Global advances in integrative medicine and health最新文献

Background: Integrated care interventions can improve patient outcomes and reduce the burden on acute health services, but need a strong evidence base to ensure their effectiveness. Understanding the meso and macro context in which care is delivered and determining whether patient needs are met are essential to successful implementation. Care coordination in New South Wales (NSW), Australia has evolved over time to meet the needs of an ageing population with chronic health conditions and multi-morbidity with the aim of reducing potentially preventable hospitalisations.

Objective: To examine how an integrated care coordination program was understood and implemented at state, district and clinician levels in NSW. The Integrated Care for People with Chronic Conditions (ICPCC) program was implemented statewide, however local implementation varied. Patients who were suitable for integrated care coordination were identified via a hospitalisation risk prediction algorithm and/or referrals from health professionals.

Methods: Understanding and implementation of ICPCC were assessed via interviews and a focus group with a range of health staff. Qualitative data were analysed using NVivo software and normalisation process theory.

Results: There was a strong sense of program coherence from management, clinicians and referrers. They viewed ICPCC as effective in coordinating care for patients at risk of hospitalisation and incorporating self-management at home. All health staff interviewed understood the program purpose and necessity, including the importance of achieving patient and systemic goals. Networking, linking services and program promotion were important, as was reporting on benefits. While the algorithm effectively identified previously hospitalised patients, it did not identify all suitable patients in the community with an increasing risk of requiring acute health care intervention. Referrals from health professionals familiar with patient needs and complexity were an important additional mechanism for patient selection.

Conclusions: There was a shared sense of coherence and understanding of the ICPCC program among health staff at the three levels of implementation within NSW. The program played an important role in assisting patients with a range of chronic conditions to access and benefit from integrated care coordination, while increasing their capacity to self-manage at home. Program intake via hospitalisation risk prediction algorithm plus referrals from health professionals familiar with patient needs and complexity can effectively identify those who may benefit from integrated care coordination.

Introduction: This study aims to comprehensively evaluate health care access and utilization in rural Pakistan, shedding light on the multifaceted challenges and opportunities within the health care landscape. It explores the healthcare-seeking behaviours of individuals, particularly focusing on underserved populations.

Methods: The study employed a qualitative data collection method. Focus Group Discussions (FGDs) were conducted to gather qualitative insights. Data were analysed using thematic content analysis allowing for a comprehensive understanding of health care challenges.

Results: The study reveals significant findings, including limited healthcare-seeking behaviours due to financial constraints, lack of health insurance, and distrust in health care systems. Government health care facilities in rural areas were perceived as inadequate, with under-resourced staff and subpar quality of care. Participants expressed support for medical camps and educational sessions to address these issues.

Conclusion: This study provides critical insights into rural Pakistan's health care access and utilization challenges. Policymakers, health care practitioners, and community leaders can draw from these findings to formulate effective strategies for improving health care access and outcomes in underserved rural areas.

Mindfulness-Based Programs (MBPs) are increasingly being introduced into a range of mainstream contexts such as health care, education, criminal justice, workplace, community settings, and leadership. MBPs are available in some form in every continent, and in some countries have become established as part of standard care in publicly funded health care systems and routinely embedded into school curriculums. Efficacy and effectiveness research demonstrate gold standard evidence in some areas and significant promise in others, and cost-effectiveness evaluations are encouraging. However, understanding how to assess and ensure the fidelity of program delivery is at a germinal stage. Without clear, robust, and coordinated approaches to this issue within the international field, ongoing dissemination and implementation could be compromised by variable standards of teaching skill and adherence to program form. These issues are relevant in practice contexts where approaches to teacher training internationally need to adhere to commonly held principles, understandings, and standards. They are also relevant in research contexts where assessment of intervention fidelity needs to ensure that the variable of the teaching process and curriculum is addressed in the research design and conveyed to readers in the presentation of data. In this special collection, we bring together articles reporting on research and practice on MBP intervention fidelity in teacher training, implementation, and development of governance for the emerging mindfulness-based field. This paper introduces the special collection, summarizes the papers included, and offers an analysis of where we are now as a field and of what steps are needed to further our understanding on these issues. We hope to share current best practice and catalyse new understandings and directions of inquiry that will provide a compass to navigate forward and benefit this promising field.

Background: Underrepresentation of diverse populations in clinical trials poses challenges to equity and external validity in health care research. To successfully recruit underrepresented participants in pragmatic clinical trials, researchers must understand the perspectives and needs of individuals from diverse backgrounds who participate in research.

Objective: The purpose of this qualitative study was to gain an understanding of the needs and perspectives of participants of the OPTIMUM trial -- a pragmatic trial evaluating mindfulness-based stress reduction for chronic low back pain.

Methods: This qualitative study employed focus groups with participants from 3 clinical sites: Boston Medical Center, the University of North Carolina at Chapel Hill, and the University of Pittsburgh. Focus group discussions centered on participants' experiences, barriers, and facilitators to engagement in the OPTIMUM trial. Data were analyzed using thematic content analysis and the rapid qualitative analysis method, Lightning Reports, for real-time feedback integration into the trial process.

Results: Six focus groups were conducted with 46 participants, of whom 39.1% were first-time research participants and 56.5% identified as Black or African American. Qualitative analysis identified five key themes:1) The importance of providers in the recruitment of cLBP patients, (2) Motivators to participate and stay engaged in clinical research, (3) Participant lack of understanding of randomized control trials (RCTs) and general research processes, (4) Desire for social connection and community-building among participants, and (5) the Positive impact of regular study staff interaction.

Conclusion: Equity in RCTs requires intentional strategies to address barriers to participation and engagement faced by historically underrepresented populations. Engaging health care providers in recruitment, fostering positive interactions with study staff, and creating opportunities for social connection can improve recruitment, retention, and engagement. Incorporating community-engaged research methods and real-time feedback mechanisms can further support inclusivity and equity in pragmatic clinical trials.

Background: Mental health of emerging, young adults remains a concern, particularly in lower income groups who receive less mental healthcare. Mindfulness-based interventions yield mental health benefits and have been widely applied, though reach and accessibility remain limited. Poor mental health can negatively impact job performance, physical health, and life trajectories.

Objective: A mindfulness elective was offered through a year-long job training program serving diverse, low-income emerging adults. We investigated relevant outcomes in a mixed methods quasi-experimental study.

Methods: Pre-/post-elective surveys assessed mindfulness, mental health, and well-being using established measures. We analyzed within- and between-group differences comparing mindfulness vs control (Year 1) and 12-week vs 6-week (Year 2) participants using t-tests and mixed effects models. Focus groups were conducted and analyzed using codebook thematic analysis.

Results: Participants (n = 212) provided evaluation data. Over two years, 195 participated in a mindfulness elective (mean age = 22.3 [SD = 2.7] years; 47.2% female, 94.4% from racially and ethnically minoritized groups). In Year 1, mindfulness participants exhibited many pre-to-post improvements, including greater mindfulness (+8.4, 95% CI: 5.8, 11.0) and life satisfaction (+10.3, 95% CI: 7.0, 13.6) and lower stress (-8.2, 95% CI: -10.4, -5.9); no changes in controls were observed. In Year 2, mindfulness participants improved in mindfulness and life satisfaction plus self-compassion (12-week: +0.6, 95% CI: 0.4, 0.8; 6-week: +0.4, 95% CI: 0.1, 0.6), connectedness (12-week: +0.7, 95% CI: 0.5, 0.9; 6-week: +0.4, 95% CI: 0.2, 0.6), and mind-body connection (12-week: +1.8, 95% CI: 1.2, 2.4; 6-week: +0.6, 95% CI: 0.0, 1.3). Additional benefits were observed (eg, in stress, focus, emotional reactivity) but significance varied by elective length. Focus groups were generally concordant with quantitative results. Respondents described how the elective enabled self-care, supporting health and professional development.

Conclusions: Integrating mindfulness into job training for underserved emerging adults was well-received, effective, and supports mental health equity.

Background: Several clinical trials support the efficacy of Whole Systems Traditional Chinese Medicine (WS-TCM) modalities, including acupuncture, for improving outcomes among women undergoing in vitro fertilization (IVF), but few studies have described its real-world integration within an academic medical setting or its immediate effects on pain, stress, and anxiety.

Objective: To characterize the clinical delivery of WS-TCM and assess its effects on patient-reported outcomes (PROs) among patients receiving WS-TCM while undergoing IVF.

Methods: A retrospective review of patients who received ≥1 WS-TCM treatment associated with ≥1 embryo transfer at a single center was conducted. A linear mixed model adjusting for the random effect of patients seen over multiple treatments was used to calculate PRO changes among those with pre-treatment PROs ≥1 on a 0-10 numeric rating scale.

Results: 1896 WS-TCM treatments were provided during 202 embryo transfers among 146 patients. Patients (mean age 35.76 ± 4.37) were predominantly white (79.5%), and 26.7% had a documented mental health diagnosis. Of the 202 embryo transfers, 64.9% included pre-transfer treatment, 88.6% included day-of-transfer treatment, and 32.2% included post-transfer treatment. Patients reporting pre-treatment PROs ≥1 reported clinically significant mean [95% CI] reductions in pain (-1.38 [-1.70, -1.07]), stress (-2.11 [-2.47, -1.74]), and anxiety (-2.22 [-2.63, -1.81]) within a single treatment.

Conclusions: This study supports the integration of WS-TCM within IVF and its benefits for reducing acute pain, stress, and anxiety. WS-TCM may improve patient experiences and be a useful treatment for psychosocial concerns that often accompany IVF.

Background: Mindfulness training has been associated with improved health outcomes among family caregivers of people living with dementia, but access to training is limited, especially in rural areas. Moreover, mindfulness training that addresses the unique perspectives of African American families is needed.

Objectives: The study aimed to test the feasibility and acceptability of a theory-driven, telephone-delivered mindfulness intervention for caregivers of African Americans with moderate-to-severe dementia living in rural eastern North Carolina.

Methods: In this single-arm, multiple-methods study, pairs of informal caregivers attended an 8-week mindfulness training program involving weekly one-hour telephone-delivered sessions, and an online retreat. Feasibility outcomes included enrollment, retention, attendance, and acceptability. Exploratory pre-post endpoints related to our theoretical model included perceived caregiver burden (Zarit Burden Interview), uncertainty intolerance (Intolerance of Uncertainty Scale), and positive emotions (Meaning and Purpose Scale).

Results: Seventy-eight percent of screened individuals enrolled, 86% completed the study, and 88% attended ≥6 sessions. Participants found the program valuable, especially via telephone. Perceived burden decreased from pre-to-post intervention (mean difference [MD] -2.7, (95% CI: -4.5, -1.3; Cohen's d -0.47) and positive emotions increased (MD 2.7, 95% CI 0.81, 4.5; d = 0.37). Both inhibitory (MD -1.0, 95% CI -1.8, -0.09; d = -0.28) and prospective (MD -1.2, 95% CI -2.7, 0.3; d = -0.20) intolerance of uncertainty were lower post-intervention.

Discussion: A telephone-delivered mindfulness training intervention was feasible and shows promise for reducing perceived burden among rural-dwelling informal caregivers of African Americans with dementia. Further testing in a randomized parallel-group trial comparing mindfulness training to a credible control intervention is warranted.

Trial registration: ClinicalTrials.gov NCT04058886.

Background: The integrative medicine (IM) clinic is an innovative care model that may increase access to guideline-concordant nonpharmacologic treatment use in healthcare delivery systems for prevalent conditions such as low back pain (LBP).

Objective: To describe the use and effectiveness of IM services for LBP in IM clinics.

Research design: Prospective cohort study.

Subjects: Adult patients with LBP enrolled at seventeen IM clinics.

Measures: Patterns of IM service use were assessed over 12 months. Changes in clinical outcomes were assessed between index visit and 12-month follow-up using linear mixed-effects models. Primary (pain interference, physical function) and secondary (pain intensity, anxiety, depression, fatigue, sleep disturbance, social participation) outcomes were obtained from the PROMIS-29 instrument.

Results: We identified 660 participants with LBP (mean age = 51.6 years, 75% female). Over the 12-month study period, common IM services were IM consults (56%), acupuncture (44%), chiropractic care (24%), physical therapy (19%), and massage (17%). Over two-thirds (70%) of participants received at least one guideline-concordant nonpharmacologic treatment. Participants with follow-up outcome data (n = 443, 67%) reported a modest reduction in pain interference with life activities in the short- and long-term (2-month mean difference [MD] = -1.47, 95%CI = -2.98, -0.64; 12-month MD = -1.98, 95%CI = -3.12, -0.88). By contrast, improvements in physical function were not statistically or clinically significant (2-month MD = 0.37, 95%CI = -0.28, 1.01; 12-month MD = 0.69, 95%CI = -0.31, 1.69). At 12 months, small improvements were observed on all secondary outcomes (pain intensity, anxiety, depression, and social participation) except fatigue and sleep disturbance.

Conclusions: Most patients with LBP receiving care at IM clinics received at least one guideline-recommended nonpharmacologic treatment. However, improvements on clinical outcomes were relatively small. Additional multi-site studies are needed to explore the optimal implementation approach.

Barriers to the use of integrative medicine modalities are complex, with associated disparities in awareness, access, and utilization within marginalized communities. This article details our experience in creating a virtual community designed to empower Hispanic women in the US to lead healthier lives through culturally aware health education in Spanish. Our digital health programs utilize a mind-body medicine approach to foster positive social connections and promote integrative health equity within the Hispanic community living in the US.