Comella Nicole, Elwy Rani A
Warren Alpert Medical School of Brown University, Providence, RI, USA.
Boston Medical Center, Boston, MA, USA.
J Integr Complement Med. 2025 Feb;31(2):155-165. doi: 10.1089/jicm.2024.0370. Epub 2024 Oct 24.
Complementary and integrative health (CIH) therapies are widely used and make up billions of dollars in out-of-pocket expenditures. This quality improvement project aimed to identify stakeholders' perceptions of implementing CIH therapies in health care systems to examine the barriers and facilitators to CIH implementation in Rhode Island (RI). A qualitative approach guided by the Consolidated Framework for Implementation Research (CFIR) was used to conduct interviews with key stakeholder groups: health care administrators, health insurance administrators, physicians, and CIH practitioners. Interviews were analyzed by directed content analysis of transcripts with CFIR as the coding framework. Eleven subconstructs within four major domains were most prominent in interviews across all stakeholder groups. Key barriers in the "innovation" domain include a perceived lack of evidence and credibility of CIH therapies, logistical and administrative complexity of implementation, high costs to patients, and little financial incentive for hospitals and insurance companies. The "outer setting" domain highlights the utility of market pressure in decision making to implement CIH and the role of health policy. The "inner setting" domain demonstrates the varied personal beliefs about CIH, credentialing challenges, and the dissonance between medical system priorities and patient needs. Positive facilitation of implementation is marked by personal exposure to CIH and provider satisfaction in the "implementation process" domain. CIH therapies offer the medical system low risk and effective interventions that meet patient needs not currently met by Western medicine. However, implementation is difficult due to poor perception of evidence and lack of financial gain for the medical system. Acupuncture and massage may be modalities better situated for implementation in the RI medical system. Further education, awareness, and advocacy for CIH therapies would help meet patients' needs for CIH availability.
补充与整合健康（CIH）疗法被广泛使用，自付费用高达数十亿美元。本质量改进项目旨在确定利益相关者对在医疗保健系统中实施CIH疗法的看法，以研究罗德岛州（RI）实施CIH疗法的障碍和促进因素。采用以实施研究综合框架（CFIR）为指导的定性方法，对关键利益相关者群体进行访谈：医疗保健管理人员、健康保险管理人员、医生和CIH从业者。访谈采用以CFIR为编码框架的转录本定向内容分析法进行分析。在所有利益相关者群体的访谈中，四个主要领域中的11个子结构最为突出。“创新”领域的关键障碍包括认为CIH疗法缺乏证据和可信度、实施的后勤和行政复杂性、患者成本高，以及医院和保险公司缺乏经济激励。“外部环境”领域强调市场压力在实施CIH决策中的作用以及卫生政策的作用。“内部环境”领域表明对CIH的个人信念各不相同、认证挑战，以及医疗系统优先事项与患者需求之间的不一致。在“实施过程”领域，个人接触CIH和提供者满意度标志着对实施的积极促进。CIH疗法为医疗系统提供了低风险且有效的干预措施，满足了目前西医无法满足的患者需求。然而，由于对证据的认知不佳以及医疗系统缺乏经济收益，实施起来很困难。针灸和按摩可能是更适合在RI医疗系统中实施的方式。对CIH疗法进行进一步教育、提高认识和宣传将有助于满足患者对CIH可用性的需求。
