VA Health Services Research & Development (HSR&D), Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
VA QUERI Complementary and Integrative Health Evaluation Center, Los Angeles, CA, USA.
J Altern Complement Med. 2021 Mar;27(S1):S124-S130. doi: 10.1089/acm.2020.0395.
Certain complementary and integrative health (CIH) approaches have increasingly gained attention as evidence-based nonpharmacological options for pain, mental health, and well-being. The Veterans Health Administration (VA) has been at the forefront of providing CIH approaches for years, and the 2016 Comprehensive Addiction and Recovery Act mandated the VA expand its provision of CIH approaches. : To conduct a national organizational survey to document aspects of CIH approach implementation from August 2017 to July 2018 at the VA. CIH program leads at VA medical centers and community-based outpatient clinics ( = 196) representing 289 sites participated. Delivery of 27 CIH and other nonpharmacologic approaches was measured, including types of departments and providers, visit format, geographic variations, and implementation challenges. Respondents reported offering a total of 1,568 CIH programs nationally. Sites offered an average of five approaches (range 1-23), and 63 sites offered 10 or more approaches. Relaxation techniques, mindfulness, guided imagery, yoga, and meditation were the top five most frequently offered. The most approaches were offered in physical medicine and rehabilitation, primary care, and within integrative/whole health programs, and VA non-Doctor of Medicine clinical staff were the most common type of CIH provider. Only 13% of sites reported offering CIH approaches through telehealth at the time. Geographically, southwestern sites offered the smallest number of approaches. Implementation challenges included insufficient staffing, funding, and space, hiring/credentialing, positioning CIH as a priority, and high patient demand. The provision of CIH approaches was widespread at the VA in 2017-2018, with over half of responding sites offering five or more approaches. As patients seek nonpharmacologic options to address their pain, anxiety, depression, and well-being, the nation's largest integrated health care system is well-positioned to meet that demand. Providing these therapies might not only increase patient satisfaction but also their health and well-being with limited to no adverse events.
某些补充和综合健康（CIH）方法作为基于证据的非药物选择，越来越受到关注，可用于治疗疼痛、心理健康和幸福感。退伍军人健康管理局（VA）多年来一直处于提供 CIH 方法的前沿，2016 年《全面成瘾和康复法案》授权 VA 扩大 CIH 方法的提供。目的是在 2017 年 8 月至 2018 年 7 月期间，通过全国性组织调查，记录 VA 实施 CIH 方法的各个方面。共有 196 名 VA 医疗中心和社区门诊诊所的 CIH 项目负责人（ = 196）参与了调查，代表 289 个地点。共测量了 27 种 CIH 和其他非药物方法的实施情况，包括科室和提供者类型、就诊形式、地理差异和实施挑战。受访者报告称，全国范围内共提供了 1568 种 CIH 方案。各站点提供的方案平均为 5 种（范围为 1-23 种），有 63 个站点提供 10 种或更多种方案。放松技术、正念、引导想象、瑜伽和冥想是最常提供的前五名方法。物理医学与康复、初级保健以及综合/整体健康项目中提供的方法最多，VA 非医学博士临床工作人员是最常见的 CIH 提供者类型。当时只有 13%的站点报告通过远程医疗提供 CIH 方法。从地理位置上看，西南部的站点提供的方案数量最少。实施挑战包括人员配备、资金和空间不足，招聘/认证，将 CIH 作为优先事项，以及患者需求高。2017-2018 年，VA 广泛提供 CIH 方法，超过一半的回应站点提供 5 种或更多种方法。随着患者寻求非药物选择来解决他们的疼痛、焦虑、抑郁和幸福感，这个国家最大的综合医疗保健系统已经做好了满足这一需求的准备。提供这些治疗方法不仅可以提高患者满意度，还可以提高他们的健康和幸福感，而且几乎没有不良反应。
