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Evolving use of Complementary and Alternative Medicine and Integrative Health in the VAHCS PowerPoint Presentation

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Description : This medical presentation by Associate Director, Integrative Health VA Salt Lake City, defines the scientific model of healthcare and the emergence of new models that include CAM, provides findings of VAHCS surveys on CAM use and practice, and describes VAHCS CAM initiative opportunities, challenges and barriers.

Tags : CAM, VAHCS surveys, Complementary, Alternative Medicine

Published on : Apr 14, 2021 | Views : 1409 | Downloads : 3

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Evolving use of Complementary and Alternative Medicine (CAM) and Integrative Health in the VAHCS Sandra J W Smeeding PhD, CNS, FNP-BC Associate Director Integrative Health VA Salt Lake City
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Objectives 1. Describe the scientific model of healthcare and the emergence of new models that include CAM. 2. Learn about VAHCS surveys reveal about CAM use and practice. 3. Describe VAHCS CAM initiative opportunities. 4. Describe VAHCS CAM initiative challenges and barriers.
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Scientific Disease Model Medical Scientific model: pathophysiology of disease, cellular and molecular, mechanistic knowledge. Multiple specialties and subspecialties, all necessary; focus attention on parts with pharmaceuticals to fix the parts. Increase in Chronic Disease: 33% have one, nearly 65% >65 yrs. have > one chronic illness, decreasing quality of life, increasing health care utilization and expenditures. - 41% of soldiers < 30 yrs. from Iraq and Afghanistan have HTN, MH concerns PTSD, depression, anxiety, back pain. Cost: Chronic care > $1.5 trillion/yr or 75% of all medical expenses. US highest in healthcare cost - 37th in national health (1).
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Chronic Illness Multiple medications, many specialists, a “pill for every ill.” Non Adherence/ADR’s/Side effects/Drug recalls: - 6% hospital admissions traced to non adherence (2-3). - 40-50% Diabetics, 40% HTN don’t follow medication Rx. - 40% Depression stop taking medication in 3 months and another 50% in 4 months. Chronic complex problems involve the mental, emotional, social, environmental and physical. Science and technology, the pathophysiological model alone are insufficient to shape healthcare.
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Emergence of Complementary and Alternative Medicine (CAM) and Integrative Health CAM use: JAMA (1998) more than 42% of surveyed adults used complementary therapies.(4). - 629 million visits to alternative practitioners . - $21 Billion spent with $12 billion out of pocket. 2007 National Health Interview Survey (NHIS), approximately 38 percent of Americans, adults use CAM. Integrative Health is a bridge between conventional and CAM assisting in epidemic of chronic diseases related to patient centered, self-management and prevention focus (5).
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Why use CAM? Pursuit of well-being. Maintain improve health and health related quality of life, disease prevention. New method/relief from suffering from chronic illness. Uninsured-limited access to care. Cost effective, not high tech. Concerns about pharmaceuticals safety: multiple medications, safety recalls, side effects.
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Klemm analysis Assessment of Current VHA Practices and Future Opportunities(1999) A benchmark study: CAM Literature review, site visits VHA provider survey and expert opinions . Every VA site reported some CAM therapies use. Providers insufficient knowledge of CAM to use or refer and varying belief’s within each facility. Internal communication about CAM minimal, Education and communication critical barriers. Veterans have chronic conditions not responding well to conventional treatments, a large proportion are using CAM for management of chronic conditions (6).
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Klemm Analysis (con’t) Systematically understand Veterans CAM use. Extend scientific literature review for CAM. Expand research on safety, efficacy and cost effectiveness in prevalent chronic conditions. Consider expanding CAM for diseases that conventional treatments are not optimally effective. Adopt quality standards for CAM substances sold at VA retail concessions.
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White House commission on Complementary and Alternative Medicine (2002) Ensure public policy maximizes potential benefits of CAM (7). Four main areas of focus: -Coordination of research to increase knowledge. -Education and training of CAM healthcare providers. -Reliable and useful information about CAM practices. -Guidance for appropriate access to and delivery of CAM. Emphasis of Report: Whole person care, individualization, evidence of safety and efficacy, partnership, prevention, wellness/health promotion and self-care as guiding principles. 19 of 29 white House commission recommendations applicable to VA.
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Research review: evidence on safe and effective. 2. Credentialing of VA CAM Providers to ensure safety. - Establish standards for training, credentialing, scope of practice for CAM practitioners-guidelines completed(2010). - Identify therapies & practices to be integrated into VA care. - Implementation strategies: therapies, resources, timelines. Research and Funding: Assist ORD. Education and Training of CAM Providers and Community of Practice. Clearing house for information. A. VAHCS CAM Survey: CAM Use & Practices- (2002) and repeat survey (2010). National VA CAM Field Advisory (2002)
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VA Hospital Survey: CAM Use and Practices (HAIG-2002) 98% response (8). 84% VA’s provided or referred out for CAM therapies. 16% (23 locations) did not. CAM therapies (21): Acupressure, acupuncture, aromatherapy, biofeedback, herbal/nutritional supplements, energy healing, Guided Imagery, hypnotherapy, massage, meditation, music therapy, Native Am. Healing, chiropractic, stress management, relaxation therapy, Tai chi/Qigong, yoga. Therapies at VA sites: Stress management, relaxation (86), Biofeedback (66), Guided Imagery (65), Hypnosis (48), Music (38), Meditation (36), Acupuncture (32), Massage (32).
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VA Hospital Survey: CAM Use and Practices (HAIG-2002) Chronic disease: #1 Stress management, Pain, Anxiety, Back pain, Headache/migraine, Depression. Clinical privileging of CAM Therapies & Providers: Clinical Executive Board (45), Professional Standards Board (74), provider supervisor (54), other (28) and no process (21). Providers offering CAM: Psychologist (310), Nursing (NP,CNS,RN) (106), MD/DO (85), PT/OT (68), LCSW (66), Clergy (32). Summary: Wide use of CAM, Limited evidence, additional research; need for integrative models
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Complementary and Alternative Medicine use by Veterans Primary Care Survey, VA Southern Arizona. -50% reported CAM use for chronic pain & illness as well as prevention/health promotion (9). - Mind-body therapies, energy medicine, TCM, nutritional and spiritual modalities. - Veterans generally satisfied with conventional care (10). - Dissatisfied: reliance on pharmaceuticals, lack of whole person approach, inadequate information nutrition, exercise, social and spiritual aspects of health.
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Complementary and Alternative Medicine use by Veterans Oncology & Chronic Pain Survey, VA Bedford, Mass (11). 6 selected CAM treatments: herbs/dietary supplements, homeopathy chiropractic, massage, acupuncture. 27% Veterans reported CAM use in the past 12-months. No difference in use between groups. 76% of CAM non-users would use it if offered at the VA.
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Complementary and Alternative Medicine and VA Providers VA Integrative & CAM (icam) list serve: >159 VA staff; Elizabeth.Hakas@va.gov (need VA e-mail address). VA Acupuncture list serve: > 80 VA staff; Elizabeth.Hakas@va.gov (need VA e-mail address). VASLC experience and assistance to VA sites and providers in over 27 states on the integration of CAM (12). Sandra.Smeeding@va.gov . Samueli/VA webinars: Integrative health business plan; PTSD and acupuncture research. Innovation in Practice Awards.
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The Patient Protection and Affordable Care Act (PPACA) Title IV—Prevention of chronic disease and improving public health, modernizing disease prevention (subtitle A). Federal Coordination Council and leadership of prevention, wellness, health promotion. Evidence-based, innovative, transformative models for prevention, integrative health, on individual and community level. Advisory Group including integrative health practitioners addressing health promotion, prevention and lifestyle.
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CAM Effectiveness Considerations Evidence base, research methods. Clinical effectiveness evaluation model - health outcomes. - Have final approval from government regulatory bodies. - The scientific evidence on the effect on health outcomes. - Must improve the net health outcome. - Must be beneficial as any current, established treatment. - Improvement must be attainable outside the investigational research setting in clinical settings. Medicare: reasonable and necessary: - Safe and effective. - Not experimental or investigational. - Appropriate.
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Educational and Cost Effectiveness Considerations Inconsistent CAM provider standards and scope of practice: credentialing, licensing, and regulations across state lines. Acupuncturist in 35 states (11 states have introduced legislature), massage in 27 states, naturopathic in 14 states, homeopathic in 4 states. - Practice of CAM without sufficient CAM training or credentials. Cost driven HCS, need CAM studies on cost-effectiveness. - Need for uniform or consistent insurance coverage criteria for eval. and comparative analyses of CAM and conventional tx. - Cost & outcomes of CAM providers: MD CAM & non MD CAM.
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VA CAM initiative Opportunities and strengths Chronic conditions not responsive to convention treatment may be responsive to CAM. VHA centralized, regional and local mechanisms enabling overall uniform consistent standards and criteria. Regional & local phased implementation tailored to local conditions. Collaborative relationships: academic and research . Opportunity to conduct outcomes research contributing to scientific literature. Offer patient services used by a large and growing percent of U.S population.
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VA Integration of CAM Considerations and Challenges Acceptance VA providers, administration, management, staff. Clinical effectiveness & Research: objective eval. methods (13,14). Standardization of education, training, licensure, certification providers. Cost effectiveness of modalities and provider classifications. Operational and Implementation steps clearly articulated goals. Definition of success realistic and clear from the beginning. Education on CAM use, methods, diagnosis, communication!
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Integration of Conventional and CAM Benefits Combined - addresses the physical, emotional and spiritual aspects of health and disease, health promotion and prevention. Whole person, CAM long hx. of use in world cultures. Can reduce suffering, improve health related Quality of Life. Promotes patient self-management & empowerment. Veteran/consumer and provider demand. May reduce cost: self management, decreased utilization of chronic care long term.
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References 1. Center for Disease Control and Prevention Chronic disease prevention (2009). 2. Sullivan SD, Kreling DH, Hazlet TK. Noncompliance with medication regimens and subsequent hospitalizations: literature analysis and cost of hospitalization estimate. Res Pharm Ec. 1990;2(2):19-33. 3. Nagasaw, Smith MC, Barnes JH, Fincham JE. Meta-analysis of correlates of diabetes patients' compliance with prescribed medications. Diabetes Educ. 1990;16(3):192-200. 4. Eisenberg DM, Davis RB, Etner SL, et al. Trends in alternative medicine use in the United States, 1990-1997. JAMA. 1998;280:1569-1575. 5. Maizes V, Rakel D., Niemiee J., Integrative Health and patient centered care. Explore J Science and Healing (2009)5(5):277-289
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References 6. Klemm Analysis Group: Alternative Medicine Therapy: Assessment of Current VHA Practices and Opportunities.(1999) Washington, DC. 7. White House Commission on Complementary and Alternative Medicine Policy, Final Report (2002) www.whccamp.hhs.gov 8. Rick C, Feldman J, et al Survey of complementary and alternative medicine (CAM) (2002). Washington, DC: Department of Veterans Affairs Health Administration. Office of Policy and Planning, Healthcare Analysis and Information Group. 9. Baldwin C, Long K, Kroesen K. A profile of military veterans in the southwestern US who use complementary and alternative medicine: Implications for integrated care Arch. Intern. Med.(2002) 12:1697-1704. 10. Kroesen K, Baldwin C. et al: U.S. military veterans’ perceptions of the conventional medical care system and their use of CAM. Family Pract. (2002),19:57-64.
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References 11. McEachrane-Gross, Liebschutz J Berlowitz D., Use of selected complementary and alternative medicine (CAM) treatments in veterans with cancer or chronic pain: a cross-sectional survey BMC Comple & Alt Med.. (2006) (6)34:1-7. 12. Smeeding S, Osguthorpe S., Development of an Integrative Healthcare Model in the Salt Lake City Veterans Affairs. Healthcare System. Altern Ther Health Med. (2005) 11:46-51. 13. Smeeding S, Bradshaw D, et al Outcome evaluation of the Veterans Affairs Salt Lake City Integrative Health Clinic for Chronic Pain and Stress related depression, anxiety and Post Traumatic Stress Disorder. J. Alt and Compl. Med.,Aug. (2010) . 14. Smeeding S, Bradshaw D, et al: Outcome evaluation of the Veterans Affairs Salt Lake City Integrative Health Clinic for chronic nonmalignant pain Clin. J. Pain Fall (2010)