By Elizabeth Sommers, PhD, MPH, LAc and Kristen E. Porter, PhD, MS, MAc, LAc
The American Public Health Association (APHA) held its 140th annual meeting in San Francisco from October 27-30, 2012. Over 12,000 delegates attended the conference, whose theme was "Health and Wellness Across the Life Span." Although most delegates came from throughout the US, international attendees from South Africa, China and Canada were also represented.
Introductory keynote speakers included Gail Sheehy, best-selling author of Passages, which examines issues related to maximizing health and happiness throughout an individual's lifetime. A surprise visit to the event was Nancy Pelosi (D-CA). Her remarks addressed the need and status of health care reform in the U.S.
Within APHA, there are a number of special interest groups, reflecting the variety of professional backgrounds and focus that compose the public health spectrum. Of particular interest to our Acupuncture Today readers is the group Alternative and Complementary Health Practices (ACHP). Organizers from this group planned over two days of programming, including both oral and poster presentations. Over 40 posters, including several submitted by students of public health and acupuncture-related disciplines, were displayed and discussed; several round-table discussions were also well-attended and offered opportunities for participants to share their expertise on such topics as use of medicinal cannabis; public health and hip-hop culture; and integrating Traditional Chinese Medicine with biomedicine in developing culturally-relevant colorectal educational materials.
Over 20 oral presentations spanned the entire range of complementary/alternative/integrative approaches, including acupuncture and Chinese herbal medicine, homeopathy, Ayurvedic medicine, yoga, chiropractic care, mind/body techniques, the role of spirituality, and use of these forms of healthcare by various populations.
ACHP also held a special session featuring keynote speaker Donald Abrams MD. The title of his talk was "Integrative Oncology: Challenges and Controversies." Abrams highlighted that integrative oncology emphasizes increased levels of patients' self-control and self-care; reducing stress and inflammation; enhancing immunity; and promoting hope. He highlighted the role of acupuncture in reducing nausea and vomiting during chemotherapy and addressing hiccups, xerostomia, pain, sleeplessness, and anxiety.
Invited speakers for the "Donna Feeley Memorial Lecture" included Josephine Briggs MD, chief of NIH's National Center for Complementary and Alternative Medicine (NCCAM). Because of Hurricane Sandy, she was unable to travel to the conference. Her remarks were delivered by Adam Burke PhD MPH, LAc, who has participated in NCCAM's Advisory Board for the past few years. These remarks included a national overview of promises and concerns related to CAIM. Janet Kahn PhD, LMT, who serves as an appointee to President Obama's Advisory on Prevention, Public Health and Integrated Care, discussed the concept of ‘salutogenesis', namely, promoting improved health and wellness. Much of her work focuses on Patient-Centered Outcomes Research Institute.
Three speakers addressed acupuncture research from a variety of perspectives: Adam Burke (above); Pratibha Shah MA Ayurveda, MPH and one of this column's authors (Sommers).
Burke's talk was entitled "Patient Perceptions of Communication Practices of Traditional and Allopathic Providers." Data was collected from a convenience sample of 222 participants who had received treatment from a CAIM provider at least once. An 88-item survey was employed, which included 20 communication items.
Results indicated that CAIM providers were perceived to communicate more effectively. This included listening carefully, answering questions satisfactorily, providing enough information about the problem, taking the patients' views into consideration, offering an explanation of the problem, offering lifestyle advice, and related items including spending enough time, providing emotional support, showing optimism for the treatment, and helping patients feel in control of their healing process. Satisfaction with acupuncture treatment was found to be particularly related to the client's perceived efficacy of treatment and having provider address client's questions to the client's satisfaction.
Burke concluded that communication style appears to contribute to patient healthcare satisfaction. Taking time to answer patient questions was specifically found to be a significant predictor in this sample. Perceived communication differences may be one factor influencing patient healthcare decision making related to the use of CAIM.
Shah reported on two successful models of integrated care in a hospital (Boston Medical Center [BMC]) and private practice setting (Zanjabee Integrative Medicine and Primary Care, located in Waban, Massachusetts). Both settings include acupuncture. Services at BMC also include massage, yoga, Healing Touch, and cooking classes. Educational activities are also an intrinsic part of BMC's approach. These activities include grand rounds, training for Family Medicine physicians and medical students, and internship programs for students of the New England School of Acupuncture. The hospital offers acupuncture in its Adolescent Clinic, Pediatric In-patient Unit, hematology and oncology clinics, and to staff. Seventy percent of the clients who use these services are from medically-underserved communities, including racial and ethnic minorities.
Zanjabee's services include primary care, Ayurveda, acupuncture, massage, yoga, and meditation. The use of electronic medical records has been incorporated and weekly team meetings are held to facilitate understanding and clinical staff training and development. Community education is also a priority. All of Zanjabee's services are reimbursed through out-of-pocket client fees.
At BMC, contributing factors for the successful integration of services include a large referral base and connection to academic institutions (Boston University Schools of Public Health and Medicine). Challenges include providing follow-up to clients and developing close relationships between providers and clients. On the other hand, Zanjabee has been able to foster close collaboration between clients and providers and has achieved a high level of integration related to treatment planning. However, challenges include necessity of charging clients directly, and a lack of marketing staff.
Sommers described a work-in-progress being conducted at Pathways to Wellness in Boston. Partnering with a community health center and managed care network, Sommers reported on results from the first five years of this ongoing assessment, which has currently been in process for over six years. The project evaluates acupuncture treatment as provided according to standards of care in a naturalistic setting (i.e. all treatments involve true acupuncture in the way that it is practiced, as determined by acupuncturists). There is no comparison group and pre and post data are based on clients' self-reported clinical assessments. In addition to the clinical outcome measurements, there are components of quality of life, client satisfaction and cost savings associated with acupuncture.
In the first five years, 488 individuals received acupuncture treatment. Seventy-five percent of these individuals received referrals for some type of musculoskeletal pain. Highly significant reductions in both most severe as well as average level of pain have been noted. Likewise, for clients referred for headache or migraine, highly significant improvement was noted. Using anonymous surveys, clients were asked about their satisfaction with care. High levels of approval and willingness to refer family and friends were evident from the responses. Preliminary data on cost savings indicated that acupuncture saved money for the managed care group.
Professor Angela Davis was the featured speaker for the closing plenary presentation. Her discussion included the effects of incarceration on public health of prisoners as well as of their families. She noted the intrinsic inter-relationships that influence our collective world with emphasis on wellness, health and justice.
Next year's APHA annual meeting and exposition will be held in Boston from November 2 to 6, 2013. The theme of the gathering will be "Think Global. Act Local'. Emphasis will be on identifying ways to achieve health equity and viewing it as an achievable goal. To get further information about submitting abstracts or participating in the exhibition hall, go to www.apha.org
Click here for more information about Elizabeth Sommers, PhD, MPH, LAc.
Click here for more information about Kristen E. Porter, PhD, MS, MAc, LAc.
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