Optimizing delivery to meet demand for integrative medicine services in an academic hospital setting: A pilot study.

CONTEXT: A rapidly growing body of evidence shows the positive benefits of integrative medicine (IM) services for patients in hospital-based settings. IM therapies, such as acupuncture, massage, meditation and relaxation, and animal-assisted therapy, reduce symptom burden of pain, anxiety, and stress and increase sense of well-being and satisfaction in hospitalized patients. Current challenges facing hospitals are to move beyond proof-of-concept studies and to provide hospital-based IM therapies. OBJECTIVE: The aim of our quality improvement project was to develop, implement, and evaluate a feasible, scalable, hospital-based "best practice" model for increasing demand for IM services and optimizing their delivery. DESIGN: A multidisciplinary team convened to use quality improvement tools to outline a process for providing IM services. SETTING: A large academic medical center in the Midwestern United States. PARTICIPANTS: IM leadership staff, IM providers, nurses, hospital team members, support staff, and quality improvement staff. INTERVENTIONS: After determining baseline levels of demand and service delivery, we sought to (1) increase nursing staff awareness of available IM services; (2) improve communication between IM providers and nurses; and (3) reinforce communication at the level of nurse supervisors, patients, and family members. MAIN OUTCOME MEASURES: We recorded the numbers and types of IM services ordered at baseline and postimplementation and determined the new delivery rate of requested services. RESULTS: We noted an increase in the number of IM orders, percentage of delivered IM services, and percentage of patients who reported that IM services improved their hospital stay.

The Impact of a 20-Minute Animal-Assisted Activity Session on the Physiological and Emotional States in Patients With Fibromyalgia.

OBJECTIVE: To study the direct physiological and emotional impact of an animal-assisted activity (AAA) session (a form of complementary and integrative medicine) in patients with fibromyalgia (FM). PATIENTS AND METHODS: The study population consisted of 221 participants with FM who were attending Mayo Clinic's Fibromyalgia Treatment Program between August 5, 2017, and September 1, 2018. This was a randomized controlled trial. Participants were randomly assigned to either the treatment group (a 20-minute session with a certified therapy dog and handler) or the control group (a 20-minute session with a handler only). To gain a better understanding of the direct physiological and emotional effects of AAA in patients with FM, we used multiple noninvasive physiologic-emotional biomarkers, including salivary cortisol and oxytocin concentrations, tympanic membrane temperatures, and various cardiac parameters, in addition to standardized pain and mood-based questionnaires. RESULTS: Results show a decrease in heart rate, an increase in heart rate variability, an increase in well-being survey scores, an increase in salivary oxytocin, and subsequent tympanic membrane temperature changes, suggesting that participants in the treatment group were in a more positive emotional-physiologic state as a result of the AAA session compared with the control group. CONCLUSION: Our results suggest that a 20-minute therapy dog visit in an outpatient setting can significantly and positively impact the physical and mental health of patients with FM.

Canine-Assisted Therapy in Hospitalized Patients Awaiting Heart Transplantation.

OBJECTIVES: Patients awaiting heart transplantation can be listed for prolonged periods of time and, as a result, the prevalence of anxiety and depression is high. Our study evaluates the feasibility of canine-assisted therapy (CAT) in this population. METHODS: A prospective, multicenter study was performed on all status 1a patients admitted during a 12-month period to await transplantation. Patients were asked to complete the Generalized Anxiety Disorder 7-item scale and the Patient Health Questionnaire-9 at baseline, week 2, and week 6, and the Perceived Stress Scale at baseline and week 4. At the conclusion of the study, patients completed a questionnaire assessing the overall efficacy of CAT. RESULTS: Baseline measures demonstrated high levels of anxiety, depression, and stress. The complete Generalized Anxiety Disorder 7-item scale (average score 10.9 vs 8; P = 0.14) and the Patient Health Questionnaire-9 (average score 12.3 vs 9.5; P = 0.057) scores decreased from baseline to week 6 and the Perceived Stress Scale (average score 29.8 vs 27; P = 0.16) decreased from baseline to week 4 with trends toward significance. All of the patients perceived CAT as improving the overall quality of hospitalization, would recommend CAT to other patients, and would elect for CAT during subsequent admissions. No infectious concerns were reported. CONCLUSIONS: Anxiety, stress, and depression are prevalent among 1a heart transplantation candidates, and CAT is a welcomed adjunct to the usual medical care in this population.