Traditional & Complementary Systems Research

Patient Perspectives on Care Received at Community Acupuncture Clinics: A Qualitative Thematic Analysis

Principal Investigator: Kim Tippens ND, MPH, MSAOM


BACKGROUND: Community acupuncture is a recent innovation in acupuncture service delivery in the U.S. that aims to improve access to care through low-cost treatments in group-based settings. Patients at community acupuncture clinics represent a broader socioeconomic spectrum and receive more frequent treatments compared to acupuncture users nationwide. As a relatively new model of acupuncture in the U.S., little is known about the experiences of patients at community acupuncture clinics and whether quality of care is compromised through this high-volume model. The aim of this study was to assess patients’ perspectives on the care received through community acupuncture clinics.

METHODS: The investigators conducted qualitative, thematic analysis of written comments from an observational, cross-sectional survey of clients of the Working Class Acupuncture clinics in Portland, Oregon. The survey included an open-ended question for respondents to share comments about their experiences with community acupuncture. Comments were received from 265 community acupuncture patients.

RESULTS: Qualitative analysis of written comments identified two primary themes that elucidate patients’ perspectives on quality of care: 1) aspects of health care delivery unique to community acupuncture, and 2) patient engagement in health care. Patients identified unique aspects of community acupuncture, including structures that facilitate access, processes that make treatments more comfortable and effective and holistic outcomes including physical improvements, enhanced quality of life, and empowerment. The group setting, community-based locations, and low cost were highlighted as aspects of this model that allow patients to access acupuncture.

CONCLUSIONS: Patients’ perspectives on the values and experiences unique to community acupuncture offer insights on the quality of care received in these settings. The group setting, community-based locations, and low cost of this model potentially reduce access barriers for those who might not otherwise consider using acupuncture. In addition, the community acupuncture model may offer individuals the opportunity for increased frequency of treatments, which raises pertinent questions about the dose-response relationship of acupuncture and health outcomes. This study provides preliminary data for future evaluations of the quality and effectiveness of community acupuncture. Future studies should include the perspectives of patients who initiated, and subsequently, discontinued community acupuncture treatment.

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Descriptive Clinical Informatics in NUNM Clinics

Principal Investigator: Erica Oberg, ND, MPH

There is an increasing interest in naturopathic doctors as primary care providers to address needs that may not be met by conventional primary care providers. Naturopathic doctors spend more time with patients, offer patient-centered care, and are experts in health promotion. Descriptions of current naturopathic medical practice are limited and there is an ongoing need to characterize the quantity and quality of care.

This study collected patient visit data to explore similarities and differences between conventional and naturopathic primary care. Administrative data from the main teaching clinics of 4 of the 8 North American naturopathic academic institutions were integrated into a database containing 5 years (2006-2010) of medical data. Descriptive analyses of healthcare services were compared to those used in conventional medicine.

Over the five-year period, 300,483 patient visits occurred at the 4 clinics. Patients payed out of pocket more frequently at naturopathic clinics as compared to national conventional primary care practices (50 percent vs. 4 percent), naturopathic clinics more frequently offered discounted care (26 percent vs. 0.3 percent) and there was a 32-44 percent overlap in the top 25 primary care diagnoses. Naturopathic care differed in that greater diagnostic diversity was represented. The results of these descriptive analyses are prerequisites to conversations with stakeholders, policy makers, and other health professionals about the future role of naturopathic medicine within the larger healthcare setting.

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Preliminary Evidence for Potential Phytochemical Synergism in Classical Chinese Herbal Pairs

Principal Investigator: Morgan Schafer, MA

Abstract: In classical Chinese medicine, herbs are predominantly prescribed in pairs within the context of a larger herbal formula. The biochemical framework for why these pairs exist has not been fully evaluated. Current botanical medicine research has largely investigated herbal constituents in isolation and not the chemical interactions between herbs when extracted together. This study aims to investigate a potential synergistic relationship using three herbs commonly found in pairs within classical Chinese medicine.  Dried herbs were decocted in deionized water for 30 minutes at 100 ºC either independently or in pairs of Licorice with Ginger and Licorice with Bupleurum, at varying ratios. The supernatant from the decoction was centrifuged and filtered for remaining botanical particles and analyzed by high-performance liquid chromatography (HPLC). Peak area, retention time, and peak shape were collected and compared between samples of individual herbs and the herbal pairs. Licorice, Ginger and Bupleurum showed chromatographic differences in pairs versus in isolation including increases and decreases in peak area, and potential new peak formation. The observed variation in the chemical signature is indicative of potential synergy among classical Chinese medicine herbal pairs. Future studies are needed to determine the chemical structure of these possible novel peaks, as well as their potential for clinical application.

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Utilization of Group-Based, Community Acupuncture Clinics: A Comparative Study With a Nationally Representative Sample of Acupuncture Users

Principal Investigator: Maria Chao

Co-Investigator: Kim Tippens ND, MPH, MSAOM


OBJECTIVES: Acupuncture utilization in the United States has increased in recent years, but is less common among racial/ethnic minorities and those of low socioeconomic status. Group-based, community acupuncture is a delivery model gaining in popularity around the United States, due in part to low-cost treatments provided on a sliding-fee scale. Affordable, community-based acupuncture may increase access to health care at a time when increasing numbers of people are uninsured. To assess the population using local community acupuncture clinics, sociodemographic factors, health status, and utilization patterns compared to national acupuncture users were examined.

DESIGN: Data were employed from (1) a cross-sectional survey of 478 clients of two community acupuncture clinics in Portland, Oregon and (2) a nationally representative sample of acupuncture users from the 2007 National Health Interview Survey.

RESULTS: Portland community acupuncture clients were more homogeneous racially, had higher educational attainment, lower household income, and were more likely to receive 10 or more treatments in the past 12 months (odds ratio=5.39, 95% confidence interval=3.54, 8.22), compared to a nationally representative sample of U.S. acupuncture users. Self-reported health status and medical reasons for seeking acupuncture treatment were similar in both groups. Back pain (21%), joint pain (17%), and depression (13%) were the most common conditions for seeking treatment at community acupuncture clinics.

CONCLUSIONS: Study findings suggest that local community acupuncture clinics reach individuals of a broad socioeconomic spectrum and may allow for increased frequency of treatment. Limited racial diversity among community acupuncture clients may reflect local demographics of Portland. In addition, exposure to and knowledge about acupuncture is likely to vary by race and ethnicity. Future studies should examine access, patient satisfaction, frequency of treatment, and clinical outcomes of group-based models of community acupuncture clinics located in racially and socioeconomically diverse communities.

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Reliability of Three Constitutional Questionnaires in Ayurveda Diagnosis

Principal Investigators: Carolyn Nygaard, ND & Corina Dunlap, ND

The traditional Indian medical model known as Ayurveda is one of the most ancient and widely practiced forms of medicine today. As demand in the western world for traditional forms of medicine increase, there is growing interest to ensure quality in training, research, and practice. The efficacy of Ayurvedic treatments are often researched, however there is little research examining reliability of the various diagnostic techniques used to determine these Ayurvedic treatments. The Ayurveda diagnosis consists of determining an individual’s constitution and current imbalance. Many Ayurveda physicians also employ a constitutional questionnaire during the initial patient intake to determine an individual’s dosha, or metabolic force. There are, however, many types of constitutional questionnaires available today, without formal standardization or evidence of validity. Research on the reliability and validity of these questionnaires is imperative in order to ensure that specific Ayruvedic treatments are warranted.

This study examined three constitutional questionnaires from three well-known western Ayurveda educational institutions in order to examine their reliability and validity. 19 participants answered the three questionnaires at two time points, one month apart. Depending up their answers, each participant was given a numerical score as well as a dosha diagnoses.

The study found that the self-reporting Ayurveda questionnaires had moderately good reliability according to numerical scores, but highly variable reliability when it came to Ayurveda diagnoses. The consistency of one of the questionnaires was found to be highly questionable. Based upon these results, further research is necessary to develop a reliable and standardized Ayruveda diagnoses questionnaire that can be used to determine Ayruvedic treatment options.

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