المؤلفون: Michael D. Finch, David Watson, Kristen H. Griffin, Rachael L. Rivard, Jeffery A. Dusek

المصدر: The Journal of Alternative and Complementary Medicine. 24:557-563

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Hospitalized patients, Minnesota, Task (project management), 03 medical and health sciences, 0302 clinical medicine, Cost Savings, Electronic health record, medicine, Electronic Health Records, Humans, Pain Management, 030212 general & internal medicine, health care economics and organizations, Aged, Retrospective Studies, Integrative Medicine, business.industry, Original Articles, Length of Stay, Middle Aged, Pain management, medicine.disease, 030205 complementary & alternative medicine, Cost savings, Hospitalization, Complementary and alternative medicine, Female, Medical emergency, Integrative medicine, Outcomes research, business

الوصف: 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%.

URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::9e5d205bfd26f4627866fc911ac682d1
https://doi.org/10.1089/acm.2017.0203

المؤلفون: Ariana Thompson-Lastad, Evelyn Y. Ho, Maria T. Chao, Nicole Thompson, Xiaoyu Zhang, Rachele Lam

المصدر: J Altern Complement Med

مصطلحات موضوعية: Adult, Counseling, Male, medicine.medical_specialty, Acupuncture Therapy, Context (language use), law.invention, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Acupuncture, Humans, Pain Management, Medicine, Qualitative Research, Randomized Controlled Trials as Topic, Integrative Medicine, business.industry, Cancer, Cancer Pain, Original Articles, Middle Aged, Pain management, medicine.disease, 030205 complementary & alternative medicine, Treatment Outcome, Complementary and alternative medicine, Physical therapy, Female, business

الوصف: 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.

URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::d34a2428bba077933f3d573b13705129
https://doi.org/10.1089/acm.2020.0387

المؤلفون: Craig A. Morioka, Stephanie L. Taylor, Nell Marshall, Yijun Shao, Qing Zeng, Karen Chu, Anita Yuan, Patricia M. Herman, Karl A. Lorenz

المصدر: The Journal of Alternative and Complementary Medicine. 25:32-39

مصطلحات موضوعية: Adult, Complementary Therapies, Male, Musculoskeletal pain, medicine.medical_specialty, Adolescent, Alternative medicine, Veterans Health, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Musculoskeletal Pain, medicine, Retrospective analysis, Humans, Veterans, Integrative Medicine, business.industry, Chronic pain, Middle Aged, Pain management, medicine.disease, 030205 complementary & alternative medicine, Complementary and alternative medicine, Opioid, Physical therapy, Female, Chronic Pain, business, medicine.drug

الوصف: To partially address the opioid crisis, some complementary and integrative health (CIH) therapies are now recommended for chronic musculoskeletal pain, a common condition presented in primary care. As such, health care systems are increasingly offering CIH therapies, and the Veterans Health Administration (VHA), the nation's largest integrated health care system, has been at the forefront of this movement. However, little is known about the uptake of CIH among patients with chronic musculoskeletal pain. As such, we conducted the first study of the use of a variety of nonherbal CIH therapies among a large patient population having chronic musculoskeletal pain.We examined the frequency and predictors of CIH therapy use using administrative data for a large retrospective cohort of younger veterans with chronic musculoskeletal pain using the VHA between 2010 and 2013 (n = 530,216). We conducted a 2-year effort to determine use of nine types of CIH by using both natural language processing data mining methods and administrative and CPT4 codes. We defined chronic musculoskeletal pain as: (1) having 2+ visits with musculoskeletal diagnosis codes likely to represent chronic pain separated by 30-365 days or (2) 2+ visits with musculoskeletal diagnosis codes within 90 days and with 2+ numeric rating scale pain scores ≥4 at 2+ visits within 90 days.More than a quarter (27%) of younger veterans with chronic musculoskeletal pain used any CIH therapy, 15% used meditation, 7% yoga, 6% acupuncture, 5% chiropractic, 4% guided imagery, 3% biofeedback, 2% t'ai chi, 2% massage, and 0.2% hypnosis. Use of any CIH therapy was more likely among women, single patients, patients with three of the six pain conditions, or patients with any of the six pain comorbid conditions.Patients appear willing to use CIH approaches, given that 27% used some type. However, low rates of some specific CIH suggest the potential to augment CIH use.

URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::a940d5d4e07b905ddc699f5e71fd8a30
https://doi.org/10.1089/acm.2018.0276