Adjunctive acupuncture for pain and symptom management in the inpatient setting: protocol for a pilot hybrid effectiveness-implementation study  

作　　者：Maria T.Chao Alexandra Chang Sanjay Reddy James D.Harrison Joseph Acquah Miria Toveg Trilce Santana Frederick M.Hecht 

机构地区：[1]Osher Center for Integrative Medicine,University of California San Francisco [2]Division of General Internal Medicine,Zuckerberg San Francisco General Hospital,University of California San Francisco [3]Departments of Anesthesiology and Internal Medicine,Loma Linda University [4]Division of Hospital Medicine,University of California San Francisco

出　　处：《Journal of Integrative Medicine》2016年第3期228-238,共11页结合医学学报（英文版）

基　　金：Fund for Innovative Research in Integrative Medicine;the National Institutes of Health (NIH),National Center for Complementary and Integrative Health(Chao:K01AT006545;Chang:T32AT003997;Hecht:K24AT007827);the National Center for Advancing Translational Sciences (KL2TR00143)

摘　　要：BACKGROUND： Effective pain management among hospitalized patients is an important aspect of providing quality care and achieving optimal clinical outcomes and patient satisfaction. Common pharmacologic approaches for pain, though effective, have serious side effects and are not appropriate for all inpatients. Findings from randomized controlled trials（RCTs） support the efficacy of acupuncture for many symptoms relevant to inpatients including postoperative pain, cancer-related pain, nausea and vomiting, and withdrawal from narcotic use. However, the extent to which findings from RCTs translate to real-world implementation of acupuncture in typical hospital settings is unknown. METHODS/DESIGN： In partnership with the launch of a clinical program offering acupuncture services to inpatients at the University of California San Francisco’s Mount Zion Hospital, we are conducting a pilot study using a hybrid effectiveness-implementation design to：（1） assess the effectiveness of acupuncture to manage pain and other symptoms and improve patient satisfaction; and（2） evaluate the barriers and facilitators to implementing an on-going acupuncture service for inpatients. During a twomonth pre-randomization phase, we evaluated and adapted clinical scheduling and treatment protocols with acupuncturists and hospital providers and pretested study procedures including enrollment, consent, and data collection. During a six-month randomization phase, we used a two-tiered consent process in which inpatients were first consented into a study of symptom management, randomized to be offered acupuncture, and consented for acupuncture if they accepted. We are also conducting in-depth interviews and focus groups to assess evidence, context, and facilitators of key provider and hospital administration stakeholders.DISCUSSION： Effectiveness research in ＂real-world＂ practice settings is needed to inform clinical decision-making and guide implementation of evidence-based acupuncture practices. To successfully provide cBACKGROUND： Effective pain management among hospitalized patients is an important aspect of providing quality care and achieving optimal clinical outcomes and patient satisfaction. Common pharmacologic approaches for pain, though effective, have serious side effects and are not appropriate for all inpatients. Findings from randomized controlled trials（RCTs） support the efficacy of acupuncture for many symptoms relevant to inpatients including postoperative pain, cancer-related pain, nausea and vomiting, and withdrawal from narcotic use. However, the extent to which findings from RCTs translate to real-world implementation of acupuncture in typical hospital settings is unknown. METHODS/DESIGN： In partnership with the launch of a clinical program offering acupuncture services to inpatients at the University of California San Francisco’s Mount Zion Hospital, we are conducting a pilot study using a hybrid effectiveness-implementation design to：（1） assess the effectiveness of acupuncture to manage pain and other symptoms and improve patient satisfaction; and（2） evaluate the barriers and facilitators to implementing an on-going acupuncture service for inpatients. During a twomonth pre-randomization phase, we evaluated and adapted clinical scheduling and treatment protocols with acupuncturists and hospital providers and pretested study procedures including enrollment, consent, and data collection. During a six-month randomization phase, we used a two-tiered consent process in which inpatients were first consented into a study of symptom management, randomized to be offered acupuncture, and consented for acupuncture if they accepted. We are also conducting in-depth interviews and focus groups to assess evidence, context, and facilitators of key provider and hospital administration stakeholders.DISCUSSION： Effectiveness research in ＂real-world＂ practice settings is needed to inform clinical decision-making and guide implementation of evidence-based acupuncture practices. To successfully provide c

关 键 词：acupuncture therapy medicine traditional INPATIENTS randomized controlled trials hybrid trials clinicalprotocols 

分 类 号：R473[医药卫生—护理学]