The number of adult Medicaid recipients and other low-income people with multiple chronic health conditions is rapidly rising (Kaiser Commission on Medicaid and the Uninsured, 2012). Health systems struggle to meet their needs, and effective approaches to support and treatment are lacking even as the ACA makes care accessible to larger numbers of low-income people. Many of these people are part of the growing demand for integrative medicine, but struggle to access these services because of their typically high out-of-pocket cost (Fritts, Calvo, Jonas, & Bezold, 2009). Group visits are an increasingly widely used innovation, bringing multiple patients together for medical care, education and support with one or more clinicians. Several studies have examined the use of integrative medicine in group medical visits (Chao, 2012; Geller, Orkaby, & Cleghorn, 2011) including culturally specific approaches (Mehl-Madrona, 2010). However, it is not clear how widely integrative medicine and group visit approaches are being combined and implemented, and whether patients and clinicians view group medical visits as an acceptable approach to integrative treatment. The purpose of this research training proposal is to acquire the necessary training for research that will examine the use of group visits as an approach to disseminating integrative medicine and increasing patient engagement in care. This exploratory, mixed-methods study seeks to understand the implementation and use of integrative medicine group visits across multiple health conditions, focusing on settings that serve Medicaid recipients and uninsured people. Methods will include a web-based survey of clinicians as well as interviews and participant observation with patients and clinicians, with the following specific aims: 1) Describe how integrative medicine and group visit approaches are being combined through a web-based survey of clinicians using this approach in safety-net settings, evaluating which complementary health approaches are being implemented for what health conditions; 2) Identify how clinicians assess the effectiveness, benefits and limitations of combining integrative medicine and group visit approaches in safety-net settings through interviews and observations; 3) Assess patient satisfaction levels and engagement in care in safety-net settings that combine integrative medicine and group visit approaches through interviews and observations. The long-term goal of this research is to assess the potential contributions of innovative integrative medicine delivery methods to address disparities in access to complementary health approaches as well as health disparities more broadly.
This research training proposal will support efforts to increase low-income people's access to integrative medicine, with the goal of making complementary health approaches available to more Medicaid recipients and uninsured people with chronic health conditions. The training program will further this goal by preparing the PI, Ms. Jostad-Laswell, through: formal training in mixed-methods and integrative medicine research, mentored research experiences in integrative medicine research, and professional development training and opportunities for publication and presentation. The research project will highlight innovative approaches to health promotion and chronic illness treatment that integrate complementary health approaches with existing care provided in community health centers and other safety-net settings.
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|Fleming, Mark D; Shim, Janet K; Yen, Irene H et al. (2017) Patient engagement at the margins: Health care providers' assessments of engagement and the structural determinants of health in the safety-net. Soc Sci Med 183:11-18|
|Thompson-Lastad, Ariana; Yen, Irene H; Fleming, Mark D et al. (2017) Response to commentary, ""Trauma and the structuring of complex care: Back to the settlements?"" by Elizabeth Bowen. Soc Sci Med 192:28-29|