Acupuncture should play a more prominent role in U.S. healthcare during and after this post-Affordable Care Act era when chronic care and population health management are key concerns for all healthcare providers.
Participants receiving treatment from both an acupuncturist and a physician were overall more confident and proactive than those who received acupuncture treatment only. Participants who received both forms of care were more confident in following instructions from their provider, asking the provider questions about their condition, sharing that they did not understand something, and requesting copies of their health information. In addition, these participants were 55% more likely to have used an Internet-based rating service to research the quality of a healthcare provider.
Participants were also asked to compare the treatment received from their acupuncturist and their physician for the same condition. Those receiving both acupuncture and conventional treatment were 33% more satisfied overall with acupuncture care than conventional care. Ninety-three (93%) of these participants would recommend acupuncture treatment to their friends and family, while only 14% would recommend treatment at their physician's office. Participants also felt the following health measures were more improved after treatment by an acupuncturist versus a physician: sleep (44% more improved), well-being (37%), stress level (32%), and overall health (19% more improved). Participants were 28% more satisfied with the quality of care they received from their acupuncturist than from their physician. They were 36% more satisfied with the acupuncturist' concern for their mental health or emotional well-being, 31% more satisfied that the acupuncturist listened to what they had to say, 30% more satisfied in the overall quality of the acupuncture care, and 26% more satisfied about receiving information regarding what to do after leaving the acupuncture office versus the physician office.
Study participants were asked what they liked best and least about acupuncture and conventional medical treatments. For acupuncture, patients liked: 1. effectiveness; 2. ability to reduce pain; 3. creation of a calming effect; and 4. feeling that the care team really listened and cared. They did not like the noise level, pricking of the needle, and the fact that care was not covered by insurance. For physician care, patients liked 1. the physicians' knowledge, expertise, and credentials; 2. care being covered by insurance; and 3. drugs and tests being obtained with ease. They did not like the waiting time, the lack of time the physician spent with them, the detached nature of the interaction, and their receipt of too many prescriptions.
While this study provides valuable information comparing conventional and acupuncture care, it also contains several limitations. First, the information is not generalizable to all patients. The acupuncture clinic, located in the northeast United States, was affiliated with a NCCAOM-accredited acupuncture school where care was provided by students, supervised by licensed faculty. Survey participants were comprised of a convenience sample of patients whose current encounter was at least their third acupuncture treatment for the same problem. The typical patient in this study possessed the following characteristics: 46 year-old female (60%) or male (40%), covered by private insurance (63%), more than a 4-year college degree (41%), believes health is very good (38%), has been treated with acupuncture for current problem for less than one year (79%), and has received less than five acupuncture treatments for their current health problem (49%). Another limitation of this study includes the fact that patients completed the survey after they had just received an acupuncture treatment. Finally, surveys are an initial research tool to be validated using more complex research methodologies. Hence, these findings provide preliminary support as well as a basis for conducting further investigation of the value of acupuncture in chronic care and population health management (PHM).
Thanks to the Affordable Care Act's legislative requirements, all healthcare providers must incorporate population health management (PHM) activities and measures into their practices. The essential components of PHM include a focus on chronic care management and health promotion while simultaneously developing patient engagement, self-care, and shared-decision making. These survey results support the use of acupuncture for both its effectiveness in alleviating chronic conditions as well as its patient-centered approach. It is possible that the patient who pursues acupuncture may have certain pre-existing characteristics that create a greater likelihood for engagement and decision-making. However, these findings support that acupuncture also resulted in improved health and wellbeing, better communication with providers, more effective pain reduction, and overall greater satisfaction with acupuncture versus conventional treatment for the same chronic condition – all essential elements of PHM.
The findings of this research suggest that acupuncture is not only an effective treatment for chronic conditions, but also a conduit for improved patient satisfaction and proactivity, necessary in engagement, self-care and shared decision making between the patient and any healthcare provider. It may also be possible that the receipt of acupuncture facilitates the development of certain skills or expectations, such as greater comfort with the provider, more likely to result in shared decision making. Indeed, skills nurtured as a result of the patient-acupuncturist relationship may be able to be extended to improve a patient's confidence, communication, and engagement with her conventional medical practitioners. These are all important suggestions, in need of further research.
References:
- Paterson, C., & Britten, N. (2003). Acupuncture for people with chronic illness: Combining qualitative and quantitative outcome assessment. The Journal of Alternative and Complementary Medicine. 9, No. 5: 671-681.
- Patient Protection and Affordable Care Act (ACA). (2010). Pub. L. 111-148, 124 Stat. 11942. U.S.C.
- Russo, R. (2013). Conventional practitioners' communication of integrative alternatives for chronic back pain: An evidence-based, patient-centered model. Integrative Medicine Journal, 13, 2, 31 – 37.
Ruthann Russo is a Managing Director with Berkeley Research Group where she provides Population Health, Integrative Health and Informatics strategies and consulting services to healthcare systems. She is also a faculty member in Saybrook University's Graduate School of Integrative Medicine and Health Services. She earned her PhD in Mind-Body Medicine and is also a licensed, board certified acupuncturist, certified health coach, and yoga teacher.