Acupuncture and chiropractic care for chronic pain in an integrated health plan: a mixed methods study

BMC Complementary and Alternative Medicine

Study Protocol

Mikel Aickin¹  Cheryl Ritenbaugh¹  Rick Deyo²  Bobbi Jo Yarborough³  Richard Meenan³  Charles Elder³  Lynn L DeBar³  John Dickerson³  Jennifer A Webster³ 

[1] Department of Family & Community Medicine, University of Arizona, Tucson, Arizona, USA;Department of Family Medicine, Oregon Health and Science University, Portland, Oregon, USA;Kaiser Permanente, The Center for Health Research, Portland, Oregon, USA;

关键词: Electronic Medical Record;    Health Maintenance Organization;    Propensity Score Analysis;    Chronic Musculoskeletal Pain;    Chiropractic Care;   

DOI  :  10.1186/1472-6882-11-118

 received in 2011-10-31, accepted in 2011-11-25,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundSubstantial 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/DesignThis 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.DiscussionSuccessful 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 registrationClinicalTrials.gov: NCT01345409

【 授权许可】

CC BY   
© DeBar et al; licensee BioMed Central Ltd. 2011