| dc.description.abstract | According to a 2019 Health and Human Services report, two primary gaps in implementing evidence based CIH care for chronic pain are a lack of clarity on how to deliver therapies for chronic pain and lack of access to CIH services. Aim one of this study conceptualizes clinic visits within an academic CIH clinic as dosage and reports on the service use behavior of chronic pain patients over a 12 month period following presentation to the clinic. It also applies a health services lens to define and report on recommended use of integrative consults, acupuncture, integrative physical therapy, group mindfulness classes, group yoga and taichi classes and individual therapeutic movement therapy. Aim two of this study reports on 12 different patient characteristics that have been previously identified as impacting the prevalence of chronic pain and health care utilization and their association with total usage of a CIH clinic over a 12 month period.
A descriptive retrospective cohort design was used to achieve the two aims of this dissertation study. The first aim was to describe service use behavior of a cohort of chronic pain patients attending a whole person CIH clinic in an academic medical center, the second aim was to determine the associations of patient [biological (sex, age), psychological (anxiety, depression, pain interference) and social (race, distance from clinic, education level, income, employment status, insurance status and marital status)] characteristics with total service use [total visits (all types within 12 months of presentation to clinic) and use of an interdisciplinary team (NP visit and at least one other type of visit)].
Results:
Primary findings for Aim 1 of this study were the number of visits chronic pain patients used during a 12-month period in a CIH clinic [median=5.0, (1.7, 14.0)] and the identification of the most used service types (NP visits, PT visits, acupuncture visits, psychiatric NP visits). Rates of achievement of recommended use levels within the subsamples of patients using specific services ranged from 33% of the 626 patients for acupuncture visits to 85% for group movement visits. Only patients using integrative psychology groups (51%), yoga or tai chi classes (85%), or individual yoga or taichi (50%) types of services had more than 50% alignment with recommended use criteria.
The primary findings for Aim 2 were twofold. First, a patient’s distance from the clinic (those farther away had fewer visits) and education level (those with more education had more visits) were associated with total clinic visits. Second, distance from the clinic (those farther away were less likely to use an interdisciplinary team) and employment status (part-time employees more likely to use an interdisciplinary team) were associated with use of an interdisciplinary team. While additional patient characteristics were significant in the unadjusted models (sex, anxiety, depression) those associations did not hold up when accounting for all patient characteristics.
Conclusions:
Our study of chronic pain patients using a CIH clinic in an academic medical center builds on previous studies of CIH use in this population and provides a level of detail of service use not previously seen. Our study examines the specific types and amount of services used and compares them to clinical guidelines for care delivery. This is also the first study to examine the amount of use (total visits) and type of use (interdisciplinary team) while controlling for biological, psychological and social patient characteristics. Patient characteristics of sex (female), higher anxiety, higher depression, less than a college education, and income less than $20,000 have previously been associated with prevalence of chronic pain and use of health care services, including CIH services. These associations were confirmed in this study. However, when controlling for all the patient characteristics, the strongest association for amount of use and type of use was with a patient’s distance from the clinic. The strength of this association outweighed several the previously identified patient characteristics. In the multivariate models, in addition to distance from clinic, only education level (in the total visits analysis) and employment type (interdisciplinary use analysis) remained statistically significantly associated. | |
