Harrison James D, Reddy Sanjay, Liu Rhianon, Adler Shelley R, Chao Maria T
1 Department of Medicine, Division of Hospital Medicine, University of California San Francisco, San Francisco, CA.
2 Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, CA.
J Altern Complement Med. 2019 May;25(5):503-508. doi: 10.1089/acm.2018.0348. Epub 2019 Feb 12.
To explore an interprofessional group of health care providers' perspectives on the facilitators and barriers to implementation of an inpatient acupuncture service for pain and symptom management. Qualitative. An urban, academic, tertiary care health system. Key interprofessional health care providers, including physicians, nurses, and administrators. We used interviews and focus group with questions guided by the Promoting Action on Research Implementation in Health Services framework to explore three domains of implementation-evidence, context, and facilitation. Data were analyzed using content analysis. Thirty health professionals participated in 11 interviews and 1 focus group. We identified 12 codes or topics, grouped into 3 categories: (1) facilitators to implementation, (2) barriers to implementation, and (3) strategies to promote successful implementation. Health professionals' awareness of acupuncture was high, and the positive support was based on beliefs that acupuncture fills a biomedical gap in treatment and adds institutional value by enhancing the reputation of the health system. Many thought that to provide comprehensive care, acupuncture should be available to inpatients, but opinions varied on the appropriateness and timing of acupuncture in patients' disease or care trajectory. Concerns about inconsistencies in insurance coverage and resulting expenses patients may incur were noted. Strategies to overcome implementation challenges included ensuring buy-in, setting appropriate expectations of the benefits of acupuncture, and educating patients and providers. Our study finds clear support for acupuncture. These strong endorsements were the foundation of facilitating factors that can guide implementation of acupuncture in the inpatient setting. Although we also identified potential barriers to implementation that must be addressed, we also report a number of actionable steps to operationalize evidence-based acupuncture to patients who are inpatients.
探讨一个跨专业医疗服务提供者团队对于实施住院针灸服务以进行疼痛和症状管理的促进因素和障碍的看法。定性研究。一家城市学术型三级医疗保健系统。关键的跨专业医疗服务提供者，包括医生、护士和管理人员。我们采用访谈和焦点小组的方式，以卫生服务研究实施促进行动框架为指导提出问题，探讨实施的三个领域——证据、背景和促进因素。使用内容分析法对数据进行分析。30名卫生专业人员参与了11次访谈和1次焦点小组。我们确定了12个编码或主题，分为3类：（1）实施的促进因素，（2）实施的障碍，（3）促进成功实施的策略。卫生专业人员对针灸的认知度很高，积极支持基于这样的信念，即针灸填补了生物医学治疗的空白，并通过提升卫生系统的声誉增加了机构价值。许多人认为，为了提供全面护理，住院患者应能接受针灸治疗，但对于针灸在患者疾病或护理过程中的适用性和时机，意见不一。有人指出了对保险覆盖不一致以及患者可能产生的费用的担忧。克服实施挑战的策略包括确保各方支持、对针灸的益处设定适当期望，以及对患者和提供者进行教育。我们的研究明确支持针灸。这些强烈的认可意见是促进因素的基础，可指导在住院环境中实施针灸。虽然我们也确定了实施过程中必须解决的潜在障碍，但我们也报告了一些可操作的步骤，以便为住院患者实施循证针灸。
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