Setting
Though integrating acupuncture into traditional healthcare settings poses challenges, data suggest that complementary health integration is on the rise in the United States and is associated with improved pain and lower healthcare costs.
Barriers
Difficulties in communication channels and philosophical differences may limit effective information transfer and care coordination between acupuncturists and other healthcare providers.
Clinical space is a premium within hospital settings. Acupuncture care delivery requires either large-group rooms for multiple patients in a community-style practice or single-occupancy rooms for 30-60 minutes. The number of available rooms or staffed acupuncture providers often contributes to the overall clinical availability of the acupuncture service. Some efforts have been made to address this time constraint through protocolized acupuncture (e.g., BFA). Community acupuncture models can also address space and time constraints that individual care models do not.
Acupuncture has not explicitly been integrated within the care pathways for specific conditions to optimize resource utilization and patient outcomes. For example, patients with knee osteoarthritis may interface with acupuncture early in the disease progression or near end-stage disease before or after other modalities of care have been trialed. In contrast, therapeutic exercise, medication, and intra-articular injections are managed in a stepwise fashion before total knee arthroplasty is considered.
Facilitators
As previously described, acupuncture can be delivered in a variety of settings, including communal care settings. These settings involve a single practitioner providing acupuncture to a group of care recipients in a group setting. This enables lower-cost delivery and greater efficiency, allowing providers to deliver care to multiple individuals simultaneously. Qualitative research suggests that both providers and care recipients enjoy the lower costs and wider access afforded by this care delivery model.
Qualitative research suggests that education materials aimed at bolstering communication between acupuncturists (and CIH providers more broadly) and primary care physicians are of interest to both groups and may improve communication and collaboration between provider types.
From 1998 to 2010, the percentage of hospitals offering complementary and integrative health therapies for pain increased from 6% to 42%. Studies show that when offered, complementary services like acupuncture for pain are utilized, can improve pain outcomes, and can reduce total healthcare expenditures. Individuals exposed to protocol-based acupuncture (e.g., battlefield acupuncture) are more likely to engage in full-body acupuncture. Built-in referral processes within the shared electronic health record enhance accessibility to acupuncture.
Acupuncture was incorporated into the Veterans' health benefits package (circa 2017) as part of CIH services at the development of Whole Health. This removed economic and geographic barriers for many US veterans, but the lack of resource management (e.g., staffing, space, etc.) remains a limiting factor.