Nicosia Francesca M, Purcell Natalie, Bertenthal Dan, Usman Hajra, Seidel Ilana, McGrath Sarah, Hildebrand Caitlin, McCarthy Brittan, Seal Karen H
San Francisco VA Healthcare System, San Francisco, CA, USA.
Institute for Health & Aging, University of California, San Francisco, CA, USA.
Glob Adv Integr Med Health. 2024 Jun 11;13:27536130241260034. doi: 10.1177/27536130241260034. eCollection 2024 Jan-Dec.
The Integrative Health and Wellness Clinic (IHWC), established in 2019 at the San Francisco VA Health Care System, is an interdisciplinary clinic consisting of a medical provider, dietician, physical therapist, and psychologist trained in complementary and integrative health (CIH) following the VA Whole Health model of care. Veterans with complex chronic conditions seeking CIH and nonpharmacologic approaches are referred to the IHWC. This study evaluated the clinic's acceptability and feasibility among veteran patients and its preliminary impact on health and wellbeing, health-related goals, and use of CIH approaches.
Mixed methods were used to assess patient-reported outcomes and experiences with the IHWC. Participants completed surveys administered at baseline and 6-months and a subset completed a qualitative interview. Pre- and post-scores were compared using t-tests and chi-square tests.
Thirty-five veterans completed baseline and 6-month follow up surveys. Of these, 13% were women; 24% < 50 years of age, and 44% identified as racial/ethnic minorities. Compared to baseline, at 6 months, there were significant ( < .05) improvements in overall health, physical health, perceived stress, and perceived helpfulness of clinicians in assisting with goal attainment; there was a trend toward improved mental health ( = .057). Interviews (n = 25) indicated satisfaction with the interdisciplinary clinical model, support of IHWC providers in goal attainment, and positive impact on physical and mental health. Areas for improvement included logistics related to scheduling of multiple IHWC providers and referrals to other CIH services.
Results revealed significant improvement in important clinical domains and satisfaction with interprofessional IHWC clinic providers, but also opportunities to improve clinic processes and care coordination. An interdisciplinary clinic focused on CIH and Whole Health is a feasible and acceptable model of care for veterans with complex chronic health conditions in the VA healthcare system.
综合健康与保健诊所（IHWC）于2019年在旧金山退伍军人事务部医疗保健系统成立，是一家跨学科诊所，由一名接受过遵循退伍军人事务部整体健康护理模式的补充与综合健康（CIH）培训的医疗服务提供者、营养师、物理治疗师和心理学家组成。寻求CIH和非药物治疗方法的患有复杂慢性病的退伍军人会被转介到IHWC。本研究评估了该诊所在退伍军人患者中的可接受性和可行性，以及其对健康和幸福感、与健康相关的目标以及CIH方法使用的初步影响。
采用混合方法评估患者报告的IHWC结果和体验。参与者完成了在基线和6个月时进行的调查，一部分参与者完成了定性访谈。使用t检验和卡方检验比较前后得分。
35名退伍军人完成了基线和6个月的随访调查。其中，13%为女性；24%年龄小于50岁，44%为种族/族裔少数群体。与基线相比，6个月时，整体健康、身体健康、感知压力以及临床医生在协助实现目标方面的感知帮助性均有显著改善（P<0.05）；心理健康有改善趋势（P = 0.057）。访谈（n = 25）表明对跨学科临床模式感到满意，对IHWC提供者在实现目标方面的支持以及对身心健康有积极影响。改进领域包括与安排多名IHWC提供者相关的后勤工作以及转介到其他CIH服务。
结果显示在重要临床领域有显著改善，对跨专业IHWC诊所提供者感到满意，但也有改善诊所流程和护理协调的机会。一个专注于CIH和整体健康的跨学科诊所对于退伍军人事务部医疗保健系统中患有复杂慢性健康状况的退伍军人来说是一种可行且可接受的护理模式。
