The past decade has seen a substantial increase in research examining the efficacy and biological basis of many types of therapies typically characterized as complementary or alternative medicine (CAM). However, much of this work has overlooked the """"""""real world"""""""" use of CAM despite calls for CAM treatments to be studied in the manner in which they are practiced and urging high prioritization for research that includes clinical outcomes, cost-effectiveness, and the decision- making process for patients and providers. Recent research suggests that Americans seek CAM treatments far more often for chronic pain (CP) than for any other condition. This finding together with the alarming recent increase in use of opioid medications by those with CP conditions suggests the need to evaluate the outcomes associated with promising non-pharmacological treatments for CP such as acupuncture, which is often well accepted by patients and increasingly used in the community. This application responds to the NCCAM program announcement PAR-08-045, """"""""Outcomes, Cost- Effectiveness and the Decision Making Process to Use CAM."""""""" The multi-phase, mixed methods study will comprehensively describe and predict clinical and quality-of-life outcomes, health care service use, and costs among adults with CP who do and do not use adjunctive acupuncture services to help manage their condition. Data will be gathered prospectively from self-report structured questionnaires and semi-structured interviews, and we will use both prospective and historic health plan electronic medical records and administrative records. We will delineate similarities and differences between groups and outcomes associated with acupuncture by comparing health plan members with CP who use and do not use such services. We will also estimate the incremental cost-effectiveness of adjunctive acupuncture used by these patients relative to standard care. Three sequential phases will include: Phase 1-conducting retrospective analysis of acupuncture use by health plan members with CP, establishing matching criteria for Phase 3 participant recruitment, and estimating out-of-plan use of acupuncture for CP by cross-sectional member survey;Phase 2-using qualitative methods to describe characteristics of acupuncture-related care and exploring patients'and allopathic providers'decision-making processes as they choose to use/recommend acupuncture services;and Phase 3-conducting prospective cohort follow-up comparing CP patients with an incident episode of adjunctive acupuncture treatment to matched controls over the subsequent 52 weeks. Our setting strengths and multidisciplinary team allow this comprehensive and innovative approach to examining patterns of use and effectiveness of real-world acupuncture practice.

Public Health Relevance

Americans seek complementary or alternative medicine (CAM) treatments far more often for chronic pain than for any other condition. Yet because research into the """"""""real world"""""""" use of CAM remains sparse, we know little about its outcomes, costs, and how it is practiced in the community. The proposed study will look at how adults use acupuncture services to manage chronic pain and describe and predict clinical and quality-of-life outcomes, health care service use, and costs.

National Institute of Health (NIH)
National Center for Complementary & Alternative Medicine (NCCAM)
Research Project (R01)
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Special Emphasis Panel (ZRG1-HDM-F (50))
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Huntley, Kristen V
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Kaiser Foundation Research Institute
United States
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Penney, Lauren S; Ritenbaugh, Cheryl; Elder, Charles et al. (2016) Primary care physicians, acupuncture and chiropractic clinicians, and chronic pain patients: a qualitative analysis of communication and care coordination patterns. BMC Complement Altern Med 16:30
Elder, Charles; DeBar, Lynn; Ritenbaugh, Cheryl et al. (2015) Acupuncture and chiropractic care: utilization and electronic medical record capture. Am J Manag Care 21:e414-21
Debar, Lynn L; Kindler, Lindsay; Keefe, Francis J et al. (2012) A primary care-based interdisciplinary team approach to the treatment of chronic pain utilizing a pragmatic clinical trials framework. Transl Behav Med 2:523-530
DeBar, Lynn L; Elder, Charles; Ritenbaugh, Cheryl et al. (2011) Acupuncture and chiropractic care for chronic pain in an integrated health plan: a mixed methods study. BMC Complement Altern Med 11:118