integrative therapies is feasible and associated with significant improvements in clinicians’ sense of self-efficacy, confidence in providing compassionate care, and engagement with work. Additional studies are needed to determine the impact on quality of care and long-term workforce engagement.
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Affiliation(s)
| | - Ellie Hill
- 1 The Ohio State University, Columbus, OH, USA
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Chao MT, Chang A, Reddy S, Harrison JD, Acquah J, Toveg M, Santana T, Hecht FM. Adjunctive acupuncture for pain and symptom management in the inpatient setting: protocol for a pilot hybrid effectiveness-implementation study. JOURNAL OF INTEGRATIVE MEDICINE 2016; 14:228-38. [PMID: 27181130 PMCID: PMC5050044 DOI: 10.1016/s2095-4964(16)60252-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Effective pain management among hospitalized patients is an important aspect of providing quality care and achieving optimal clinical outcomes and patient satisfaction. Common pharmacologic approaches for pain, though effective, have serious side effects and are not appropriate for all inpatients. Findings from randomized controlled trials (RCTs) support the efficacy of acupuncture for many symptoms relevant to inpatients including postoperative pain, cancer-related pain, nausea and vomiting, and withdrawal from narcotic use. However, the extent to which findings from RCTs translate to real-world implementation of acupuncture in typical hospital settings is unknown. METHODS/DESIGN In partnership with the launch of a clinical program offering acupuncture services to inpatients at the University of California San Francisco's Mount Zion Hospital, we are conducting a pilot study using a hybrid effectiveness-implementation design to: (1) assess the effectiveness of acupuncture to manage pain and other symptoms and improve patient satisfaction; and (2) evaluate the barriers and facilitators to implementing an on-going acupuncture service for inpatients. During a two-month pre-randomization phase, we evaluated and adapted clinical scheduling and treatment protocols with acupuncturists and hospital providers and pretested study procedures including enrollment, consent, and data collection. During a six-month randomization phase, we used a two-tiered consent process in which inpatients were first consented into a study of symptom management, randomized to be offered acupuncture, and consented for acupuncture if they accepted. We are also conducting in-depth interviews and focus groups to assess evidence, context, and facilitators of key provider and hospital administration stakeholders. DISCUSSION Effectiveness research in "real-world" practice settings is needed to inform clinical decision-making and guide implementation of evidence-based acupuncture practices. To successfully provide clinical acupuncture services and maintain a rigorous research design, practice-based trials of acupuncture require careful planning and attention to setting-specific, contextual factors. TRIAL REGISTRATION This trial has been registered in ClinicalTrials.gov. The identifier is NCT01988194, registered on November 5, 2013.
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Affiliation(s)
- Maria T. Chao
- Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, CA 94143-1726, USA
- Division of General Internal Medicine at the Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, California, USA
| | - Alexandra Chang
- Departments of Anesthesiology and Internal Medicine, Loma Linda University, Loma Linda, California, USA
| | - Sanjay Reddy
- Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, CA 94143-1726, USA
- Division of Hospital Medicine, University of California San Francisco, San Francisco, California, USA
| | - James D. Harrison
- Division of Hospital Medicine, University of California San Francisco, San Francisco, California, USA
| | - Joseph Acquah
- Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, CA 94143-1726, USA
| | - Miria Toveg
- Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, CA 94143-1726, USA
| | - Trilce Santana
- Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, CA 94143-1726, USA
| | - Frederick M. Hecht
- Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, CA 94143-1726, USA
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Reinstein AS, Erickson LO, Griffin KH, Rivard RL, Kapsner CE, Finch MD, Dusek JA. Acceptability, Adaptation, and Clinical Outcomes of Acupuncture Provided in the Emergency Department: A Retrospective Pilot Study. PAIN MEDICINE 2016; 18:169-178. [PMID: 26917627 DOI: 10.1093/pm/pnv114] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objective To evaluate acceptability and clinical outcomes of acupuncture on patient-reported pain and anxiety in an emergency department (ED). Design Observational, retrospective pilot study. Setting Abbott Northwestern Hospital ED, Minneapolis, MN. Methods Retrospective data was used to identify patients receiving acupuncture in addition to standard medical care in the ED between 11/1/13 and 12/31/14. Feasibility was measured by quantifying the utilization of acupuncture in a novel setting and performing limited tests of its efficacy. Patient-reported pain and anxiety scores were collected by the acupuncturist using an 11-point (0-10) numeric rating scale before (pre) and immediately after (post) acupuncture. Efficacy outcomes were change in pain and anxiety scores. Results During the study period, 436 patients were referred for acupuncture, 279 of whom were approached by the acupuncturist during their ED visit. Consent for acupuncture was obtained from 89% (248/279). A total of 182 patients, who had a pre-pain score >0 and non-missing anxiety scores, were included in analyses. Of the 52% (94/182) who did not have analgesics before or during the acupuncture session, the average decrease of 2.37 points (95% CI: 1.92, 2.83) was not different (p > 0.05) than the mean decrease of 2.68 points for those receiving analgesics (95% CI 2.21, 3.15). The average pre-anxiety score was 4.73 points (SD = 3.43) and the mean decrease was 2.27 points (95% CI: 1.89, 2.66). Conclusions Results from this observational trial indicate that acupuncture was acceptable and effective for pain and anxiety reduction, in conjunction with standard medical care. These results will inform future randomized trials.
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Affiliation(s)
- Adam S Reinstein
- Integrative Health Research Center, Penny George Institute for Health and Healing, Allina Health, Minneapolis, Minnesota, USA
| | - Lauren O Erickson
- Integrative Health Research Center, Penny George Institute for Health and Healing, Allina Health, Minneapolis, Minnesota, USA
| | - Kristen H Griffin
- Integrative Health Research Center, Penny George Institute for Health and Healing, Allina Health, Minneapolis, Minnesota, USA
| | - Rachael L Rivard
- Integrative Health Research Center, Penny George Institute for Health and Healing, Allina Health, Minneapolis, Minnesota, USA
| | | | - Michael D Finch
- Medical Industry Leadership Institute, Carlson School of Management, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jeffery A Dusek
- Integrative Health Research Center, Penny George Institute for Health and Healing, Allina Health, Minneapolis, Minnesota, USA
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Rhee TG, Leininger BD, Ghildayal N, Evans RL, Dusek JA, Johnson PJ. Complementary and integrative healthcare for patients with mechanical low back pain in a U.S. hospital setting. Complement Ther Med 2016; 24:7-12. [PMID: 26860795 DOI: 10.1016/j.ctim.2015.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 11/19/2015] [Accepted: 11/21/2015] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Complementary and integrative healthcare (CIH) is commonly used to treat low back pain (LBP). While the use of CIH within hospitals is increasing, little is known regarding the delivery of these services within inpatient settings. We examine the patterns of CIH services among inpatients with mechanical LBP in a hospital setting. METHODS This is a retrospective, practice-based study conducted at Abbot Northwestern hospital in Minnesota. Using electronic health record data from July 2009 to December 2012, 8095 inpatients with mechanical LBP were identified using ICD-9 codes. We classified patients by reason for hospitalization. We examined demographic and clinical characteristics by receipt of CIH services. Then, we estimated the prevalence of types of CIH delivered and clinical foci for CIH visits among inpatients with mechanical LBP. RESULTS Most inpatients with mechanical LBP (>90%) were hospitalized for surgical procedures. Overall, 14.2% received inpatient CIH services. All demographic and clinical characteristics differed by receipt of CIH (P<0.001), except race/ethnicity. CIH recipients were in poorer health than those who did not. Most commonly delivered CIH services were massage (62.1%), relaxation techniques (42.0%) and acupuncture (25.7%). Pain (45.1%), relaxation (17.5%), and comfort (8.2%) were the top three reasons for CIH visits. CONCLUSION There are important differences between CIH recipients and non-CIH recipients among patients with mechanical LBP within a hospital setting. The reasons documented for CIH visits included addressing physical, emotional and/or mental conditions of patients. Future studies are needed to determine the effectiveness of CIH services health and wellbeing outcomes in this population.
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Affiliation(s)
- Taeho Greg Rhee
- Integrative Health & Wellbeing Research Program, Center for Spirituality & Healing, Academic Health Center, University of Minnesota, Minneapolis, MN, United States; Department of Pharmaceutical Care and Health Systems, College of Pharmacy, University of Minnesota, Minneapolis, MN, United States.
| | - Brent D Leininger
- Integrative Health & Wellbeing Research Program, Center for Spirituality & Healing, Academic Health Center, University of Minnesota, Minneapolis, MN, United States
| | - Neha Ghildayal
- Division of Health Policy & Management, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Roni L Evans
- Integrative Health & Wellbeing Research Program, Center for Spirituality & Healing, Academic Health Center, University of Minnesota, Minneapolis, MN, United States
| | - Jeffery A Dusek
- Penny George Institute of Health and Healing, Allina Health, Minneapolis, MN, United States
| | - Pamela Jo Johnson
- Integrative Health & Wellbeing Research Program, Center for Spirituality & Healing, Academic Health Center, University of Minnesota, Minneapolis, MN, United States; Division of Health Policy & Management, School of Public Health, University of Minnesota, Minneapolis, MN, United States; Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
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Practitioner Perspectives on Delivering Integrative Medicine in a Large, Acute Care Hospital. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 2015:394040. [PMID: 26693242 PMCID: PMC4674616 DOI: 10.1155/2015/394040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 11/12/2015] [Indexed: 02/08/2023]
Abstract
Background. We describe the process and challenges of delivering integrative medicine (IM) at a large, acute care hospital, from the perspectives of IM practitioners. To date, minimal literature that addresses the delivery of IM care in an inpatient setting from this perspective exists. Methods. Fifteen IM practitioners were interviewed about their experience delivering IM services at Abbott Northwestern Hospital (ANW), a 630-bed tertiary care hospital. Themes were drawn from codes developed through analysis of the data. Results. Analysis of interview transcripts highlighted challenges of ensuring efficient use of IM practitioner resources across a large hospital, the IM practitioner role in affecting patient experiences, and the ways practitioners navigated differences in IM and conventional medicine cultures in an inpatient setting. Conclusions. IM practitioners favorably viewed their role in patient care, but this work existed within the context of challenges related to balancing supply and demand for services and to integrating an IM program into the established culture of a large hospital. Hospitals planning IM programs should carefully assess the supply and demand dynamics of offering IM in a hospital, advocate for the unique IM practitioner role in patient care, and actively support integration of conventional and complementary approaches.
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20
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Johnson JR, Crespin DJ, Griffin KH, Finch MD, Dusek JA. Effects of integrative medicine on pain and anxiety among oncology inpatients. J Natl Cancer Inst Monogr 2015; 2014:330-7. [PMID: 25749600 DOI: 10.1093/jncimonographs/lgu030] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Few studies have investigated the effectiveness of integrative medicine (IM) therapies on pain and anxiety among oncology inpatients. METHODS Retrospective data obtained from electronic medical records identified patients with an oncology International Classification of Diseases-9 code who were admitted to a large Midwestern hospital between July 1, 2009 and December 31, 2012. Outcomes were change in patient-reported pain and anxiety, rated before and after individual IM treatment sessions, using a numeric scale (0-10). RESULTS Of 10948 hospital admissions over the study period, 1833 (17%) included IM therapy. Older patients had reduced odds of receiving any IM therapy (odds ratio [OR]: 0.97, 95% confidence interval [95% CI] = 0.96 to 0.98) and females had 63% (OR: 1.63, 95% CI = 1.38 to 1.92) higher odds of receiving any IM therapy compared with males. Moderate (OR: 1.97, 95% CI = 1.61 to 2.41), major (OR: 3.54, 95% CI = 2.88 to 4.35), and extreme (OR: 5.96, 95% CI = 4.71 to 7.56) illness severity were significantly associated with higher odds of receiving IM therapy compared with admissions of minor illness severity. After receiving IM therapy, patients averaged a 46.9% (95% CI = 45.1% to 48.6%, P <.001) reduction in pain and a 56.1% (95% CI = 54.3% to 58.0%, P <.001) reduction in anxiety. Bodywork and traditional Chinese Medicine therapies were most effective for reducing pain, while no significant differences among therapies for reducing anxiety were observed. CONCLUSIONS IM services to oncology inpatients resulted in substantial decreases in pain and anxiety. Observational studies using electronic medical records provide unique information about real-world utilization of IM. Future studies are warranted and should explore potential synergy of opioid analgesics and IM therapy for pain control.
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Affiliation(s)
- Jill R Johnson
- Integrative Health Research Center, Penny George Institute for Health and Healing, Allina Health, Minneapolis, MN (JRJ, KHG, JAD); Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN (DJC); Medical Industry Leadership Institute, Carlson School of Management, University of Minnesota, Minneapolis, MN (MDF).
| | - Daniel J Crespin
- Integrative Health Research Center, Penny George Institute for Health and Healing, Allina Health, Minneapolis, MN (JRJ, KHG, JAD); Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN (DJC); Medical Industry Leadership Institute, Carlson School of Management, University of Minnesota, Minneapolis, MN (MDF)
| | - Kristen H Griffin
- Integrative Health Research Center, Penny George Institute for Health and Healing, Allina Health, Minneapolis, MN (JRJ, KHG, JAD); Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN (DJC); Medical Industry Leadership Institute, Carlson School of Management, University of Minnesota, Minneapolis, MN (MDF)
| | - Michael D Finch
- Integrative Health Research Center, Penny George Institute for Health and Healing, Allina Health, Minneapolis, MN (JRJ, KHG, JAD); Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN (DJC); Medical Industry Leadership Institute, Carlson School of Management, University of Minnesota, Minneapolis, MN (MDF)
| | - Jeffery A Dusek
- Integrative Health Research Center, Penny George Institute for Health and Healing, Allina Health, Minneapolis, MN (JRJ, KHG, JAD); Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN (DJC); Medical Industry Leadership Institute, Carlson School of Management, University of Minnesota, Minneapolis, MN (MDF)
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Perceptions of providers and administrators in the Veterans Health Administration regarding complementary and alternative medicine. Med Care 2015; 52:S91-6. [PMID: 25397830 DOI: 10.1097/mlr.0000000000000225] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The integration of complementary and alternative medicine (CAM) therapies into a large organization such as the Veterans Health Administration (VHA) requires cultural change and deliberate planning to ensure feasibility and buy-in from staff and patients. At present, there is limited knowledge of VHA patient care providers' and administrators' viewpoints regarding CAM therapies and their implementation. OBJECTIVES Our purpose was to qualitatively examine knowledge, attitudes, perceived value and perceived barriers, and/or facilitators to CAM program implementation among VHA providers and administrators at a large VHA facility. RESEARCH DESIGN We are reporting the qualitative interview portion of a mixed-methods study. SUBJECTS Twenty-eight participants (patient care providers or administrators) were purposely chosen to represent a spectrum of positions and services. Participants' experience with and exposure to CAM therapies varied. MEASURES Individual interviews were conducted using a semi-structured format and were digitally recorded, transcribed, and coded for themes. RESULTS Recurrent themes included: a range of knowledge about CAM; benefits for patients and staff; and factors that can be facilitators or barriers including evidence-based practice or perceived lack thereof, prevailing culture, leadership at all levels, and lack of position descriptions for CAM therapists. Participants rated massage, meditation, acupuncture, and yoga as priorities for promotion across the VHA. CONCLUSIONS Despite perceived challenges, providers and administrators recognized the value of CAM and potential for expansion of CAM within the VHA. Interview results could inform the process of incorporating CAM into a plan for meeting VHA Strategic Goal One of personalized, proactive, patient-driven health care across the VHA.
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22
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Johnson JR, Crespin DJ, Griffin KH, Finch MD, Rivard RL, Baechler CJ, Dusek JA. The effectiveness of integrative medicine interventions on pain and anxiety in cardiovascular inpatients: a practice-based research evaluation. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 14:486. [PMID: 25494710 PMCID: PMC4301797 DOI: 10.1186/1472-6882-14-486] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 12/10/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Pain and anxiety occurring from cardiovascular disease are associated with long-term health risks. Integrative medicine (IM) therapies reduce pain and anxiety in small samples of hospitalized cardiovascular patients within randomized controlled trials; however, practice-based effectiveness research has been limited. The goal of the study is to evaluate the effectiveness of IM interventions (i.e., bodywork, mind-body and energy therapies, and traditional Chinese medicine) on pain and anxiety measures across a cardiovascular population. METHODS Retrospective data obtained from medical records identified patients with a cardiovascular ICD-9 code admitted to a large Midwestern hospital between 7/1/2009 and 12/31/2012. Outcomes were changes in patient-reported pain and anxiety, rated before and after IM treatments based on a numeric scale (0-10). RESULTS Of 57,295 hospital cardiovascular admissions, 6,589 (11.5%) included IM. After receiving IM therapy, patients averaged a 46.5% (p-value < 0.001) decrease in pain and a 54.8% (p-value < 0.001) decrease in anxiety. There was no difference between treatment modalities on pain reduction; however, mind-body and energy therapies (p-value < 0.01), traditional Chinese medicine (p-value < 0.05), and combination therapies (p-value < 0.01) were more effective at reducing anxiety than bodywork therapies. Each additional year of age reduced the odds of receiving any IM therapy by two percent (OR: 0.98, p-value < 0.01) and females had 96% (OR: 1.96, p-value < 0.01) higher odds of receiving any IM therapy compared to males. CONCLUSIONS Cardiovascular inpatients reported statistically significant decreases in pain and anxiety following care with adjunctive IM interventions. This study underscores the potential for future practice-based research to investigate the best approach for incorporating these therapies into an acute care setting such that IM therapies are most appropriately provided to patient populations.
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Kielczynska BB, Kligler B, Specchio E. Integrating acupuncture in an inpatient setting. QUALITATIVE HEALTH RESEARCH 2014; 24:1242-52. [PMID: 25079502 DOI: 10.1177/1049732314544969] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Acupuncture, a licensed health care profession in the United States, is poorly integrated into the American health care system, despite the evidence of its effectiveness. The purpose of this study was to offer a phenomenological description of the experience of acupuncturists who delivered acupuncture care in a tertiary teaching hospital in New York City. We analyzed data using methodology proposed by Colaizzi and identified four major clusters of themes: (a) acupuncturists' excitement about practicing in a hospital setting and frustration about organizational obstacles to effective acupuncture integration; (b) pride in being holistic practitioners; (c) attempts to preserve the holism and effectiveness of acupuncture while adjusting to the limitations of an inpatient setting, and (d) acupuncturists' realization that the medical staff knew very little about acupuncture and "it's all about trust." Practitioners of other healing traditions and therapies might find our study helpful in their own efforts toward similar integration.
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Kreindler G, Attias S, Kreindler A, Hen H, Haj B, Matter I, Ben-Arye E, Schiff E. Treating postlaparoscopic surgery shoulder pain with acupuncture. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2014; 2014:120486. [PMID: 24864149 PMCID: PMC4017844 DOI: 10.1155/2014/120486] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 03/14/2014] [Accepted: 03/30/2014] [Indexed: 11/17/2022]
Abstract
Objective. The purpose of this study was to examine the effect of acupuncture on postlaparoscopic shoulder pain (PLSP) which is a common side effect in patients undergoing abdominal laparoscopic surgery. Methods. Patients with moderate to severe PLSP in spite of analgesic treatment, which were referred by the medical staff to the Complementary-Integrative Surgery Service (CISS) at our institution, were provided with acupuncture treatment. The severity of PLSP and of general pain was assessed using a Visual Analogue Scale (VAS) from 0 to 10. Pain assessment was conducted prior to and two hours following acupuncture treatment. Acupuncture treatment was individualized based on traditional Chinese medicine diagnosis. Results. A total of 25 patients were evaluated during a 14-month period, from March 2011 to May 2012. A significant reduction in PLSP (mean reduction of 6.4 ± 2.3 P < 0.0001) and general pain (mean reduction 6.4 ± 2.1 P < 0.0001) were observed, and no significant side effects were reported. Conclusion. Individualized acupuncture treatments according to traditional Chinese medicine principles may improve postlaparoscopic shoulder pain and general pain when used in conjunction with conventional therapy. The primary findings of this study warrant verification in controlled studies.
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Affiliation(s)
- Gur Kreindler
- Complementary and Integrative Surgery Service, Bnai-Zion Medical Center, 47 Golomb Street, 31048 Haifa, Israel
| | - Samuel Attias
- Complementary and Integrative Surgery Service, Bnai-Zion Medical Center, 47 Golomb Street, 31048 Haifa, Israel
- School of Public Health, University of Haifa, Mount Carmel, 31905 Haifa, Israel
| | - Anna Kreindler
- Faculty of Management, Tel-Aviv University, P.O. Box 39040 , 69978 Tel-Aviv, Israel
| | - Haim Hen
- Complementary and Integrative Surgery Service, Bnai-Zion Medical Center, 47 Golomb Street, 31048 Haifa, Israel
| | - Bassel Haj
- Department of General Surgery, Bnai-Zion Medical Center, 47 Golomb Street, 31048 Haifa, Israel
| | - Ibrahim Matter
- Department of General Surgery, Bnai-Zion Medical Center, 47 Golomb Street, 31048 Haifa, Israel
| | - Eran Ben-Arye
- Complementary and Traditional Medicine Unit, Department of Family Medicine, Faculty of Medicine, Technion International School, Mauerberger building, 2nd floor, Technion City, 3200003 Haifa, Israel
| | - Elad Schiff
- Complementary and Integrative Surgery Service, Bnai-Zion Medical Center, 47 Golomb Street, 31048 Haifa, Israel
- Department of Internal Medicine, Bnai-Zion Medical Center, 47 Golomb Street, 31048 Haifa, Israel
- The Department of Complementary/Integrative Medicine, Law and Ethics, The International Center for Health, Law and Ethics, Haifa University, 199 Aba Khoushy Avenue, Mount Carmel, Haifa, Israel
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Cotton S, Luberto CM, Bogenschutz LH, Pelley TJ, Dusek J. Integrative care therapies and pain in hospitalized children and adolescents: a retrospective database review. J Altern Complement Med 2013; 20:98-102. [PMID: 24175871 DOI: 10.1089/acm.2013.0306] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Complementary or integrative care therapies are promising adjunctive approaches to pain management for pediatric inpatients that are currently underused and understudied. The purpose of this study was to examine the potential benefits of integrative care therapies delivered to hospitalized children and adolescents at a large Midwestern academic pediatric medical center over a 1-year period. METHODS A retrospective chart review of an inpatient clinical database maintained by integrative care therapists over a 1-year period was used for the current study. Pre/post pain and relaxation scores associated with the delivery of inpatient integrative care therapies (primarily massage therapy and healing touch) were examined. RESULTS Five-hundred nineteen hospitalized children and adolescents were treated by integrative care therapists for primarily pain or anxiety needs. Patients had a mean age of 10.2 years (standard deviation, 7.0), 224 were female (43%), 383 were white (74%), and most (393 [77%]) received massage therapy. Mean pain and relaxation scores decreased significantly from pre- to post-therapy across all demographic and clinical subgroups (p≤.001). CONCLUSIONS Although integrative care therapies are increasingly requested and offered in children's hospitals, provision of these approaches is driven primarily by consumer demand rather than evidence-informed practice. Future controlled studies should examine the incremental effects of integrative care therapies as an adjunct to conventional treatment, assess how these therapies work mechanistically, and determine whether they improve outcomes, such as pain and cost, for hospitalized children and adolescents.
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Affiliation(s)
- Sian Cotton
- 1 Department of Family and Community Medicine, Division of Integrative Medicine, Department of Pediatrics, University of Cincinnati College of Medicine , Cincinnati, OH
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Farrar WS, Fyfe-Johnson AL, Baechler CJ, Dusek JA. Spontaneous normal sinus rhythm conversion using integrative medicine in atrial fibrillation. Glob Adv Health Med 2012; 1:22-5. [PMID: 24278814 PMCID: PMC3833498 DOI: 10.7453/gahmj.2012.1.2.006] [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: 11/23/2022] Open
Abstract
The relationship between acute life stress and the development of atrial fibrillation (AF) has been noted in the literature. However, the use of integrative medicine (IM) in restoring cardiac rhythm has not been adequately studied. This case report describes how an IM approach was used in a patient with atrial fibrillation and acute pain. Spontaneous cardioversion to normal sinus rhythm occurred during the IM session, in addition to marked decreases in self-reported pain, anxiety, and nausea at the conclusion of IM treatment. These results provide initial support that for some cases of AF, IM therapies can help to reduce costs via avoidance of additional hospitalization, electrocardioversion, and general anesthesia.
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Affiliation(s)
- Wendy S Farrar
- Wendy S. Farrar, MSW, NCTMB, is an integrative health practitioner at Penny George Institute for Health and Healing and Allina Health/Abbott Northwestern Hospital, Minneapolis, Minnesota
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