Veterans Affairs Greater Los Angeles Healthcare System, Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), Los Angeles, California, United States of America.
RAND Corporation, Santa Monica, California, United States of America.
PLoS One. 2024 May 15;19(5):e0303651. doi: 10.1371/journal.pone.0303651. eCollection 2024.
Acupuncture and chiropractic care are evidence-based pain management alternatives to opioids. The Veterans Health Administration (VA) provides this care in some VA facilities, but also refers patients to community providers. We aimed to determine if patient-reported outcomes differ for acupuncture and chiropractic care from VA versus community providers.
We conducted an observational study using survey outcome data and electronic medical record utilization data for acupuncture and chiropractic care provided in 18 VA facilities or in community facilities reimbursed by VA. Study participants were users of VA primary care, mental health, pain clinic, complementary and integrative therapies, coaching or education services in 2018-2019. Patients received 1) 4+ acupuncture visits (N = 201) or 4+ chiropractic care visits (N = 178) from a VA or community provider from 60 days prior to baseline to six-months survey and 2) no acupuncture or chiropractic visits from 1 year to 60 days prior to baseline. Outcomes measured included patient-reported pain (PEG) and physical health (PROMIS) at baseline and six-month surveys. Multivariate analyses examined outcomes at six months, adjusting for baseline outcomes and demographics.
In unadjusted analyses, pain and physical health improved for patients receiving community-based acupuncture, while VA-based acupuncture patients experienced no change. Unadjusted analyses also showed improvements in physical health, but not pain, for patients receiving VA-based chiropractic care, with no changes for community-based chiropractic care patients. Using multivariate models, VA-based acupuncture was no different from community-based acupuncture for pain (-0.258, p = 0.172) or physical health (0.539, p = 0.399). Similarly, there were no differences between VA- and community-based chiropractic care in pain (-0.273, p = 0.154) or physical health (0.793, p = 0.191).
Acupuncture and chiropractic care were associated with modest improvements at six months, with no meaningful differences between VA and community providers. The choice to receive care from VA or community providers could be based on factors other than quality, like cost or convenience.
针灸和整脊治疗是基于证据的替代阿片类药物的疼痛管理方法。退伍军人健康管理局（VA）在一些 VA 设施中提供这种护理，但也将患者转介给社区提供者。我们旨在确定患者从 VA 与社区提供者处接受的针灸和整脊治疗的报告结果是否存在差异。
我们进行了一项观察性研究，使用了 2018-2019 年在 18 个 VA 设施或由 VA 报销的社区设施中提供的针灸和整脊治疗的调查结果数据和电子病历利用数据。研究参与者是 VA 初级保健、心理健康、疼痛诊所、补充和综合治疗、教练或教育服务的使用者。患者在基线前 60 天至六个月调查期间接受了 1）来自 VA 或社区提供者的 4+ 次针灸就诊（N=201）或 4+ 次整脊治疗就诊（N=178），2）从 1 年至 60 天基线前没有接受过针灸或整脊治疗。测量的结果包括基线和六个月调查时患者报告的疼痛（PEG）和身体健康（PROMIS）。多变量分析在调整基线结果和人口统计学因素后，检查了六个月时的结果。
在未调整的分析中，接受社区为基础的针灸治疗的患者的疼痛和身体健康状况有所改善，而接受 VA 为基础的针灸治疗的患者则没有变化。未调整的分析还表明，接受 VA 为基础的整脊治疗的患者身体健康状况有所改善，而接受社区为基础的整脊治疗的患者则没有变化。使用多变量模型，VA 为基础的针灸治疗与社区为基础的针灸治疗在疼痛（-0.258，p=0.172）或身体健康（0.539，p=0.399）方面没有差异。同样，VA 和社区为基础的整脊治疗在疼痛（-0.273，p=0.154）或身体健康（0.793，p=0.191）方面也没有差异。
针灸和整脊治疗在六个月时与适度的改善相关，VA 和社区提供者之间没有明显差异。选择从 VA 或社区提供者处接受治疗的决定可能取决于质量以外的因素，例如成本或便利性。
