TY - JOUR
T1 - Acupuncture and chiropractic care for chronic pain in an integrated health plan
T2 - a mixed methods study
AU - DeBar, Lynn L.
AU - Elder, Charles
AU - Ritenbaugh, Cheryl
AU - Aickin, Mikel
AU - Deyo, Rick
AU - Meenan, Richard
AU - Dickerson, John
AU - Webster, Jennifer A.
AU - Jo Yarborough, Bobbi
N1 - Funding Information:
The authors gratefully acknowledge funding support for this study from the National Institutes of Health, National Center for Complementary and Alternative Medicine Grant (R01 AT005896). In addition at the time this article was prepared, co-author, John Dickerson, was funded in part from a training grant from the Agency for Healthcare Research and Quality (T32HS013853). We thank Dana Foley for her helpful comments on previous versions of this article. Richard Hammerschlag and Mitch Haas provided important feedback on study design. In addition, Chris Catlin, Stephanie Hertert, Gail Morgan, Matt Hornbrook, Maureen O’Keefe-Rosetti, Lin Neighbors, and Lisa Fox have all contributed invaluable support for the early phases of the study.
PY - 2011/11/25
Y1 - 2011/11/25
N2 - Background: Substantial recent research examines the efficacy of many types of complementary and alternative (CAM) therapies. However, outcomes associated with the "real-world" use of CAM has been largely overlooked, despite calls for CAM therapies to be studied in the manner in which they are practiced. Americans seek CAM treatments far more often for chronic musculoskeletal pain (CMP) than for any other condition. Among CAM treatments for CMP, acupuncture and chiropractic (A/C) care are among those with the highest acceptance by physician groups and the best evidence to support their use. Further, recent alarming increases in delivery of opioid treatment and surgical interventions for chronic pain--despite their high costs, potential adverse effects, and modest efficacy--suggests the need to evaluate real world outcomes associated with promising non-pharmacological/non-surgical CAM treatments for CMP, which are often well accepted by patients and increasingly used in the community.Methods/Design: This multi-phase, mixed methods study will: (1) conduct a retrospective study using information from electronic medical records (EMRs) of a large HMO to identify unique clusters of patients with CMP (e.g., those with differing demographics, histories of pain condition, use of allopathic and CAM health services, and comorbidity profiles) that may be associated with different propensities for A/C utilization and/or differential outcomes associated with such care; (2) use qualitative interviews to explore allopathic providers' recommendations for A/C and patients' decisions to pursue and retain CAM care; and (3) prospectively evaluate health services/costs and broader clinical and functional outcomes associated with the receipt of A/C relative to carefully matched comparison participants receiving traditional CMP services. Sensitivity analyses will compare methods relying solely on EMR-derived data versus analyses supplementing EMR data with conventionally collected patient and clinician data.Discussion: Successful completion of these aggregate aims will provide an evaluation of outcomes associated with the real-world use of A/C services. The trio of retrospective, qualitative, and prospective study will also provide a clearer understanding of the decision-making processes behind the use of A/C for CMP and a transportable methodology that can be applied to other health care settings, CAM treatments, and clinical populations.Trial registration: ClinicalTrials.gov: NCT01345409.
AB - Background: Substantial recent research examines the efficacy of many types of complementary and alternative (CAM) therapies. However, outcomes associated with the "real-world" use of CAM has been largely overlooked, despite calls for CAM therapies to be studied in the manner in which they are practiced. Americans seek CAM treatments far more often for chronic musculoskeletal pain (CMP) than for any other condition. Among CAM treatments for CMP, acupuncture and chiropractic (A/C) care are among those with the highest acceptance by physician groups and the best evidence to support their use. Further, recent alarming increases in delivery of opioid treatment and surgical interventions for chronic pain--despite their high costs, potential adverse effects, and modest efficacy--suggests the need to evaluate real world outcomes associated with promising non-pharmacological/non-surgical CAM treatments for CMP, which are often well accepted by patients and increasingly used in the community.Methods/Design: This multi-phase, mixed methods study will: (1) conduct a retrospective study using information from electronic medical records (EMRs) of a large HMO to identify unique clusters of patients with CMP (e.g., those with differing demographics, histories of pain condition, use of allopathic and CAM health services, and comorbidity profiles) that may be associated with different propensities for A/C utilization and/or differential outcomes associated with such care; (2) use qualitative interviews to explore allopathic providers' recommendations for A/C and patients' decisions to pursue and retain CAM care; and (3) prospectively evaluate health services/costs and broader clinical and functional outcomes associated with the receipt of A/C relative to carefully matched comparison participants receiving traditional CMP services. Sensitivity analyses will compare methods relying solely on EMR-derived data versus analyses supplementing EMR data with conventionally collected patient and clinician data.Discussion: Successful completion of these aggregate aims will provide an evaluation of outcomes associated with the real-world use of A/C services. The trio of retrospective, qualitative, and prospective study will also provide a clearer understanding of the decision-making processes behind the use of A/C for CMP and a transportable methodology that can be applied to other health care settings, CAM treatments, and clinical populations.Trial registration: ClinicalTrials.gov: NCT01345409.
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U2 - 10.1186/1472-6882-11-118
DO - 10.1186/1472-6882-11-118
M3 - Article
C2 - 22118061
AN - SCOPUS:82055163879
SN - 1472-6882
VL - 11
JO - BMC Complementary and Alternative Medicine
JF - BMC Complementary and Alternative Medicine
M1 - 118
ER -