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Thursday, 30 April 2015

Integrative medicine has positive impact on patient activation, chronic pain, depression

The use of integrative medicine interventions leads to significant improvements in patient activation and patient-reported outcomes in the treatment of chronic pain, depression, and stress, according to a new report released by The Bravewell Collaborative. The findings are based on data collected by the Patients Receiving Integrative Medicine Interventions Effectiveness Registry (PRIMIER), the first-ever patient registry on integrative medicine.
"We are encouraged by these early results, and we see tremendous potential for PRIMIER to provide evidence-based research that will improve healthcare quality by pinpointing the most effective practices in integrative medicine," said Donald I. Abrams, M.D., lead author and integrative oncologist at the Osher Center for Integrative Medicine at the University of California San Francisco.
Using data from PRIMIER, researchers found that the use of integrative medicine yielded an increase in the Patient Activation Measure (PAM), which assesses to what degree patients believe they have the knowledge, skill, and confidence to take action to improve their health, and whether they are likely to maintain positive self-care actions over time. Over six months, the percentage of patients with low levels of patient activation decreased from 29 percent to 17 percent, while those with higher levels of activation increased from 71 percent to 83 percent. Previous research has found that higher scores on the PAM are strongly related to improvements in clinical outcomes such as less pain, an increase in utilization of prevention screenings, and a reduction in emergency room visits.
After reviewing the prospective data from 369 patients over six months, researchers also found significant reductions in patients' perception of depression and stress. In 179 of these patients who were being treated for chronic pain, researchers also found statistically significant decreases in pain severity and a 28 percent decrease in the degree to which pain interfered with quality of life.
PRIMIER is the first nationwide database of its kind, and is able to evaluate patient-reported outcomes over time - such as quality of life, pain, mood, and stress - for patients who supplement conventional medical care with therapies such as acupuncture, yoga, chiropractic, biofeedback, nutrition, massage, and mindfulness. The registry combines de-identified patient-reported data with information from the Electronic Health Records (EHR) from each participating center, documenting patient visit details, procedures offered, diagnosis and patient pain-assessment score. Developed and managed by BraveNet, a practice-based research network comprised of 14 integrative medicine centers based at some of the nation's leading hospitals and medical centers, the registry has enrolled more than 1,600 patients to date.
With its growing database, PRIMIER will evaluate whether patient-reported outcomes differ with the frequency and duration of each particular intervention, while also tracking variables based on multiple characteristics of the participants, such as age, gender, ethnicity, race, clinical condition, and PAM level. Data is based on patient response to questionnaires comparing their baseline with results at 2, 4, and 6 months, and up to two years.
"PRIMIER is a cost-effective tool to accelerate research on integrative medicine," said Benjamin Kligler, M.D., M.P.H., associate professor of clinical family and social medicine at Albert Einstein College of Medicine and chair of BraveNet. "The registry offers us the unique opportunity to assess the effectiveness of integrative medicine interventions in a wide variety of clinical conditions in real-world settings."

To review the complete research report, go to http://www.bravewell.org. Researchers or medical centers interested in joining PRIMIER or requesting permission to access the database should contact the BraveNet coordinating center at the Albert Einstein College of Medicine of Yeshiva University at diane.mckee@einstein.yu.edu.

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