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Srinivasan R, Rodgers-Melnick SN, Rivard RL, Kaiser C, Vincent D, Adan F, Dusek JA. Implementing paper-based patient-reported outcome collection within outpatient integrative health and medicine. PLoS One 2024; 19:e0303985. [PMID: 38809886 PMCID: PMC11135778 DOI: 10.1371/journal.pone.0303985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 05/04/2024] [Indexed: 05/31/2024] Open
Abstract
OBJECTIVE To investigate the feasibility of pre- and post-encounter patient-reported outcome (PRO) measure collection within an outpatient integrative health and medicine (IHM) clinic and to characterize factors associated with successful completion. METHODS We conducted a retrospective review of 27,464 outpatient IHM encounters including 9,520 chiropractic; 8,237 acupuncture; 5,847 massage; 2,345 IHM consultation; and 1,515 osteopathic manipulation treatment encounters at four clinics offering IHM over 18 months. Patients were asked to complete paper questionnaires rating pain, anxiety, and stress from 0-10 immediately pre- and post-encounter. Generalized linear mixed effect regression models were used to examine the relationship between demographic, clinical, and operational covariates and completing (1) pre-encounter and (2) paired (i.e., pre and post) PROs. RESULTS Patients (N = 5587, mean age 49 years, 74% white, 77% female) generally presented for musculoskeletal conditions (81.7%), with a chief complaint of pain (55.1%). 21,852 (79.6%) encounters were among patients who completed pre-encounter PROs; 11,709/21,852 (53.6%) completed subsequent post-encounter PROs. Odds of PRO completion were more impacted by provider, operational, and clinical-level factors than patient factors. Covariates associated with increased odds of pre-encounter PRO completion included being female, having additional IHM encounters, and having a pain or anxiety complaint. Covariates associated with increased odds of paired PRO completion included being aged 31-40 vs. 51-60 years and having additional IHM encounters. CONCLUSION Implementing a paper-based PRO collection system in outpatient IHM is feasible; however, collecting post-encounter PROs was challenging. Future endeavors should leverage the electronic health record and patient portals to optimize PRO collection and engage patients and clinical providers.
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Affiliation(s)
- Roshini Srinivasan
- Connor Whole Health, University Hospitals of Cleveland, Cleveland, OH, United States of America
- Duke University School of Medicine, Durham, NC, United States of America
| | - Samuel N. Rodgers-Melnick
- Connor Whole Health, University Hospitals of Cleveland, Cleveland, OH, United States of America
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, United States of America
| | - Rachael L. Rivard
- Connor Whole Health, University Hospitals of Cleveland, Cleveland, OH, United States of America
- Center for Evaluation Survey and Research, HealthPartners Institute, Minneapolis, MN, United States of America
| | - Christine Kaiser
- Connor Whole Health, University Hospitals of Cleveland, Cleveland, OH, United States of America
| | - David Vincent
- Connor Whole Health, University Hospitals of Cleveland, Cleveland, OH, United States of America
| | - Francoise Adan
- Connor Whole Health, University Hospitals of Cleveland, Cleveland, OH, United States of America
- Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, United States of America
| | - Jeffery A. Dusek
- Susan Samueli Integrative Health Institute, University of California Irvine, Irvine, CA, United States of America
- Department of Medicine, University of California Irvine, Irvine, CA, United States of America
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Rodgers-Melnick SN, Rivard RL, Block S, Dusek JA. Effectiveness of Medical Music Therapy Practice: Integrative Research Using the Electronic Health Record: Rationale, Design, and Population Characteristics. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2024; 30:57-65. [PMID: 37433198 PMCID: PMC10795501 DOI: 10.1089/jicm.2022.0701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
Background: Several clinical trials support the efficacy of music therapy (MT) for improving outcomes in hospitalized patients, but few studies have evaluated the real-world delivery and integration of MT across multiple medical centers. This article describes the rationale, design, and population characteristics of a retrospective study examining the delivery and integration of MT within a large health system. Methods: A retrospective electronic health record (EHR) review was conducted of hospitalized patients seen by and/or referred to MT between January 2017 and July 2020. MT was provided across ten medical centers, including an academic medical center, a freestanding cancer center, and eight community hospitals. Discrete demographic, clinical, and MT treatment and referral characteristics were extracted from the EHR, cleaned, and organized using regular expressions functions, and they were summarized using descriptive statistics. Results: The MT team (average 11.6 clinical fulltime equivalent staff/year) provided 14,261 sessions to 7378 patients across 9091 hospitalizations. Patients were predominantly female (63.7%), White (54.3%) or Black/African American (44.0%), 63.7 ± 18.5 years of age at admission, and insured under Medicare (51.1%), Medicaid (18.1%), or private insurance (14.2%). Patients' hospitalizations (median length of stay: 5 days) were primarily for cardiovascular (11.8%), respiratory (9.9%), or musculoskeletal (8.9%) conditions. Overall, 39.4% of patients' hospital admissions included a mental health diagnosis, and 15.4% were referred to palliative care. Patients were referred by physicians (34.7%), nurses (29.4%), or advanced practice providers (24.7%) for coping (32.0%), anxiety reduction (20.4%), or pain management (10.1%). Therapists provided sessions to patients discharged from medical/surgical (74.5%), oncology (18.4%), or intensive care (5.8%) units. Conclusions: This retrospective study indicates that MT can be integrated across a large health system for addressing the needs of socioeconomically diverse patients. However, future research is needed to assess MT's impact on health care utilization (i.e., length of stay and rates of readmission) and immediate patient-reported outcomes.
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Affiliation(s)
- Samuel N. Rodgers-Melnick
- Connor Whole Health, University Hospitals of Cleveland, Cleveland, OH, USA
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Rachael L. Rivard
- Connor Whole Health, University Hospitals of Cleveland, Cleveland, OH, USA
- Center for Survey and Evaluation Research, HealthPartners Institute, Minneapolis, MN, USA
| | - Seneca Block
- Connor Whole Health, University Hospitals of Cleveland, Cleveland, OH, USA
- Department of Psychiatry and School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Jeffery A. Dusek
- Connor Whole Health, University Hospitals of Cleveland, Cleveland, OH, USA
- Department of Psychiatry Family Medicine and Community Health, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
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Rodgers-Melnick SN, Srinivasan R, Rivard RL, Adan F, Dusek JA. Immediate Effects of Integrative Health and Medicine Modalities Among Outpatients With Moderate-To-Severe Symptoms. GLOBAL ADVANCES IN INTEGRATIVE MEDICINE AND HEALTH 2024; 13:27536130241254070. [PMID: 38737216 PMCID: PMC11088302 DOI: 10.1177/27536130241254070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 04/22/2024] [Accepted: 04/19/2024] [Indexed: 05/14/2024]
Abstract
Background Patients seeking integrative health and medicine (IHM) modalities often present with multiple physical and psychological concerns. Research supports IHM's effectiveness for addressing symptoms over longer time periods. However, few studies have evaluated immediate outpatient effects. Objective This study describes pre-encounter patient-reported outcome (PRO) clusters and examines the immediate clinical effectiveness of IHM modalities on pain, stress, and anxiety among outpatients with moderate-to-severe symptoms. Methods A retrospective review was conducted of encounters among adults presenting to outpatient acupuncture, chiropractic, massage, integrative medicine consultation, or osteopathic manipulation treatment between January 2019 and July 2020. Encounters were included if patients reported pre-encounter pain, stress, or anxiety ≥4 on a numeric rating scale (NRS). Outcome analyses included random effects for patient and provider using a mixed model. Results Across 7335 clinical encounters among 2530 unique patients (mean age: 49.14 years; 81.0% female; 75.9% White; 15.8% Black/African American), the most common pre-encounter PRO clusters were pain, stress, and anxiety ≥4 (32.4%); pain ≥4 only (31.3%); and stress and anxiety ≥4 (15.6%). Clinically meaningful single-encounter mean [95% CI] changes were observed across all modalities in pain (-2.50 [-2.83, -2.17]), stress (-3.22 [-3.62, -2.82]), and anxiety (-3.05 [-3.37, -2.73]). Conclusion Patients presenting to outpatient IHM with moderate-to-severe symptoms most often presented with pain, stress, and anxiety ≥4 on the NRS. Multiple IHM modalities yielded clinically meaningful (≥2 unit) immediate reductions in these symptoms. Future research measuring immediate and longitudinal effectiveness is needed to optimize the triage and coordination of IHM modalities to meet patients' needs.
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Affiliation(s)
- Samuel N. Rodgers-Melnick
- Connor Whole Health, University Hospitals of Cleveland, Cleveland, OH, USA
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Roshini Srinivasan
- Connor Whole Health, University Hospitals of Cleveland, Cleveland, OH, USA
- Duke University School of Medicine, Durham, NC, USA
| | - Rachael L. Rivard
- Connor Whole Health, University Hospitals of Cleveland, Cleveland, OH, USA
- Center for Evaluation and Survey Research, HealthPartners Institute, Minneapolis, MN, USA
| | - Francoise Adan
- Connor Whole Health, University Hospitals of Cleveland, Cleveland, OH, USA
- Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jeffery A. Dusek
- Department of Medicine, University of California – Irvine, Irvine, CA, USA
- Susan Samueli Integrative Health Institute, University of California – Irvine, Irvine, CA, USA
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Maheu AR, Ayubcha S, Handley NR. Integrative Medicine: An Opportunity for Improving Quality of Care in the Inpatient Setting. Qual Manag Health Care 2023; 32:257-262. [PMID: 37651590 DOI: 10.1097/qmh.0000000000000432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
As medicine shifts to a value-based focus, health care providers in inpatient settings are actively seeking approaches to providing high-quality patient care without exacerbating prevailing cost burden. Complementary and integrative medicine may offer one potential solution for this challenge. Although the benefits of utilizing integrative practices in the inpatient setting have not been explored extensively thus far, early evidence demonstrates great promise of using integrative modalities to improve symptom burden in the inpatient setting while increasing patient pain satisfaction and reducing overall costs of care. Currently, social, educational, and financial barriers exist, limiting the widespread incorporation of complementary and integrative medicine into the inpatient setting. Nonetheless, a more robust body of literature demonstrating the effectiveness of complementary and integrative medicine in reducing costs of care and improving patient outcomes may help address these limitations and lead to the acceptance of integrative practices as the standard of high-value inpatient care.
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Affiliation(s)
- Arlene R Maheu
- Sidney Kimmel Medical College (Ms Maheu and Dr Handley) and Department of Integrative Medicine and Nutritional Sciences (Dr Handley), Thomas Jefferson University, Philadelphia, Pennsylvania; and Department of Family Medicine, University of Pennsylvania, Philadelphia (Dr Ayubcha)
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McVoy M, Miller D, Bransteter I, Gubitosi-Klug R, Segal T, Surdam J, Sajatovic M, Dusek JA. A self-management plus mind body intervention for adolescents and young adults with type 2 diabetes: Trial design and methodological report. Contemp Clin Trials 2023; 133:107317. [PMID: 37625585 DOI: 10.1016/j.cct.2023.107317] [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: 06/12/2023] [Revised: 07/25/2023] [Accepted: 08/22/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND The onset of type 2 diabetes (T2D) is increasingly common in adolescents and young adults (AYAs). Improving self-management skills and the mental health of this population is important, but understudied. METHODS The goal of this research was to develop a mind-body intervention which could serve as an adjunctive therapy to support AYAs with T2D (INTEND intervention). Toward that end, we used an iterative process, including use of focus groups, advisory board, and cognitive semi-structured interviews with patients, parents of patient and clinical providers, to understand the gaps in the current information provided to AYAs with T2D. Based on the data gathered from the focus groups and interviews, we enhanced an existing self-management intervention for adults with T2D to include an additional mind body intervention for AYAs with T2D. The INTEND intervention will be piloted in a group of AYAs with T2D. RESULTS This report describes the methodology and design of the InterveNTion for Early oNset type 2 Diabetes (INTEND) study. The details of this single arm pre-post pilot feasibility trial are described. DISCUSSION If successful, the INTEND approach has the potential to advance care for vulnerable youth with T2D.
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Affiliation(s)
- Molly McVoy
- Case Western Reserve University School of Medicine (CWRU SOM), USA; University Hospitals Cleveland Medical Center (UHCMC), USA; Rainbow Babies and Children, UHCMC, USA.
| | | | | | - Rose Gubitosi-Klug
- Case Western Reserve University School of Medicine (CWRU SOM), USA; Rainbow Babies and Children, UHCMC, USA
| | - Tracy Segal
- University Hospitals Connor Whole Health, USA
| | | | - Martha Sajatovic
- Case Western Reserve University School of Medicine (CWRU SOM), USA; University Hospitals Cleveland Medical Center (UHCMC), USA
| | - Jeffery A Dusek
- Case Western Reserve University School of Medicine (CWRU SOM), USA; University Hospitals Connor Whole Health, USA
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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: 0] [Impact Index Per Article: 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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Rodgers-Melnick SN, Block S, Rivard RL, Dusek JA. Optimizing Patient-Reported Outcome Collection and Documentation in Medical Music Therapy: Process-Improvement Study. JMIR Hum Factors 2023; 10:e46528. [PMID: 37498646 PMCID: PMC10415937 DOI: 10.2196/46528] [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: 02/14/2023] [Revised: 05/30/2023] [Accepted: 06/21/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND To measure the effectiveness of nonpharmacologic interventions delivered during clinical care, investigators need to ensure robust and routine data collection without disrupting individualized patient care or adding unnecessary documentation burden. OBJECTIVE A process-improvement study was undertaken to improve documentation consistency and increase the capture of patient-reported outcomes (PROs; ie, stress, pain, anxiety, and coping) within a medical music therapy (MT) team. METHODS We used 2 Plan-Do-Study-Act (PDSA) cycles to improve documentation processes among an MT team (13.3 clinical full-time equivalent staff). Trainings focused on providing skills and resources for optimizing pre- and postsession PRO collection, specific guidelines for entering session data in the electronic health record, and opportunities for the team to provide feedback. Two comparisons of therapists' PRO collection rates were conducted: (1) between the 6 months before PDSA Cycle 1 (T0) and PDSA Cycle 1 (T1), and (2) between T1 and PDSA Cycle 2 (T2). RESULTS Music therapists' rates of capturing any PRO within MT sessions increased significantly (P<.001) from T0 to T1 and from T1 to T2 for all domains, including stress (4/2758, 0.1% at T0; 1012/2786, 36.3% at T1; and 393/775, 50.7% at T2), pain (820/2758, 29.7% at T0; 1444/2786, 51.8% at T1; and 476/775, 61.4% at T2), anxiety (499/2758, 18.1% at T0; 950/2786, 34.1% at T1; and 400/775, 51.6% at T2), and coping (0/2758, 0% at T0; 571/2786, 20.5% at T1; and 319/775, 41.2% at T2). Music therapists' feedback and findings from a retrospective analysis were used to create an improved electronic health record documentation template. CONCLUSIONS Rates of PRO data collection improved within the medical MT team. Although the process improvement in this study was applied to a nonpharmacologic MT intervention, the principles are applicable to numerous inpatient clinical providers. As hospitals continue to implement nonpharmacologic therapies in response to the Joint Commission's recommendations, routine PRO collection will provide future researchers with the ability to evaluate the impact of these therapies on pain relief and opioid use.
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Affiliation(s)
- Samuel N Rodgers-Melnick
- University Hospitals Connor Whole Health, Cleveland, OH, United States
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Seneca Block
- University Hospitals Connor Whole Health, Cleveland, OH, United States
- Department of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Rachael L Rivard
- University Hospitals Connor Whole Health, Cleveland, OH, United States
- Center for Survey and Evaluation Research, HealthPartners Institute, Minneapolis, MN, United States
| | - Jeffery A Dusek
- University Hospitals Connor Whole Health, Cleveland, OH, United States
- Department of Family Medicine and Community Health, School of Medicine, Case Western Reserve University, Cleveland, OH, United States
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Rodgers-Melnick SN, Rivard RL, Block S, Dusek JA. Effectiveness of music therapy within community hospitals: an EMMPIRE retrospective study. Pain Rep 2023; 8:e1074. [PMID: 37731473 PMCID: PMC10508459 DOI: 10.1097/pr9.0000000000001074] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 02/13/2023] [Accepted: 02/25/2023] [Indexed: 09/22/2023] Open
Abstract
Introduction Given the challenges health systems face in providing effective nonpharmacologic treatment for pain and psychological distress, clinical effectiveness studies of evidence-based strategies such as music therapy (MT) are needed. Objectives This study examined changes in patient-reported outcomes (PROs) after MT and explored variables associated with pain reduction of ≥2 units on a 0 to 10 numeric rating scale (NRS). Methods A retrospective review was conducted on initial MT interventions provided to adults receiving community hospital care between January 2017 and July 2020. Sessions were included if participants reported pre-session pain, anxiety, and/or stress scores of ≥4 on the NRS. Data analysis included a bootstrap analysis of single-session changes in PROs and a logistic regression exploring variables associated with pain reduction (ie, ≥2 units vs <2 units). Results Patients (n = 1056; mean age: 63.83 years; 76.1% female; 57.1% White; 41.1% Black/African American) reported clinically significant mean reductions in pain (2.04 units), anxiety (2.80 units), and stress (3.48 units). After adjusting for demographic, clinical, and operational characteristics in the model (c-statistic = 0.668), patients receiving an MT session in which pain management was a goal were 4.32 times more likely (95% confidence interval 2.26, 8.66) to report pain reduction of ≥2 units than patients receiving an MT session in which pain management was not a session goal. Conclusion This retrospective study supports the clinical effectiveness of MT for symptom management in community hospitals. However, additional research is needed to determine which characteristics of MT interventions and patients influence pain change.
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Affiliation(s)
- Samuel N. Rodgers-Melnick
- Connor Whole Health, University Hospitals of Cleveland, Cleveland, OH, USA
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Rachael L. Rivard
- Connor Whole Health, University Hospitals of Cleveland, Cleveland, OH, USA
- Center for Survey and Evaluation Research, HealthPartners Institute, Minneapolis, MN, USA
| | - Seneca Block
- Connor Whole Health, University Hospitals of Cleveland, Cleveland, OH, USA
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Jeffery A. Dusek
- Connor Whole Health, University Hospitals of Cleveland, Cleveland, OH, USA
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
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Groninger H, Nemati D, Cates C, Jordan K, Kelemen A, Shipp G, Munk N. Massage Therapy for Hospitalized Patients Receiving Palliative Care: A Randomized Clinical Trial. J Pain Symptom Manage 2023; 65:428-441. [PMID: 36731805 DOI: 10.1016/j.jpainsymman.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/09/2023] [Accepted: 01/17/2023] [Indexed: 02/01/2023]
Abstract
CONTEXT Massage therapy is increasingly used in palliative settings to improve quality of life (QoL) and symptom burden; however, the optimal massage "dosage" remains unclear. OBJECTIVES To compare three massage dosing strategies among inpatients receiving palliative care consultation. METHODS At an urban academic hospital, we conducted a three-armed randomized trial examining three different doses of therapist-applied massage to test change in overall QoL and symptoms among hospitalized adult patients receiving palliative care consultation for any indication (Arm I: 10-min massage daily × 3 days; Arm II: 20-min massage daily × 3 days; Arm III: single 20-min massage). Primary outcome measure was single-item McGill QoL question. Secondary outcomes measured pain/symptoms, rating of peacefulness, and satisfaction with intervention. Data were collected at baseline, pre- and post-treatment, and one-day postlast treatment (follow-up). Repeated measure analysis of variance and paired t-test were used to determine significant differences. RESULTS Total n = 387 patients were 55.7 (±15.49) years old, mostly women (61.2%) and African-American (65.6%). All three arms demonstrated within-group improvement at follow-up for McGill QoL (all P < 0.05). No significant between-group differences were found. Finally, repeated measure analyses demonstrated time to predict immediate improvement in distress (P ≤ 0.003) and pain (P ≤ 0.02) for all study arms; however, only improvement in distress sustained at follow-up measurement in arms with three consecutive daily massages of 10 or 20 minutes. CONCLUSION Massage therapy in complex patients with advanced illness was beneficial beyond dosage. Findings support session length (10 or 20 minutes) was predictive of short-term improvements while treatment frequency (once or three consecutive days) predicted sustained improvement at follow-up.
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Affiliation(s)
- Hunter Groninger
- Georgetown University Medical Center/MedStar Health (H.G., A.K.) Washington, District of Columbia, USA.
| | - Donya Nemati
- Indiana University School of Health and Human Sciences (D.N., N.M.) Indianapolis, Indiana, USA; Department of Health Sciences (D.N., N.M.) Indianapolis, Indiana, USA
| | - Cal Cates
- Healwell (C.C., K.J.) Arlington, Virginia, USA
| | | | - Anne Kelemen
- Georgetown University Medical Center/MedStar Health (H.G., A.K.) Washington, District of Columbia, USA
| | - Gianna Shipp
- Virginia Commonwealth University School of Medicine (G.S.) Richmond, Virginia, USA
| | - Niki Munk
- Indiana University School of Health and Human Sciences (D.N., N.M.) Indianapolis, Indiana, USA; Department of Health Sciences (D.N., N.M.) Indianapolis, Indiana, USA; Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Massage & Myotherapy Australia Fellow and Visiting Faculty of Health, University of Technology Sydney (N.M.) Sydney, New South Wales, Australia; National Centre for Naturopathic Medicine, Southern Cross University (N.M.) East Lismore, New South Wales, Australia
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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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11
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Jones T, Purdy M, Stewart EA, Cutshall SM, Hathcock MA, Mahapatra S, Bauer BA, Ainsworth AJ. Lavender Aromatherapy to Reduce Anxiety During Intrauterine Insemination: A Randomized Controlled Trial. Glob Adv Health Med 2021; 10:21649561211059074. [PMID: 34820153 PMCID: PMC8606920 DOI: 10.1177/21649561211059074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Infertility is a global public health issue. Therapies such as intrauterine insemination (IUI) are effective but may be associated with considerable anxiety. Preliminary data suggest that decreasing this anxiety might lead to improved outcomes. Objective To determine whether lavender aromatherapy (LA) reduces anxiety during an IUI procedure. Methods A randomized controlled trial of women undergoing IUI at a hospital-based fertility clinic. The intervention and comparison were the use of LA vs water. Measurements were the change in anxiety level during an IUI procedure, with secondary assessment of pain scores, patient satisfaction, and pregnancy rates. Results In total, 67 women were screened, and 62 women randomly assigned to either placebo (n = 31) or LA (n = 31). No differences were observed in baseline demographic characteristics or visual analog scores for anxiety before IUI (mean [95% CI], 33.9 [25.2 to 45.6] mm vs 41.0 [33.0 to 49.0] mm) in the LA and placebo groups. However, a statistically significant change in anxiety was observed after LA inhalation during the procedure (mean [95% CI], −11.2 [−19.1 to −3.2]) compared with placebo (mean [95% CI], 1.3 [−5.6 to 8.2]; P = .02). No significant difference was observed in pain during IUI in the LA group vs placebo group. Patient satisfaction was high, with 93% of respondents in the LA group satisfied with the aromatherapy during their procedure. Additionally, 76% of participants who received placebo reported that they would prefer to use LA during their IUI. No statistically significant difference was detected in pregnancy rates between the 2 groups: 19.4% with LA vs 9.7% with placebo (P = .47). Conclusion LA reduced anxiety and was preferred by women during IUI fertility treatments.
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Affiliation(s)
- Tiffanny Jones
- Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - MacKenzie Purdy
- Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Elizabeth A. Stewart
- Division of Reproductive Endocrinology and Infertility, Mayo Clinic, Rochester, MN, USA
| | | | | | - Saswati Mahapatra
- Department of Research Administration, Mayo Clinic, Rochester, MN, USA
| | - Brent A. Bauer
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
- Brent A. Bauer, Division of General Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905-0002, USA.
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12
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Lee SS, Chern JY, Frey MK, Comfort A, Lee J, Roselli N, Boyd LR. Enhanced recovery Pathways in gynecologic surgery: Are they safe and effective in the elderly? Gynecol Oncol Rep 2021; 38:100862. [PMID: 34621945 PMCID: PMC8479239 DOI: 10.1016/j.gore.2021.100862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/01/2021] [Accepted: 09/13/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To compare perioperative outcomes of the elderly versus non-elderly patients on ERPs undergoing laparotomy for gynecologic surgery. METHODS From January 2016 to June 2017, patients undergoing elective laparotomies for gynecologic surgery were enrolled in a perioperative ERP protocol. Outcomes were compared between the elderly (age ≥ 70 years) and the non-elderly (age ≤ 69 years). Primary outcomes were length of stay and perioperative complication rates. Comparisons were performed using chi-squared tests or Fisher's exact tests for categorical data and Student's t-test or Wilcoxon rank-sum tests for continuous variables, with p < 0.05 for significance. RESULTS One hundred eighty-nine patients were enrolled in the study, including 16 patients ≥ 70 years old. The median age was 75 years for the elderly and 45 years for the non-elderly. Elderly patients were more likely to have more complex surgery and longer operative times (absolute median difference of 39 min). Despite the increasing complexity of surgical procedures for elderly patients, there were no statistically significant differences in serious inpatient complications (Clavien-Dindo score 3A or greater), pain and nausea scores, 30-day complications and readmission rates. Elderly patients had a longer median length of stay compared to non-elderly patients by one day (p < 0.001), however, this was not statistically significant on multivariate analysis. CONCLUSION In our series, elderly patients on the ERP had similar rates of complications and readmission when compared to non-elderly patients, despite undergoing more complex surgeries. This suggests that ERP may be feasible and safe in the elderly population undergoing elective gynecologic laparotomy.
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Affiliation(s)
- Sarah S. Lee
- New York University School of Medicine, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, New York, NY, United States
| | - Jing-Yi Chern
- Moffitt Cancer Center, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Tampa, FL, United States
| | - Melissa K. Frey
- Weill Cornell Medicine, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, New York, NY, United States
| | - Ashley Comfort
- Boston University Medical Center, Department of Obstetrics and Gynecology, Boston, MA, United States
| | - Jessica Lee
- University of Texas Southwestern Medical Center, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Dallas, TX, United States
| | - Nicole Roselli
- New York University School of Medicine, Department of Obstetrics and Gynecology
| | - Leslie R. Boyd
- New York University School of Medicine, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, New York, NY, United States
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13
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Dyer NL, Surdam J, Dusek JA. A Systematic Review of Practiced-Based Research of Complementary and Integrative Health Therapies as Provided for Pain Management in Clinical Settings: Recommendations for the Future and A Call to Action. PAIN MEDICINE 2021; 23:189-210. [PMID: 34009391 DOI: 10.1093/pm/pnab151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The goal of this systematic review was to evaluate practice-based, real-world research of individualized complementary and integrative health (CIH) therapies for pain as provided in CIH outpatient clinics. METHODS A systematic review was conducted using PubMed, Ovid, Cochrane, Web of Science, Scopus and Embase through Dec 2020. The study was listed in the PROSPERO database (CRD42020159193). Major categories of variables extracted included study details and demographics; interventions; and outcomes. RESULTS The literature search yielded 3,316 records with 264 assessed for full text review. Of those, 23 studies (including ∼8,464 patients) were specific to pain conditions as a main outcome. Studies included chiropractic, acupuncture, multimodal individualized intervention/programs, physiotherapy, and anthroposophic medicine therapy. Retention rates ranged from 53% to 91%, with studies offering monetary incentives showing the highest retention. The 0-10 numerical rating scale was the most common pain questionnaire (n = 10, 43% of studies), with an average percent improvement across all studies and timepoints of 32% (range 18-60%). CONCLUSIONS Findings from this systematic review of practice-based, real-word research indicate that CIH therapies exert positive effects on various pain outcomes. Although all studies reported beneficial impacts on one or more pain outcomes, the heterogeneous nature of studies limits our overall understanding of CIH as provided in clinical settings. Accordingly, we present numerous recommendations to improve publication reporting and guide future research. Our call to action is future, practice-based CIH research is needed, but should be more expansive and in association with a CIH scientific society with academic and healthcare members.
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Affiliation(s)
- Natalie L Dyer
- Connor Integrative Health Network, University Hospitals, Cleveland, OH, USA
| | - Jessica Surdam
- Connor Integrative Health Network, University Hospitals, Cleveland, OH, USA
| | - Jeffery A Dusek
- Connor Integrative Health Network, University Hospitals, Cleveland, OH, USA.,Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, OH, USA
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14
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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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15
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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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16
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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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17
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Ducoulombier V, Chiquet R, Graf S, Leroy B, Bouquet G, Verdun S, Martellier F, Versavel A, Kone A, Lacroix K, Duthoit D, Lenglet Q, Devaux A, Jeanson R, Lefebvre A, Coviaux B, Calais G, Grimbert A, Ledein M, Moukagni M, Pascart T, Houvenagel E. Usefulness of a Visual Analog Scale for Measuring Anxiety in Hospitalized Patients Experiencing Pain: A Multicenter Cross-Sectional Study. Pain Manag Nurs 2020; 21:572-578. [PMID: 32362472 DOI: 10.1016/j.pmn.2020.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 01/08/2020] [Accepted: 03/11/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Anxiety is common in hospitalized patients and can worsen pain or lead to unsuccessful pain relief. AIMS The purpose of this study was to evaluate the usefulness of measuring anxiety with a visual analog scale (VAS) in the hospitalized patient experiencing pain. DESIGN We conducted a multiple-center cross-sectional study. PARTICIPANTS/SUBJECTS Adult inpatients experiencing moderate to severe pain defined by a pain VAS score ≥40 of 100 were included. METHODS Pain and anxiety data were collected using the following instruments: pain VAS, anxiety VAS, State Anxiety Scale of the Spielberger State-Trait Anxiety Inventory (STAI-YA) and Anxiety Subscale of the Hospital Anxiety and Depression Scale (HAD-A). RESULTS Data were collected from 394 patients. Of those patients, 43.6% (171 of 392) and 36.6% (143 of 391) had significant anxiety according to STAI-Ya and HAD-A, respectively. Correlation was good between anxiety-VAS and STAI-YA (ρ = 0.67 [95% confidence interval 0.61-0.72]) and moderate between anxiety VAS and HAD-D (ρ = 0.48 [0.39-0.56]). The main factor predictive of situational anxiety was history of anxiety-depression symptoms (odds ratio = 2.95 [1.93-4.56]). For anxiety VAS score ≥ 40 of 100, the sensitivity for detecting anxiety was 81% with 70% specificity. CONCLUSION This study confirmed the high prevalence of anxiety among inpatients experiencing pain, demonstrated the capacity of a VAS to assess this anxiety, determined an anxiety VAS cutoff level to screen for significant anxiety, and identified risk factors of anxiety in this population. Anxiety VAS has been found to be an easy-to-use method familiar to caregivers, with all the advantages needed for an effective screening instrument. An anxiety VAS score ≥40 of 100 would thus warrant particular attention to adapt care to the patient's anxiety-related pain and initiate specific therapeutic interventions.
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Affiliation(s)
- Vincent Ducoulombier
- Department of Rheumatology, Saint-Philibert Catholic Hospital, University of Lille, Lomme, France.
| | - Roman Chiquet
- Pain Center, Saint-Vincent Catholic Hospital, University of Lille, Lille, France
| | - Sahara Graf
- Lille Catholic hospitals, Biostatistics Department-Delegation for Clinical Research and Innovation, Lille Catholic University, Lille, France
| | - Bernard Leroy
- Pain Center, Roubaix Hospital Center, Roubaix, France
| | - Guillaume Bouquet
- Department of Palliative Care, Tourcoing Hospital Center, Tourcoing, France
| | - Stéphane Verdun
- Lille Catholic hospitals, Biostatistics Department-Delegation for Clinical Research and Innovation, Lille Catholic University, Lille, France
| | - Fabienne Martellier
- Pain Center, Saint-Vincent Catholic Hospital, University of Lille, Lille, France
| | - Adeline Versavel
- Pain Center, Saint-Vincent Catholic Hospital, University of Lille, Lille, France
| | - Alexandre Kone
- Department of Anesthésia, Sainte-Marie Catholic Hospital, University of Lille, Cambrai, France
| | - Karine Lacroix
- Department of Pharmacy, Sainte-Marie Catholic Hospital, University of Lille, Cambrai, France
| | - Didier Duthoit
- Public Mental Health Institution of Lille Metropole, Saint-André-lez-Lille, France
| | - Quentin Lenglet
- Public Mental Health Institution of Lille Metropole, Saint-André-lez-Lille, France
| | - Amelie Devaux
- Public Mental Health Institution of Lille Agglomeration, Armentières, France
| | - Robert Jeanson
- Public Mental Health Institution of Lille Agglomeration, Armentières, France
| | - Antoine Lefebvre
- Department of Pharmacy, Saint-Philibert Catholic Hospital, University of Lille, Lomme, France
| | - Benoit Coviaux
- Department of Psychiatry, Saint-Vincent Catholic Hospital, University of Lille, Lille, France
| | - Gauthier Calais
- Department of Neurology, Saint-Vincent Catholic Hospital, University of Lille, Lille, France
| | - Adeline Grimbert
- Geriatrics Unit, Saint-Vincent Catholic Hospital, University of Lille, Lille, France
| | - Marie Ledein
- Department of Intensive Care, Saint-Philibert Catholic Hospital, University of Lille, Lomme, France
| | - Marie Moukagni
- Pediatrics Department, Saint-Vincent Catholic Hospital, University of Lille, Lille, France
| | - Tristan Pascart
- Department of Rheumatology, Saint-Philibert Catholic Hospital, University of Lille, Lomme, France
| | - Eric Houvenagel
- Department of Rheumatology, Saint-Philibert Catholic Hospital, University of Lille, Lomme, France
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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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19
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Wells K, Craven P, Steenblik J, Carlson M, Cooper C, Madsen T. Prevalence and treatment of anxiety among emergency department patients with pain. Am J Emerg Med 2018; 36:1315-1317. [DOI: 10.1016/j.ajem.2017.11.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 11/15/2017] [Accepted: 11/16/2017] [Indexed: 02/02/2023] Open
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20
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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: 39] [Impact Index Per Article: 6.5] [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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21
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Vergo MT, Pinkson BM, Broglio K, Li Z, Tosteson TD. Immediate Symptom Relief After a First Session of Massage Therapy or Reiki in Hospitalized Patients: A 5-Year Clinical Experience from a Rural Academic Medical Center. J Altern Complement Med 2018; 24:801-808. [PMID: 29620922 DOI: 10.1089/acm.2017.0409] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES There is an increasing demand for and use of alternative and complementary therapies, such as reiki and massage therapy, in hospital-based settings. Most controlled studies and practice-based reports include oncology and surgical patient populations; thus the effect in a more heterogeneous hospitalized patient population is hard to estimate. We examined the immediate symptom relief from a single reiki or massage session in a hospitalized population at a rural academic medical center. DESIGN Retrospective analysis of prospectively collected data on demographic, clinical, process, and quality of life for hospitalized patients receiving massage therapy or reiki. SETTINGS/LOCATION A 396-bed rural academic and tertiary medical center in the United States. SUBJECTS Hospitalized patients requesting or referred to the healing arts team who received either a massage or reiki session and completed both a pre- and post-therapy symptom questionnaire. INTERVENTIONS First session of routine reiki or massage therapy during a hospital stay. OUTCOME MEASURES Differences between pre- and postsession patient-reported scores in pain, nausea, fatigue, anxiety, depression, and overall well-being using an 11-point Likert scale. RESULTS Patients reported symptom relief with both reiki and massage therapy. Analysis of the reported data showed reiki improved fatigue (-2.06 vs. -1.55 p < 0.0001) and anxiety (-2.21 vs. -1.84 p < 0.001) statistically more than massage. Pain, nausea, depression, and well being changes were not statistically different between reiki and massage encounters. Immediate symptom relief was similar for cancer and noncancer patients for both reiki and massage therapy and did not vary based on age, gender, length of session, and baseline symptoms. CONCLUSIONS Reiki and massage clinically provide similar improvements in pain, nausea, fatigue, anxiety, depression, and overall well-being while reiki improved fatigue and anxiety more than massage therapy in a heterogeneous hospitalized patient population. Controlled trials should be considered to validate the data.
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Affiliation(s)
- Maxwell T Vergo
- 1 Section of Palliative Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,2 Geisel School of Medicine , Lebanon, New Hampshire
| | - Briane M Pinkson
- 1 Section of Palliative Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Kathleen Broglio
- 1 Section of Palliative Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,2 Geisel School of Medicine , Lebanon, New Hampshire
| | - Zhongze Li
- 3 Division of Biostatistics, Department of Biomedical Data Science, Lebanon, New Hampshire
| | - Tor D Tosteson
- 3 Division of Biostatistics, Department of Biomedical Data Science, Lebanon, New Hampshire
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Kramlich D. Complementary Health Practitioners in the Acute and Critical Care Setting: Nursing Considerations. Crit Care Nurse 2018; 37:60-65. [PMID: 28572102 DOI: 10.4037/ccn2017181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
In response to the rising demand by patients and their families for complementary health approaches, hospitals are increasingly integrating complementary health approaches with their conventional medical practices to create healing environments. Results of the 2010 Complementary and Alternative Medicine Survey of Hospitals indicated that the top 6 inpatient modalities included pet therapy, massage therapy, music or art therapy, guided imagery, relaxation therapy, and Reiki and therapeutic touch. Whether complementary health approaches are provided by complementary health practitioners through hospital-based integrative medicine programs, volunteer practitioners, or bedside nurses, the regulatory, legal, ethical, and safety concerns remain constant. Previous articles in this column of Critical Care Nurse provided an overview of complementary health approaches that nurses may encounter in their practices, with specific attention to implications for acute and critical care nurses, as well as important legal, ethical, safety, quality, and financial implications that acute and critical care nurses should consider when integrating complementary health approaches with conventional care. This column provides the acute and critical care nurse with key information about validation of credentials, experience, and competence of nurses and volunteers providing complementary health approaches, as well as about institutional policies and scope of practice.
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Affiliation(s)
- Debra Kramlich
- Debra Kramlich is an assistant professor of nursing, University of New England, Portland, Maine. She is also a traditional Usui Reiki master/teacher with more than 10 years of experience.
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Quinlan-Woodward J, Gode A, Dusek JA, Reinstein AS, Johnson JR, Sendelbach S. Assessing the Impact of Acupuncture on Pain, Nausea, Anxiety, and Coping in Women Undergoing a Mastectomy. Oncol Nurs Forum 2017; 43:725-732. [PMID: 27768139 DOI: 10.1188/16.onf.725-732] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To compare the effect of acupuncture to a standard-of-care (control) group on pain, nausea, anxiety, and ability to cope.
. DESIGN Pilot randomized, controlled trial.
. SETTING Abbott Northwestern Hospital, a large, urban, tertiary care hospital in Minneapolis, Minnesota.
. SAMPLE 30 adult women undergoing surgery for breast cancer.
. METHODS Women were randomly assigned to two hospital-based acupuncture treatments versus usual care after breast cancer surgery. Pain, nausea, anxiety, and the patient's ability to cope pre- and post-treatment were compared within and between groups at two different time points postoperatively.
. MAIN RESEARCH VARIABLES Mean change in pain, nausea, anxiety, and ability to cope by treatment group.
. FINDINGS Compared to women assigned to the control group, women who received acupuncture reported a statistically significant greater reduction in pain, nausea, anxiety, and increase in ability to cope on the first postoperative day and in pain on the second postoperative day following mastectomy surgery.
. CONCLUSIONS Acupuncture delivered postoperatively in the hospital after mastectomy can reduce the severity of symptoms experienced, as well as increase the patient's ability to cope with her symptoms. However, before implementation as a standard of care, further research needs to be conducted.
. IMPLICATIONS FOR NURSING Acupuncture adds a nonpharmacologic intervention for symptom management in women undergoing mastectomies for breast cancer.
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Affiliation(s)
| | - Autumn Gode
- Penny George Institute for Health and Healing
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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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25
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Lee SMK, Leem J, Park JH, Yoon KH, Woo JS, Lee JM, Kim JB, Kim W, Lee S. Close look at the experiences of patients enrolled in a clinical trial of acupuncture treatment for atrial fibrillation in Korea: a qualitative study nested within a randomised controlled trial. BMJ Open 2017; 7:e013180. [PMID: 28159849 PMCID: PMC5293996 DOI: 10.1136/bmjopen-2016-013180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To explore the experiences of patients with atrial fibrillation (AF) in the context of a prospective, two-parallel-armed, participant-blinded and assessor-blinded sham-controlled randomised trial. DESIGN A nested qualitative study within an ongoing randomised controlled trial to explore acupuncture's antiarrhythmic effects on drug refractory acupuncture in persistent atrial fibrillation (AF) (ACU-AF trial). PARTICIPANTS Participants were recruited using purposeful sampling and a maximum variation strategy with regard to treatment allocation (treatment or control) and protocol completion (completion or non-completion). SETTING This was a single-centre in-depth interview qualitative study conducted at a tertiary-level university hospital in Seoul, Republic of Korea. RESULTS Data saturation was reached after 8 participants. Thematic analysis identified that most patients were not aware of their condition until medical check-up; physician referral was the main reason for trial participation, and patients had high expectations regardless of previous acupuncture experiences. Patients tended to depend on their physicians' opinions because they felt helpless of their condition. No one questioned their assigned treatment groups and generally believed acupuncture treatment was different for cardiovascular diseases. A few patients expressed disappointment in the strict and rigid protocols, in which most practitioners refrained from explaining their acupuncture procedures. CONCLUSIONS For cardiovascular patients their physician's advice was one of the biggest reasons for enrolling in the acupuncture trial therefore relying on standard recruitment methods may not be effective. Fortunately both real and sham acupuncture groups in our sample were receiving treatment as intended, but in the future, designing a more pragmatic trial (better reflecting clinical settings, expanding the inclusion criteria and using more treatment points) will allow researchers to better explore the comprehensive effects of acupuncture. The findings of this study will allow researchers to improve the currently ongoing ACU-AF trial and to further help interpretation of main trial outcomes once the trial is completed. TRIAL REGISTRATION NUMBER NCT02110537.
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Affiliation(s)
- Seung Min Kathy Lee
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Jungtae Leem
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Jun Hyeong Park
- Department of Acupuncture and Moxibustion, College of Korean Medicine, Kyung Hee University, Dongdaemun-gu, Republic of Korea
| | - Kang Hyun Yoon
- Department of Acupuncture and Moxibustion, College of Korean Medicine, Kyung Hee University, Dongdaemun-gu, Republic of Korea
| | - Jong Shin Woo
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul, Republic of Korea
| | - Jung Myung Lee
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul, Republic of Korea
| | - Jin-Bae Kim
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul, Republic of Korea
| | - Weon Kim
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul, Republic of Korea
| | - Sanghoon Lee
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
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26
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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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27
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Supporting Integrative Medicine research through an Australasian practice-based research network. ADVANCES IN INTEGRATIVE MEDICINE 2016. [DOI: 10.1016/j.aimed.2016.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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28
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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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29
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Fletcher CE, Mitchinson AR, Trumble EL, Hinshaw DB, Dusek JA. Perceptions of other integrative health therapies by Veterans with pain who are receiving massage. JOURNAL OF REHABILITATION RESEARCH AND DEVELOPMENT 2016; 53:117-26. [PMID: 27004453 PMCID: PMC4829362 DOI: 10.1682/jrrd.2015.01.0015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 09/15/2015] [Indexed: 11/05/2022]
Abstract
Veterans are increasingly using complementary and integrative health (CIH) therapies to manage chronic pain and other troubling symptoms that significantly impair health and quality of life. The Department of Veterans Affairs (VA) is exploring ways to meet the demand for access to CIH, but little is known about Veterans' perceptions of the VA's efforts. To address this knowledge gap, we conducted interviews of 15 inpatients, 8 receiving palliative care, and 15 outpatients receiving CIH in the VA. Pain was the precipitating factor in all participants' experience. Participants were asked about their experience in the VA and their opinions about which therapies would most benefit other Veterans. Participants reported that massage was well-received and resulted in decreased pain, increased mobility, and decreased opioid use. Major challenges were the high ratio of patients to CIH providers, the difficulty in receiving CIH from fee-based CIH providers outside of the VA, cost issues, and the role of administrative decisions in the uneven deployment of CIH across the VA. If the VA is to meet its goal of offering personalized, proactive, patient-centered care nationwide then it must receive support from Congress while considering Veterans' goals and concerns to ensure that the expanded provision of CIH improves outcomes.
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Affiliation(s)
- Carol Elizabeth Fletcher
- Department of Research, Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI
| | - Allison R. Mitchinson
- Department of Medicine, Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI
| | - Erika L. Trumble
- Department of Research, Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI
| | - Daniel B. Hinshaw
- Department of Palliative Care, Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI
| | - Jeffery A. Dusek
- Abbott Northwestern Hospital, Penney George Institute, Minneapolis, MN
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30
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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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31
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Ali A, Katz DL. Disease Prevention and Health Promotion: How Integrative Medicine Fits. Am J Prev Med 2015; 49:S230-40. [PMID: 26477898 PMCID: PMC4615581 DOI: 10.1016/j.amepre.2015.07.019] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 07/22/2015] [Accepted: 07/26/2015] [Indexed: 01/06/2023]
Abstract
As a discipline, preventive medicine has traditionally been described to encompass primary, secondary, and tertiary prevention. The fields of preventive medicine and public health share the objectives of promoting general health, preventing disease, and applying epidemiologic techniques to these goals. This paper discusses a conceptual approach between the overlap and potential synergies of integrative medicine principles and practices with preventive medicine in the context of these levels of prevention, acknowledging the relative deficiency of research on the effectiveness of practice-based integrative care. One goal of integrative medicine is to make the widest array of appropriate options available to patients, ultimately blurring the boundaries between conventional and complementary medicine. Both disciplines should be subject to rigorous scientific inquiry so that interventions that are efficacious and effective are systematically distinguished from those that are not. Furthermore, principles of preventive medicine can be infused into prevalent practices in complementary and integrative medicine, promoting public health in the context of more responsible practices. The case is made that an integrative preventive approach involves the responsible use of science with responsiveness to the needs of patients that persist when conclusive data are exhausted, providing a framework to make clinical decisions among integrative therapies.
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Affiliation(s)
- Ather Ali
- Yale School of Medicine, New Haven, Connecticut.
| | - David L Katz
- Yale University Prevention Research Center, Derby, Connecticut
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32
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Liu R, Chang A, Reddy S, Hecht FM, Chao MT. Improving Patient-Centered Care: A Cross-Sectional Survey of Prior Use and Interest in Complementary and Integrative Health Approaches Among Hospitalized Oncology Patients. J Altern Complement Med 2015; 22:160-5. [PMID: 26505257 DOI: 10.1089/acm.2015.0061] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To describe cancer inpatients' prior-year use of complementary and integrative health (CIH) therapies and interest in receiving CIH therapies while in the hospital. DESIGN Observational, cross-sectional survey of prior-year use of 12 different CIH approaches and interest in receiving any of 7 CIH services in the hospital. SETTING Surgical oncology ward of an academic medical center. PARTICIPANTS 166 hospitalized oncology patients, with an average age of 54 years. RESULTS The most commonly used CIH approach was vitamins/nutritional supplements (67%), followed by use of a special diet (42%) and manual therapies (39%). More than 40% of patients expressed interest in each of the therapies if it was offered during their hospital stay, and 95% of patients were interested in at least one. More than 75% expressed interest in nutritional counseling and in massage. CIH use and interest varied somewhat by demographic and clinical characteristics. CONCLUSION Rates of CIH use among patients with cancer were high, as were their preferences to have these services available in the inpatient setting. Hospitals have the opportunity to provide patient-centered care by developing capacity to provide inpatient CIH services.
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Affiliation(s)
- Rhianon Liu
- 1 Osher Center for Integrative Medicine, University of California , San Francisco, San Francisco, CA
| | - Alexandra Chang
- 2 Departments of Anesthesiology and Internal Medicine, Loma Linda University , Loma Linda, CA
| | - Sanjay Reddy
- 1 Osher Center for Integrative Medicine, University of California , San Francisco, San Francisco, CA.,3 Division of Hospital Medicine, University of California , San Francisco, San Francisco, CA
| | - Frederick M Hecht
- 1 Osher Center for Integrative Medicine, University of California , San Francisco, San Francisco, CA
| | - Maria T Chao
- 1 Osher Center for Integrative Medicine, University of California , San Francisco, San Francisco, CA.,4 Division of General Internal Medicine at San Francisco General Hospital, University of California , San Francisco, San Francisco, CA
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