Der-Martirosian Claudia, Shin Marlena, Upham Michelle L, Douglas Jamie H, Zeliadt Steven B, Taylor Stephanie L
Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.
Veterans Emergency Management Evaluation Center, Office of Patient Care Services, North Hills, California, USA.
Telemed J E Health. 2023 Apr;29(4):576-583. doi: 10.1089/tmj.2022.0209. Epub 2022 Jul 22.
Complementary and integrative health (CIH) therapies, such as in-person acupuncture, chiropractic care, and meditation, are evidence-based nonpharmaceutical treatment options for pain. During COVID-19, the Veterans Health Administration (VA) delivered several CIH therapies virtually. This study explores veterans' utilization, advantages/disadvantages, and delivery issues of yoga, Tai Chi, meditation/mindfulness (self-care), and massage, chiropractic, and acupuncture (practitioner-delivered care), using telephone/video at 18 VA sites during COVID-19. Use of virtual care was examined quantitatively with VA administrative data for six CIH therapies before and after COVID-19 onset (2019-2021). Advantages/disadvantages and health care delivery issues of these CIH therapies through virtual care were examined qualitatively using interview data (2020-2021). Overall, televisits represented a substantial portion of all CIH self-care therapies delivered by VA in 2020 (53.7%) and 2021 (82.1%), as sites developed virtual group classes using VA secure online video platforms in response to COVID-19. In contrast, a small proportion of all encounters with acupuncturists, chiropractors, and massage therapists was telephone/video encounters in 2020 (17.3%) and in 2021 (5.4%). These were predominantly one-on-one care in the form of education, follow-ups, home exercises, assessments/evaluations, or acupressure. Delivery issues included technical difficulties, lack of access to needed technology, difficulty tracking virtual visits, and capacity restrictions. Advantages included increased access to self-care, increased patient receptivity to engaging in self-care, and flexibility in staffing online group classes. Disadvantages included patient preference, patient safety, and strain on staffing. Despite delivery issues or disadvantages of tele-CIH self-care, veterans' use of teleself-care CIH therapies grew substantially during the COVID-19 pandemic.
补充与整合健康（CIH）疗法，如面对面针灸、整脊治疗和冥想，是基于证据的疼痛非药物治疗选择。在新冠疫情期间，退伍军人健康管理局（VA）以虚拟方式提供了多种CIH疗法。本研究探讨了新冠疫情期间，在18个VA站点通过电话/视频方式，退伍军人对瑜伽、太极、冥想/正念（自我护理）以及按摩、整脊和针灸（从业者提供的护理）的使用情况、优缺点及提供过程中的问题。利用VA行政数据对新冠疫情暴发前后（2019 - 2021年）六种CIH疗法的虚拟护理使用情况进行了定量分析。通过访谈数据（2020 - 2021年）对这些CIH疗法通过虚拟护理的优缺点及医疗服务提供问题进行了定性分析。总体而言，远程就诊在2020年（53.7%）和2021年（82.1%）占VA提供的所有CIH自我护理疗法的很大一部分，因为各站点为应对新冠疫情利用VA安全在线视频平台开展了虚拟团体课程。相比之下，2020年（17.3%）和2021年（5.4%）与针灸师、整脊师和按摩治疗师的所有接触中，电话/视频接触占比很小。这些主要是以教育、随访、家庭锻炼、评估/评价或指压等形式的一对一护理。提供过程中的问题包括技术困难、无法获得所需技术、难以追踪虚拟就诊以及容量限制。优点包括增加了自我护理的可及性、提高了患者参与自我护理的接受度以及在线团体课程人员配备的灵活性。缺点包括患者偏好、患者安全以及人员配备压力。尽管远程CIH自我护理存在提供过程中的问题或缺点，但在新冠疫情期间，退伍军人对远程自我护理CIH疗法的使用大幅增加。
