Integrative Group Medical Visits: A National Scoping Survey of Safety-Net Clinics

Thompson-Lastad, Ariana; Gardiner, Paula; Chao, Maria T.

doi:10.1089/heq.2018.0081

Cited by 26 publications

(31 citation statements)

References 33 publications

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“…Research on providing CIH in groups shows improvements in chronic disease management and health promotion, especially for patients with complex conditions. 20,21 Group medical visits, which combine medical care, peer support, and health education, have proven successful in safety-net settings. [22][23][24][25][26] Few studies have addressed how group models incorporating CIH might improve chronic pain treatment within a primary care setting, especially for lowincome, structurally disadvantaged populations.…”

Section: Introductionmentioning

confidence: 99%

Vulnerable Patients' Psychosocial Experiences in a Group-Based, Integrative Pain Management Program

Bruns

Befus

Wismer

et al. 2019

The Journal of Alternative and Complementary Medicine

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Objectives: To use a psychosocial framework to examine the pain experiences of low-income, ethnically diverse patients before and after an Integrative Pain Management Program (IPMP).Design and methods: IPMP is a 12-week, multimodal pain group incorporating mindfulness, acupuncture, massage, education, movement, and health coaching. The authors conducted semistructured interviews at the beginning, end, and 3 months following completion of IPMP. Interviews were digitally recorded and transcribed and analyzed using inductive coding methods.Setting: A primary care clinic in San Francisco, CA, serving low-income, ethnically diverse patients, many of whom are marginally housed and living with disabilities.Subjects: Forty-one patients with a diagnosis of chronic pain, currently receiving prescription opioids and referred by their primary care provider, who participated in IPMP.Results: Authors thematically analyzed 104 individual interviews with 41 IPMP participants, including 41 baseline, 35 three-month follow-up, and 28 six-month follow-up. Before IPMP, participants described a psychologic ''vicious cycle'' of pain symptoms that worsened with movement and anxiety, while increasing their sense of disempowerment and social isolation. Following IPMP, patients reported using new strategies to manage pain, including lowering medication use, resulting in an emerging sense of psychologic resilience, and more social connections.Conclusions: IPMP offers an accessible model for addressing psychosocial aspects of chronic pain. Vulnerable patients engaged with integrative medicine groups and developed new perspectives and tools for managing their pain; they emerged feeling hopeful and resilient. These results support the use of integrative medicine groups for targeting psychosocial aspects of chronic pain within primary care.

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Section: Introductionmentioning

confidence: 99%

Vulnerable Patients' Psychosocial Experiences in a Group-Based, Integrative Pain Management Program

Bruns

Befus

Wismer

et al. 2019

The Journal of Alternative and Complementary Medicine

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“…The results indicate the most common consultation model used in NCCs is a one-on-one model including a longer initial appointment (approximately 60 min) followed by shorter follow-up appointments (approximately 30–45 min), aligning with other reports highlighting the longer nature of naturopathic consultations emphasizing the patient-centered approach implemented by NPs [ 15 ]. However, 20% of NCCs also reported using group consultations (in addition to one-on-one) – a model not often reported in general naturopathic practice, but becoming more common with medical and other integrative medicine practitioners for reaching diverse and underserved communities and addressing healthcare disparities [ 16 , 17 ]. Further research is needed to determine the reasons for and impact of using a group model within NCCs.…”

Section: Discussionmentioning

confidence: 99%

Naturopathic community clinics: an international cross-sectional survey

Lloyd¹,

Gerontakos

Cardozo

2021

BMC Health Serv Res

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Background Globally, naturopathic practitioners offer services in 98 countries, reaching every world region and providing care to diverse populations for a range of acute and chronic health conditions. Community clinics provide free or low-cost healthcare services and play a key role in providing necessary primary healthcare for underprivileged or marginalized populations. However, the reach and impact of naturopathic community clinics (NCCs) has not yet been examined. The aim of this study was to identify the characteristics of NCCs around the world, determine the types of services they offer and provide insight into the populations being served. Methods Two online cross-sectional surveys were administered using purposive and snowball sampling. A 6-item screening survey was administered first to identify clinics and institutions who fit the criteria for NCC services, followed by a 40-item follow-up survey. Descriptive analysis was conducted using frequencies and means. Results The screening survey returned a total of 37 responses from six world regions. Of those respondents who indicated involvement in NCCs, 74% went on to complete the follow-up survey. The majority of the responding NCCs were located in North America (50%), followed by Western Pacific (17%), Europe (10%), Asia (13%), Latin America (7%) and Africa (3%). The vast majority (71%) of the NCCs that have been in operation for more than 10 years are located in North America, while 43% of the NCCs that have been operational less than 5 years are in the Western Pacific Region. 80% of the responding NCCs were affiliated with a naturopathic school. The majority of respondents (76%) mentioned that they aim to serve underserved and/or marginalized populations, with 34% indicating that their target population is low-income families, 21% focusing on serving immigrants and refugees, 21% on serving people experiencing homelessness, 14% on serving Indigenous peoples, 14% on serving those with specific gender differences, 10% on serving seniors and 10% on serving drug users. Conclusion The naturopathic profession offers free or significantly low-cost naturopathic services through community clinics around the world. The findings of this survey provide insight into the important role of the naturopathic profession in primary health care and provide rationale for exploring this topic in greater detail.

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“…26 IMGV is one of few IPM interventions that is widely reimbursable and was therefore selected as part of a larger effort to develop a financially sustainable Integrative Medicine Clinic. 27 In this study, the authors describe the IMGV intervention and implementation mapping process used to identify relevant implementation strategies. This project was reviewed by the Institutional Review Board of the University of North Carolina at Chapel Hill, protocol number 20-0147.…”

Section: Methodsmentioning

confidence: 99%

“…The IMGV for chronic pain is one of few efficacious IPM interventions to address the lack of access to complementary and integrative health therapies due to financial barriers; however, it has been only minimally implemented. 27,35…”

Section: Integrative Medical Group Visitsmentioning

confidence: 99%

Feasibility of Implementation Mapping for Integrative Medical Group Visits

Roth

Tiedt

Barnhill

et al. 2021

The Journal of Alternative and Complementary Medicine

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Objectives: Implementation science is key to translating complementary and integrative health intervention research into practice as it can increase accessibility and affordability while maximizing patient health outcomes. The authors describe using implementation mapping to (1) identify barriers and facilitators impacting the implementation of an Integrative Medical Group Visit (IMGV) intervention in an outpatient setting with a high burden of patients with chronic pain and (2) select and develop implementation strategies utilizing theory and stakeholder input to address those barriers and facilitators.Design: The authors selected a packaged, evidence-based, integrative pain management intervention, the IMGV, to implement in an outpatient clinic with a high burden of patients with chronic pain. The authors used implementation mapping to identify implementation strategies for IMGV, considering theory and stakeholder input. Stakeholder interviews with clinic staff, faculty, and administrators (n = 15) were guided by the Consolidated Framework for Implementation Research.Results: Based on interview data, the authors identified administrators, physicians, nursing staff, and scheduling staff as key stakeholders involved in implementation. Barriers and facilitators focused on knowledge, buy-in, and operational procedures needed to successfully implement IMGV. The implementation team identified three cognitive influences on behavior that would impact performance: knowledge, outcome expectations, and self-efficacy; and three theoretical change methods: cue to participate, communication, and mobilization. Implementation strategies identified included identifying and preparing champions, participation in ongoing training, developing and distributing educational materials, and organizing clinician implementation team meetings.Conclusions: This study provides an example of the application of implementation mapping to identify theory-driven implementation strategies for IMGV. Implementation mapping is a feasible method that may be useful in providing a guiding structure for implementation teams as they employ implementation frameworks and select implementation strategies for integrative health interventions.

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Integrative Group Medical Visits: A National Scoping Survey of Safety-Net Clinics

Cited by 26 publications

References 33 publications

Vulnerable Patients' Psychosocial Experiences in a Group-Based, Integrative Pain Management Program

Vulnerable Patients' Psychosocial Experiences in a Group-Based, Integrative Pain Management Program

Naturopathic community clinics: an international cross-sectional survey

Feasibility of Implementation Mapping for Integrative Medical Group Visits

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