Use of Acupuncture & Chiropractic Care for Chronic Pain within an Integrated Hlth

最近的大量研究检查了许多类型的补充和替代（CAM）疗法的疗效和生物学基础。然而，CAM在现实世界中的应用在很大程度上被忽视了，尽管人们呼吁以实践的方式研究CAM疗法，并敦促对包括临床结果、成本效益和患者和提供者的决策过程在内的研究给予高度优先考虑。因此，我们更加需要丰富的理解，特别是考虑到CAM的日益普及，它幸运地为研究提供了大量的新数据。最近的研究表明，美国人因慢性肌肉骨骼疼痛（CMP）而寻求CAM治疗的频率远远高于其他任何疾病。在针对慢性脊髓炎的辅助医学治疗中，针灸和脊椎指压疗法（A/C）是医生群体接受度最高的治疗方法，也是支持其使用的最佳证据。此外，最近阿片类药物治疗和慢性疼痛手术干预的增加令人担忧，尽管它们的成本高，潜在的不良反应，和适度的疗效，表明有必要评估有前途的非药物/非手术辅助治疗CMP的结果，这些治疗方法通常被患者所接受，并越来越多地在社区中使用。本应用程序响应NCCAM项目公告PAR-08-045，使用CAM的结果，成本效益和决策过程。这项多阶段、混合方法的研究将：(1)利用大型HMO电子病历（emr）中的信息进行回顾性研究，以确定可能与不同的空调使用倾向和/或与此类护理相关的不同结果相关的独特CMP患者群（例如，具有不同人口统计学、疼痛病史、使用对抗疗法和CAM健康服务以及合并症概况的患者群）；(2)使用定性访谈探讨对抗疗法提供者对空调的建议和患者对继续进行和保留辅助护理的决定；(3)相对于接受传统CMP服务的仔细匹配的比较参与者，前瞻性地评估与接收A/C相关的卫生服务/成本以及更广泛的临床和功能结果。敏感性分析将比较仅依赖于EMR衍生数据的方法与补充EMR数据的分析与常规收集的患者和临床医生数据的方法。这些总体目标的成功完成将提供与A/C服务的实际使用相关的结果评估。这三项回顾性、定性和前瞻性研究还将使人们更清楚地了解在CMP中使用a /C的决策过程，并提供一种可移植的方法，可应用于其他卫生保健机构、CAM治疗和临床人群。

Substantial recent research examines the efficacy and biological basis of many types of complementary and alternative (CAM) therapies. However, ¿real-world¿ use of CAM has been largely overlooked, despite calls for CAM therapies 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. There is, therefore, heightened need for enriched understanding¿particularly given CAM¿s growing popularity, which fortunately offers stores of new data for research. Recent studies suggest that Americans seek CAM treatments far more often for chronic musculoskeletal pain (CMP) than for any other condition. Among CAM treatments for CMP, acupuncture and chiropractic (A/C) care are among those with the highest acceptance by physician groups and the best evidence to support their use. Further, recent alarming increases in delivery of opioid treatment and surgical interventions for chronic pain¿despite their high costs, potential adverse effects, and modest efficacy¿ suggests the need to evaluate the outcomes associated with promising non-pharmacological/non-surgical CAM treatments for CMP, which are 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.¿ This multi-phase, mixed methods study will: (1) conduct an retrospective study using information from electronic medical records (EMRs) of a large HMO to identify unique clusters of patients with CMP (e.g., those with differing demographics, histories of pain condition, use of allopathic and CAM health services, and comorbidity profiles) that may be associated with different propensities for A/C utilization and/or differential outcomes associated with such care; (2) use qualitative interviews to explore allopathic providers¿ recommendations for A/C and patients¿ decisions to pursue and retain CAM care; and (3) prospectively evaluate health services/costs and broader clinical and functional outcomes associated with the receipt of A/C relative to carefully matched comparison participants receiving traditional CMP services. Sensitivity analyses will compare methods relying solely on EMR-derived data versus analyses supplementing EMR data with conventionally collected patient and clinician data. Successful completion of these aggregate aims will provide an evaluation of outcomes associated with the real-world use of A/C services. The trio of retrospective, qualitative, and prospective study will also provide a clearer understanding of the decision-making processes behind the use of A/C for CMP and a transportable methodology that can be applied to other health care settings, CAM treatments, and clinical populations.