Integrative medicine and health in undergraduate and postgraduate medical education.

Background and objective: Integrative Medicine and Health (IMH) is a theory-based paradigm shift for health, disease and health care, which can probably only be achieved by supplementing medical roles and competences. Definition of IMH: The definitions of the Academic Consortium for Integrative Medicineand Health 2015 and the so-called Berlin Agreement: Self-Responsibility and Social Action in Practicing and Fostering Integrative Medicine and Health Globally are used. The basic features of evidence-based Integrative Medicine and Health (EB-IMH) are based on the recommendations on EBM by David L. Sackett. Global State of Undergraduate and Postgraduate Medical Education (UG-PGME) for IMH: The USA and Canada are most advanced in the development of IMH regarding practice, teaching and research worldwide. Despite socio-cultural peculiarities, they can provide guidance for Europe and especially for Germany. Of interest here are competences for UG-PGME in IMH in primary care and in some specialist disciplines (e.g. internal medicine, gynecology, pediatrics, geriatrics, oncology, palliative care). For these specialties, the need for an interprofessional UG-PGME for IMH was shown in the early stages of development. UG-PGME for IMH in Germany: In the course of the development of the new Medical Licensure Act in Germany (ÄApprO), based on a revision of the National Competence-based Catalogue of Learning Objectives for Medicine (NKLM 2.0) and new regulations for Postgraduate Medical Education in Germany, suggestions for an extension of UG-PGME are particularly topical. To some extent there are already approaches to IMH. Old and new regulations are set out and are partly compared. As a result, some essential elements of IMH are mapped in the new ÄApprO. The new regulations for Postgraduate Medical Education do not mention IMH. Conclusion: The development of medical competences for IMH in the continuum of the UG-PGME could be supported by the coordinated introduction of appropriate entrustable professional activities (EPA) and IMH sub-competences combined with appropriate assessment.

Complementary and Integrative Health Approaches Offered in the Veterans Health Administration: Results of a National Organizational Survey.

Introduction: Certain complementary and integrative health (CIH) approaches have increasingly gained attention as evidence-based nonpharmacological options for pain, mental health, and well-being. The Veterans Health Administration (VA) has been at the forefront of providing CIH approaches for years, and the 2016 Comprehensive Addiction and Recovery Act mandated the VA expand its provision of CIH approaches. Objective/Design: To conduct a national organizational survey to document aspects of CIH approach implementation from August 2017 to July 2018 at the VA. Participants: CIH program leads at VA medical centers and community-based outpatient clinics (n = 196) representing 289 sites participated. Measures: Delivery of 27 CIH and other nonpharmacologic approaches was measured, including types of departments and providers, visit format, geographic variations, and implementation challenges. Results: Respondents reported offering a total of 1,568 CIH programs nationally. Sites offered an average of five approaches (range 1-23), and 63 sites offered 10 or more approaches. Relaxation techniques, mindfulness, guided imagery, yoga, and meditation were the top five most frequently offered. The most approaches were offered in physical medicine and rehabilitation, primary care, and within integrative/whole health programs, and VA non-Doctor of Medicine clinical staff were the most common type of CIH provider. Only 13% of sites reported offering CIH approaches through telehealth at the time. Geographically, southwestern sites offered the smallest number of approaches. Implementation challenges included insufficient staffing, funding, and space, hiring/credentialing, positioning CIH as a priority, and high patient demand. Conclusions: The provision of CIH approaches was widespread at the VA in 2017-2018, with over half of responding sites offering five or more approaches. As patients seek nonpharmacologic options to address their pain, anxiety, depression, and well-being, the nation's largest integrated health care system is well-positioned to meet that demand. Providing these therapies might not only increase patient satisfaction but also their health and well-being with limited to no adverse events.

Herbal Supplements for Common Women's Health Issues.

The use of alternative therapies for health problems specific to women is increasing. As many as 67% of women admit to using complementary therapies of some kind, including supplements, chiropractic intervention, acupuncture, and acupressure. Many women turn to herbal supplements because they think that pharmacologic interventions are unsafe or not effective. Current literature provides conflicting information regarding many complementary and alternative therapies, including herbal supplements. Although most are not harmful, it is important to review the safety and efficacy of supplements for women's health issues.

Factors that promote and sustain the use of traditional, complementary and integrative medicine services at LEKMA hospital, Ghana, 2017: an observational study.

BACKGROUND: About 70% of Ghanaians depend on traditional, complementary and integrative medicine (TCIM) practices for primary healthcare needs. It was therefore integrated into mainstream healthcare delivery system by the Ministry of Health in September 2012. LEKMA hospital was one of the institutions for piloting TCIM services. We assessed factors that promote the usage and sustainability of TCIM services within the formal healthcare system. METHODS: We conducted a cross-sectional study from April-June 2017 at the LEKMA hospital, Accra, Ghana. Patients and managers of TCIM clinic were interviewed. Data was collected through qualitative and quantitative approaches. We defined usage of TCIM as its current use, and sustainability as structures in place to run TCIM services. For assessing usage, a five-point Likert scale was used to assess five domain areas via exit interviews. Managers were assessed on the sustainability of TCIM services through in-depth interviews. Likert scales responses were analysed quantitatively using descriptive tertile statistics. Thematic analysis was used for qualitative analysis. RESULTS: Overall, 72.7% (40/55) of the clients showed a high preference for TCIM usage and 80.0% (4/5) of the managers valued it as partially sustainable. Eighty per cent (44/55) of patients indicated that the location of TCIM services and availability of visible directional signs influenced the good usage; 84% (46/55) of the patients agreed that the usage of TCIM was influenced by their perceived effectiveness. Managers indicated that human resources for providing services was a challenge and TCIM integration into the operations of the hospital needed to be improved. CONCLUSION: We observed a high preference for usage of TCIM among users at LEKMA hospital. The general belief in the potency, perceived effectiveness, location and availability of TCIM services are key determinants of the high preference for usage of TCIM. Provision of TCIM services in its current form is partially sustainable from the managers' perspective. We recommend that the Ministry of Health ensures the availability of staff and create awareness of TCIM services among the general populace.

Complementary, Integrative, and Nondrug Therapy Use for Pain Among US Military Veterans on Long-term Opioids.

BACKGROUND: Long-term opioid therapy for chronic pain arose amid limited availability and awareness of other pain therapies. Although many complementary and integrative health (CIH) and nondrug therapies are effective for chronic pain, little is known about CIH/nondrug therapy use patterns among people prescribed opioid analgesics. OBJECTIVE: The objective of this study was to estimate patterns and predictors of self-reported CIH/nondrug therapy use for chronic pain within a representative national sample of US military veterans prescribed long-term opioids for chronic pain. RESEARCH DESIGN: National two-stage stratified random sample survey combined with electronic medical record data. Data were analyzed using logistic regressions and latent class analysis. SUBJECTS: US military veterans in Veterans Affairs (VA) primary care who received ≥6 months of opioid analgesics. MEASURES: Self-reported use of each of 10 CIH/nondrug therapies to treat or cope with chronic pain in the past year: meditation/mindfulness, relaxation, psychotherapy, yoga, t'ai chi, aerobic exercise, stretching/strengthening, acupuncture, chiropractic, massage; Brief Pain Inventory-Interference (BPI-I) scale as a measure of pain-related function. RESULTS: In total, 8891 (65%) of 13,660 invitees completed the questionnaire. Eighty percent of veterans reported past-year use of at least 1 nondrug therapy for pain. Younger age and female sex were associated with the use of most nondrug therapies. Higher pain interference was associated with lower use of exercise/movement therapies. Nondrug therapy use patterns reflected functional categories (psychological/behavioral, exercise/movement, manual). CONCLUSIONS: Use of CIH/nondrug therapies for pain was common among patients receiving long-term opioids. Future analyses will examine nondrug therapy use in relation to pain and quality of life outcomes over time.

Participating in Complementary and Integrative Health Approaches Is Associated With Veterans' Patient-reported Outcomes Over Time.

BACKGROUND: Veterans Affairs is dedicated to providing a Whole Health approach to care, including offering complementary and integrative health (CIH) approaches to Veterans. OBJECTIVE: The objective of this study was to examine the association of CIH participation with Veterans' patient-reported outcomes over time. RESEARCH DESIGN: A survey of patient-reported outcomes at 5 timepoints: baseline, 2, 4, 6, and 12 months. SUBJECTS: Veterans participating in any type of CIH approach at 2 Veterans Affairs medical centers. MEASURES: Mixed hierarchical models with repeated variables were used to test the hypothesis that participating in any CIH approach would be associated with Veterans' overall physical/mental health [Patient-Reported Outcomes Measurement Information System 28 (PROMIS 28)], pain intensity, perceived stress (Perceived Stress Scale-4), and engagement in their care (Patient Activation Measure-13), controlling for age, male sex, site, participation in other CIH approaches, and surveys completed. RESULTS: We received 401 surveys from 119 Veterans (72% male, age range: 29-85 y) across all timepoints. Yoga participation was related to decreases in perceived stress (P<0.001), while tai chi participation was associated with improvements in overall PROMIS 28 physical and mental health functioning (P<0.02). Specific types of CIH were associated with significant improvements in PROMIS 28 subscales: meditation participation with physical functioning at 2, 6, and 12 months; tai chi participation with anxiety at 2 and 6 months, and ability to participate in social role activities at 2 months. No CIH approach was associated with Veterans' pain or engagement in their care. CONCLUSION: As specific CIH approaches are associated with improvements in patient-reported outcomes, clinicians, Veterans, and family members may use this information in discussions of nonpharmacological options to address health and well-being.

Advanced Practice Providers' Knowledge, Attitudes, and Utilization of Complementary and Integrative Medicine at an Academic Medical Center.

CONTEXT: Complementary and integrative medicine comprises treatments used along with conventional medical care. Its use within care settings and communities has increased. OBJECTIVE: We aimed to assess baseline knowledge and use of complementary and integrative medicine among advanced practice providers at an academic medical center and their attitudes toward it. METHODS: A 50-question survey was sent to 1018 advanced practice providers at our academic medical center to evaluate their knowledge, attitudes, and utilization of complementary and integrative medicine therapies. RESULTS: The 556 respondents (54.6% response rate) included physician assistants, nurse practitioners, certified registered nurse anesthetists, clinical nurse specialists, and certified nurse midwives. Respondents reported a positive attitude toward complementary and integrative medicine and were likely to refer their patients to a complementary and integrative medicine practitioner (59%). They agreed that patients whose providers incorporate complementary and integrative medicine into their care have better clinical outcomes (nurse practitioners, 93%; certified registered nurse anesthetists, 87%; physician assistants, 85%; P = .002) and improved patient satisfaction (all respondents, 84%). Advanced practice providers, especially nurse practitioners, stated that they initiate the conversation to discuss the benefits and harms of complementary and integrative medicine with their patients (nurse practitioners, 93%; certified registered nurse anesthetists, 87%; physician assistants, 85%; P < .001). Respondents most frequently endorsed overall exercise, massage, and melatonin. Prospective randomized controlled trials were the most influential factor for attitude toward complementary and integrative medicine among physician assistants (50%), and personal experience was the most influential factor among nurse practitioners (52.9%) and certified registered nurse anesthetists (46.8%). CONCLUSIONS: Advanced practice providers generally have positive attitudes toward complementary and integrative medicine, but utilization appears limited by a self-report of low knowledge of benefits and risks of various therapies. For patient safety and satisfaction, advanced practice providers require a strong complementary and integrative medicine knowledge base to counsel patients.

Perspective Of Elderly People Using Integrative Health Practices: A Qualitative Study.

INTRODUCTION: Integrative health practices are extensively used in addition to pharmacologic treatments by elderly individuals who has chronic diseases to relieve or overcome symptoms. METHODS: This qualitative study was performed on 12 elderly individuals with the aim of determining the reasons for the use of integrative health practices and identifying their thoughts regarding these practices. Face to face interview method was used for data collection. Data were collected with information forms that include informations about elderly individuals and semistuctured interview forms. All interviews with elderly individuals are made with in-depth interview method. The data was evaluated using qualitative content analysis. RESULTS: As a result of in-depth interviews, three main themes and eight sub-themes were identified, with the main themes being the feelings before using integrative health practices, the sources of information, and the experiences after use. The majority of the individuals reported that they used integrative health practices due to feelings of helplessness/hopelessness, depression and fear; that their sources of information were not professional sources; and that, in the end, the majority of them experienced negative emotions. It can hence be recommended that healthcare personnel should carefully evaluate the elderly. CONCLUSION: In this study; It is determined that elderly individuals were using integrative metods in addition to pharmacologic methods for symptom management. It can hence be recommended that healthcare personnel should carefully evaluate the elderly in geriatric assessment.

Do patients of integrative anthroposophic pediatric inpatient departments differ? Comparative analysis to all pediatric inpatients in Germany considering demographic and clinical characteristics.

BACKGROUND: Integrative medicine (IM) is a patient-centered, evidence-based, therapeutic paradigm which combines conventional and complementary approaches. The use of IM in pediatrics has increased in the past two decades and parents' demand for it is growing. An IM whole systems approach is anthroposophic medicine. Considering the growing demand for integrative approaches in children, it is relevant from a public health perspective to find out which kind of children use IM in Germany and whether they differ from the entirety of pediatric inpatients in Germany. Moreover, it would be interesting to known, whether these patients are willing to travel a longer distance to gain integrative treatment. METHODS: The present study investigates the standard ward documentation datasets of 29,956 patients of all German integrative anthroposophic pediatric inpatient wards from 2005 to 2016 and compares them systematically to collect data of the entirety of all pediatric inpatient wards in Germany. Apart from patients' age and gender, and the ICD-10 admission diagnoses, the geographical catchment area of the hospitals were analyzed. RESULTS: Sociodemographic characteristics of pediatric inpatients in the integrative anthroposophic departments (IAH) did not differ from the entirety of all pediatric inpatients. Regarding clinical characteristics, higher frequencies were found for endocrine, nutritional and metabolic diseases (IAH: 7.24% vs. 2.98%); mental, behavioral, and neurodevelopmental disorders (IAH: 9.83% vs. 3.78%) and nervous diseases (IAH: 8.82% vs. 5.16%) and lower frequencies for general pediatric diseases such as respiratory diseases (IAH: 17.06% vs. 19.83%), digestive diseases (IAH: 3.90% vs. 6.25%), and infectious and parasitic diseases (IAH: 12.88% vs. 14.82%) in comparison to the entirety of all pediatric inpatients in Germany. The IAH showed a broad catchment area, with most patients being from former, Western federal republic of Germany. Large catchment areas (> 100 km) for the IAH are merely covered by severe and chronic diseases. CONCLUSION: Pediatric inpatients of IAH do not differ from the entirety of pediatric inpatients in Germany regarding sociodemographic characteristics but show differences regarding clinical characteristics. Parents are willing to travel further distance to get specialized integrative anthroposophic medical care for children with severe and chronic diseases.

Differences in demographics and complementary and alternative medicine use between patients attending integrative kampo versus biomedical clinics in Japan.

OBJECTIVES: Growing interest in integrative medicine motivates examination of who seeks integrative care, and why. By examining differences in demographics and complementary and alternative medicine (CAM) use between patients recruited from Japanese Kampo (traditional herbal medicine) versus biomedical clinics, this study aimed to identify whether integrative medicine options might attract different patients. DESIGN AND SETTING: In this cross-sectional, observational study we administered the International Complementary and Alternative Medicine-Questionnaire (I-CAM-Q) to 209 patients recruited from four hospital clinics. Demographics, use of different types of CAM (self-help CAM, CAM practitioners, CAM products), and motivations were compared between Kampo and Non-Kampo patients and by gender. Factors influencing attendance at the Kampo clinic and CAM use were identified using logistic regression. RESULTS: While some demographic characteristics, CAM provider and total CAM use differed between Kampo and non-Kampo patients, self-help CAM use did not. Motivations (for acute, long-term, health maintenance, or other reasons) differed between Kampo and non-Kampo clinic patients for going to non-Kampo physicians (P = 0.02) and Kampo physicians (P = 0.1). Logistic regression results for 'any CAM' use showed odds ratio of 0.32 (95%CI 0.15-0.67) for self-rated health, and 1.60 (95%CI 1.10-2.32) for Macarthur subjective social status scale. Attendance at the Kampo clinic showed odds ratios of 1.50 (95%CI 1.11-2.02) for education and 0.56 (95%CI 0.39-0.80) for employment status. CONCLUSIONS: Better understanding of factors such as motivation, self-rated health, and socioeconomic conditions that influence patients' CAM use and integrative clinic attendance may enable more effective targeting of populations and integration of CAM into biomedical settings.

Assessment of the complementary and integrative medicine utilization among patients with multiple sclerosis using a translated and adapted version of the international questionnaire (I-CAM-QP): A cross-sectional study in Southern Iran.

AIMS: To assess the prevalence of and factors related to complementary and integrative medicine (CIM) use among multiple sclerosis (MS) patients, using a translated and adapted version of a standard international questionnaire. METHODS: International complementary and alternative medicine questionnaire (I-CAM-Q) was used. A cross-sectional study was done to assess the prevalence of and factors associated with CIM use among MS patients in Southern Iran. Patients who were randomly selected from MS registry center, were interviewed via phone calls. RESULTS: Three hundred patients were enrolled in the study; 69% of them were female. Their mean age was 36.6±8.53 years and the mean duration of the disease was 5.6 ±â€¯4.22 years. In all, 99.3% (95% CI) of the patients had used at least one type of CIM. Herbal medicines and dietary supplements were the most commonly used CIM type (97.3%; 95% CI). Praying was the most common modality among all CIM subgroups (81.3%; 95% CI). Long term illness (MS) was selected as the main reason for the last use of all CIM types. Having non-tertiary education and having sequel due to MS were related to visiting a CIM provider (adjusted odds ratio (AOR) = 2.32, 95% confidence interval (CI) = 1.22-4.43), (AOR = 2.67, 95% CI = 1.47-4.83) respectively. Being female was related to the use of self-help practices (AOR = 3.41, 95% CI = 1.5-7.72). CONCLUSION: There is a high prevalence of CIM use among MS patients. Therefore, patient- physician communication about CIM use should be emphasized.

Complementary medicine use and costs in patients with breast cancer who experienced treatment-related side effects: A cross-sectional survey in Korea.

OBJECTIVES: Population-based information on the costs of complementary medicine for treatment-related side effects in patients with breast cancer is scarce. We aimed to investigate the prevalence and expenditure on complementary medicine in patients with breast cancer who experienced treatment-related side effects. DESIGN AND SETTING: Two datasets were analyzed: 1) a 2017 survey on direct and indirect costs for treatment-related side effects, which was completed by 100 patients with stage 0-IV breast cancer, and 2) a Korean representative cross-sectional survey (Patient Survey 2014) that examined the prevalence of integrative medicine in 41 patients with breast cancer. MAIN OUTCOME MEASURES: The direct and indirect costs for treatment-related side effects. RESULTS: In the first dataset, the mean total direct medical cost for complementary medicine was US$1,584 and the mean indirect cost was US$6,988 per patient per year. Some patients (6%) visited non-medical institutions to utilize complementary medicine and additionally spent US$460 per patient per year. Approximately one-third of participants reported a substantial-to-heavy financial burden for using complementary medicine. However, only 17% of patients got information about complementary medicine through their physician. In the second dataset, 49% of patients with breast cancer who were discharged from Korean Medicine hospitals in Patient Survey 2014 data indicated that integrative medicine had been used. CONCLUSIONS: Despite some complementary medicine could be reimbursed by National Health Insurance in Korea, a considerable number of patients reported an economic burden associated with their use of complementary medicine. Strategies for guiding patients to receive evidence-based and cost-effective complementary medicine are needed.

Utilization of integrative medicine differs by age among pediatric oncology patients.

PURPOSE: Coping with symptoms related to cancer treatment is challenging for pediatric patients with cancer and their caregivers. Additionally, caring for pediatric patients requires specialized expertise to incorporate age-appropriate interventions to improve outcomes. Despite the increase in pediatric inpatient integrative medicine (IM) therapies, there is a paucity of knowledge about whether the utilization of IM therapies differs by patient age. METHODS: We conducted a retrospective analysis on IM utilization among pediatric inpatients between 2008 and 2016 in a tertiary urban cancer center using electronic medical records. Multivariable logistic regression models examined the relationship between age and specific type of IM utilization, adjusting for specific demographic factors. RESULTS: Between 2008 and 2016, the pediatric inpatient IM service had 20 686 visits and treated 1877 unique patients. A significant age difference (P < 0.001) by modality was noted: dance therapy (mean age ± standard deviation: 5.9 ± 5.3 years), music therapy (8.0±7.0 years), mind-body therapies (13.0 ± 7.7 years), massage (14.5 ± 7.8 years), and acupuncture (20.0 ± 7.9 years). In multivariable analysis, the association between age and use of specific IM therapies remained significant (P < 0.001 for all). CONCLUSION: Specific types of inpatient IM therapy usage significantly differed by the age of pediatric patients with cancer; therefore, designing and providing age-appropriate IM interventions with consideration for developmental stage are needed to ensure that the most appropriate and effective therapies are provided to children with cancer.

Exploring Sick Leave in Integrative Care-Retrospective Observations and Future Study Recommendations.

OBJECTIVES: To describe and contrast the prevalence and trends of sick leave in patients with pain or stress disorders referred to inpatient care that integrates conventional and complementary therapies, that is, integrative care (IC). METHODS: County council and social insurance data were used to retrospectively observe cross-sectional sick leave prevalence at four time points: 1 year before the first registered inpatient visit with the target diagnosis, after referral at index, and at 1 and 2 years after index. To contrast the IC findings, observations of patients with similar background characteristics referred to conventional care (CC) were used. RESULTS: The sick leave prevalence of IC pain patients and IC stress patients increased from the preceding year to peak at index, where after it decreased back toward preindex levels over 2 years. Overall sick leave prevalence was higher in IC than in CC, where analogous but lower prevalence trends of sick leave changes were observed. CONCLUSIONS: Observed sick leave prevalences, which were higher in IC than in CC, gradually decreased over time following IC or CC referral. While natural recovery or other reasons for change of sick leave cannot be excluded, future prospective and randomized clinical trials are recommended.

Integrative Oncology: International Perspectives.

Interest in integrative oncology (IO) is growing globally. Patients with cancer are actively using traditional complementary and integrative medicine (TCIM) as part of their cancer and survivorship care. Published studies from around the world report increasing use of TCIM by people living with cancer. This article summarizes the presentations that took place during a symposium titled, "Integrative Oncology: International Perspectives" at the International Research Congress on Integrative Medicine and Health in Baltimore, 2018. The purpose of the presentations was to examine whether cancer services across a variety of geographical regions, including Australia, Canada, the United States, and the European Union, were actively responding to cancer survivors' demand for TCIM. The presenters highlighted utilization rates and both facilitators and barriers to the provision of IO services in their respective countries and regions. The audience discussion following the presentations drew out many noteworthy perspectives.

Referrals of Plastic Surgery Patients to Integrative Medicine Centers: A Review of Resource Utility.

BACKGROUND: Integrative medicine (IM) centers are becoming more established nationwide and provide an expansive range of therapeutic services. Given the high prevalence of IM usage among plastic surgery patients, we sought to define referrals rates to IM centers by plastic surgeons to investigate (1) the role of IM in the continuous care process of plastic surgery patients and (2) whether IM centers are being effectively utilized. METHODS: Institutions with plastic surgery residency programs were identified using the American Medical Association's Fellowship and Residency Electronic Interactive Database Access System in January 2017. Data on the presence of a named IM center, director/administrator contact information, and types of therapeutic services offered were extracted. The total number of IM services at these centers was summed and tabulated for preliminary analyses. A survey questionnaire was sent to the center to ascertain referral patterns in February 2017. RESULTS: Of 96 institutions with plastic and reconstructive surgery residency programs in North America, 49 (51%) provide IM services, and 24 (25%) have affiliated named IM centers of which we attained a survey response from 13 (54.5%). Of these centers, 10 (76.9%) evaluate more than 50 patients per week. Patient referrals to these centers were primarily from the department of medicine (73.8%) as opposed to surgery (13.1%) (P < 0.0001). An average of 0.77% of surgical referrals, or 0.077% of all referrals, arose from plastic and reconstructive surgery. CONCLUSIONS: Plastic surgeons appear to infrequently refer patients to IM centers. Given the high prevalence of IM usage among our patient population, IM centers are an underutilized adjunct in the care of our patients. Further study into specific IM services that may benefit our patients would be helpful in increasing IM utilization in our field.

Effect of Integrative Medicine Services on Pain for Hospitalized Patients at an Academic Health Center.

BACKGROUND: Pharmaceuticals such as opioids have routinely been prescribed for pain management. However, there has been an increasing epidemic of prescription opioid abuse, causing demand for nonpharmacologic complementary and integrative therapies for pain management. OBJECTIVE: To determine if integrative medicine services provided to inpatients could help reduce pain posttreatment. In addition, this study aimed to track total services requested and performed over the fourth quarter of 2017. DESIGN, SETTING, AND PARTICIPANTS: This prospective study analyzed documented integrative medicine services requested, indications for the requests, and pre- and posttreatment pain scores. A paired t test was used to determine significance. The study population was inpatients, from October 1, 2017, through December 31, 2017, at Mayo Clinic's Methodist and St. Mary's Hospitals in Rochester, Minnesota. RESULTS: During the study period, 1220 integrative services were provided with a majority being massage therapy (1,064; 87.2%), followed by acupuncture (112; 9.1%). Massage therapy and acupuncture were highly significant (P < 0.00) at reducing pain scores posttreatment to inpatients. Over one-third of patients fell asleep during their therapy service time. CONCLUSION AND RELEVANCE: Integrative therapies are appropriate modalities to help alleviate pain and other symptoms for the inpatient population. Due to the effectiveness of these modalities, integrative therapies may be a complement to opioids prescribed for pain. In addition, with over one-third of the patients falling asleep during therapy, our results suggest that integrative therapies can promote a state of relaxation. Future studies are warranted to determine the impact of integrative medicine therapies on sleep deprivation and other common symptoms of hospitalized patients.

Health Disparities in Access to Nonpharmacologic Therapies in an Urban Community.

OBJECTIVE: The overuse of prescription opioids for chronic pain is recognized as a public health crisis. Yet, poor access to nonpharmacologic treatments is the norm in low-income, racially and ethnically diverse patients with chronic pain. The main objective of this study was to understand how chronic pain impacts low-income individuals with chronic pain and their communities from multiple perspectives. DESIGN: This was a qualitative study using a Science Café methodology. SETTING: The Science Café event was held at an urban community center in Boston, MA. SUBJECTS: Inclusion criteria included the following: having the ability to attend the event, being at least 18 years of age or older, and participating in English. METHODS: Data were collected through self-reported questionnaires and audio or video recordings of two focus groups. Quantitative and qualitative data were analyzed with SAS 9.3 and NVivo 10. RESULTS: Thirty participants attended the Science Café event. The average age was 45 years, 77% reported as female, 42% identified as black, and 19% as Hispanic. Participants identified themselves as either patients (46%) or providers (54%) to the chronic pain community. Our forum revealed three major themes: (1) nonpharmacologic options for chronic pain management are warranted, (2) larger sociodemographic and contextual factors influence management of chronic pain, and (3) both patients and providers value the patient-provider relationship and acknowledge the need for better communication for patients with chronic pain. CONCLUSIONS: Future research should consider identifying and addressing disparities in access to nonpharmacologic treatments for chronic pain in relation to underlying social determinants of health, particularly for racially and ethnically diverse patients.