TY - JOUR
T1 - Complementary and Integrative Health Approaches and Pain Care Quality in the Veterans Health Administration Primary Care Setting
T2 - A Quasi-Experimental Analysis
AU - Han, Ling
AU - Luther, Stephen L.
AU - Finch, Dezon K.
AU - Dobscha, Steven K.
AU - Skanderson, Melissa
AU - Bathulapalli, Harini
AU - Fodeh, Samah J.
AU - Hahm, Bridget
AU - Bouayad, Lina
AU - Lee, Allison
AU - Goulet, Joseph L.
AU - Brandt, Cynthia A.
AU - Kerns, Robert D.
N1 - Publisher Copyright:
Copyright © 2023, Mary Ann Liebert, Inc., publishers 2023.
PY - 2023/7/1
Y1 - 2023/7/1
N2 - Background: Complementary and integrative health (CIH) approaches have been recommended in national and international clinical guidelines for chronic pain management. We set out to determine whether exposure to CIH approaches is associated with pain care quality (PCQ) in the Veterans Health Administration (VHA) primary care setting. Methods: We followed a cohort of 62,721 Veterans with newly diagnosed musculoskeletal disorders between October 2016 and September 2017 over 1-year. PCQ scores were derived from primary care progress notes using natural language processing. CIH exposure was defined as documentation of acupuncture, chiropractic or massage therapies by providers. Propensity scores (PSs) were used to match one control for each Veteran with CIH exposure. Generalized estimating equations were used to examine associations between CIH exposure and PCQ scores, accounting for potential selection and confounding bias. Results: CIH was documented for 14,114 (22.5%) Veterans over 16,015 primary care clinic visits during the follow-up period. The CIH exposure group and the 1:1 PS-matched control group achieved superior balance on all measured baseline covariates, with standardized differences ranging from 0.000 to 0.045. CIH exposure was associated with an adjusted rate ratio (aRR) of 1.147 (95% confidence interval [CI]: 1.142, 1.151) on PCQ total score (mean: 8.36). Sensitivity analyses using an alternative PCQ scoring algorithm (aRR: 1.155; 95% CI: 1.150-1.160) and redefining CIH exposure by chiropractic alone (aRR: 1.118; 95% CI: 1.110-1.126) derived consistent results. Discussion: Our data suggest that incorporating CIH approaches may reflect higher overall quality of care for patients with musculoskeletal pain seen in primary care settings, supporting VHA initiatives and the Declaration of Astana to build comprehensive, sustainable primary care capacity for pain management. Future investigation is warranted to better understand whether and to what degree the observed association may reflect the therapeutic benefits patients actually received or other factors such as empowering provider-patient education and communication about these approaches.
AB - Background: Complementary and integrative health (CIH) approaches have been recommended in national and international clinical guidelines for chronic pain management. We set out to determine whether exposure to CIH approaches is associated with pain care quality (PCQ) in the Veterans Health Administration (VHA) primary care setting. Methods: We followed a cohort of 62,721 Veterans with newly diagnosed musculoskeletal disorders between October 2016 and September 2017 over 1-year. PCQ scores were derived from primary care progress notes using natural language processing. CIH exposure was defined as documentation of acupuncture, chiropractic or massage therapies by providers. Propensity scores (PSs) were used to match one control for each Veteran with CIH exposure. Generalized estimating equations were used to examine associations between CIH exposure and PCQ scores, accounting for potential selection and confounding bias. Results: CIH was documented for 14,114 (22.5%) Veterans over 16,015 primary care clinic visits during the follow-up period. The CIH exposure group and the 1:1 PS-matched control group achieved superior balance on all measured baseline covariates, with standardized differences ranging from 0.000 to 0.045. CIH exposure was associated with an adjusted rate ratio (aRR) of 1.147 (95% confidence interval [CI]: 1.142, 1.151) on PCQ total score (mean: 8.36). Sensitivity analyses using an alternative PCQ scoring algorithm (aRR: 1.155; 95% CI: 1.150-1.160) and redefining CIH exposure by chiropractic alone (aRR: 1.118; 95% CI: 1.110-1.126) derived consistent results. Discussion: Our data suggest that incorporating CIH approaches may reflect higher overall quality of care for patients with musculoskeletal pain seen in primary care settings, supporting VHA initiatives and the Declaration of Astana to build comprehensive, sustainable primary care capacity for pain management. Future investigation is warranted to better understand whether and to what degree the observed association may reflect the therapeutic benefits patients actually received or other factors such as empowering provider-patient education and communication about these approaches.
KW - VHA primary care
KW - complementary and integrative health approaches (CIH)
KW - musculoskeletal disorders (MSD)
KW - natural language processing (NLP)
KW - pain care quality (PCQ)
KW - propensity score (PS)
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U2 - 10.1089/jicm.2022.0686
DO - 10.1089/jicm.2022.0686
M3 - Article
C2 - 36971840
AN - SCOPUS:85162235514
SN - 2768-3605
VL - 29
SP - 420
EP - 429
JO - Journal of Integrative and Complementary Medicine
JF - Journal of Integrative and Complementary Medicine
IS - 6-7
ER -