Châm cứu và trị liệu chỉnh hình cho cơn đau mãn tính trong một kế hoạch y tế tích hợp: một nghiên cứu phương pháp hỗn hợp

BMC Complementary and Alternative Medicine - Tập 11 - Trang 1-18 - 2011
Lynn L DeBar1, Charles Elder1, Cheryl Ritenbaugh2, Mikel Aickin2, Rick Deyo3, Richard Meenan1, John Dickerson1, Jennifer A Webster1, Bobbi Jo Yarborough1
1Kaiser Permanente, The Center for Health Research, Portland, USA
2Department of Family & Community Medicine, University of Arizona, Tucson, USA
3Department of Family Medicine, Oregon Health and Science University, Portland, USA

Tóm tắt

Nghiên cứu gần đây đã xem xét hiệu quả của nhiều loại liệu pháp bổ trợ và thay thế (CAM). Tuy nhiên, những kết quả liên quan đến việc sử dụng CAM trong thực tế "thế giới thật" đã bị bỏ qua, mặc dù có những lời kêu gọi cần nghiên cứu các liệu pháp CAM theo cách mà chúng được thực hiện. Người Mỹ tìm kiếm các liệu pháp CAM thường xuyên hơn cho cơn đau cơ xương khớp mãn tính (CMP) so với bất kỳ tình trạng nào khác. Trong số các liệu pháp CAM cho CMP, chăm sóc châm cứu và chỉnh hình (A/C) là một trong những liệu pháp được chấp nhận cao nhất bởi các nhóm bác sĩ và có chứng cứ tốt nhất để hỗ trợ việc sử dụng của chúng. Hơn nữa, những gia tăng đáng lo ngại gần đây trong việc cung cấp điều trị opioid và can thiệp phẫu thuật cho cơn đau mãn tính - bất chấp chi phí cao, tác dụng phụ tiềm tàng và hiệu quả khiêm tốn - cho thấy nhu cầu đánh giá kết quả thực tế liên quan đến các liệu pháp CAM không dược lý/không phẫu thuật đầy triển vọng cho CMP, những liệu pháp này thường được bệnh nhân chấp nhận tốt và ngày càng được sử dụng trong cộng đồng. Nghiên cứu đa giai đoạn, phương pháp hỗn hợp này sẽ: (1) thực hiện một nghiên cứu hồi cứu sử dụng thông tin từ hồ sơ y tế điện tử (EMR) của một HMO lớn để xác định những cụm bệnh nhân duy nhất có CMP (ví dụ, những người có nhân khẩu học khác nhau, lịch sử tình trạng đau khác nhau, sử dụng dịch vụ y tế chính thống và CAM, và hồ sơ bệnh đi kèm) có thể liên quan đến các xu hướng khác nhau trong việc sử dụng A/C và/hoặc các kết quả khác nhau liên quan đến chăm sóc như vậy; (2) sử dụng phỏng vấn định tính để khám phá các khuyến nghị của các nhà cung cấp y tế chính thống về A/C và quyết định của bệnh nhân trong việc theo đuổi và duy trì dịch vụ CAM; và (3) đánh giá theo cách nhìn nhận các dịch vụ y tế/chi phí và kết quả lâm sàng và chức năng rộng hơn có liên quan đến việc nhận A/C so với các đối tượng so sánh được khớp cẩn thận nhận dịch vụ CMP truyền thống. Phân tích nhạy cảm sẽ so sánh các phương pháp chỉ dựa trên dữ liệu từ EMR với các phân tích bổ sung dữ liệu EMR bằng dữ liệu bệnh nhân và lâm sàng được thu thập theo phương pháp truyền thống. Việc hoàn thành thành công các mục tiêu tổng hợp này sẽ cung cấp một đánh giá về kết quả liên quan đến việc sử dụng thực tiễn các dịch vụ A/C. Bộ ba nghiên cứu hồi cứu, định tính và tiềm năng cũng sẽ cung cấp một hiểu biết rõ ràng hơn về quá trình ra quyết định liên quan đến việc sử dụng A/C cho CMP và một phương pháp có thể áp dụng cho các thiết lập chăm sóc sức khỏe khác, các liệu pháp CAM và các quần thể lâm sàng.

Từ khóa


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The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1472-6882/11/118/prepub

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BMC Complementary and Alternative Medicine

Tập 11

1-18

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