Patient-reported pain and physical health for acupuncture and chiropractic care delivered by Veterans Affairs versus community providers

• Published in: PloS one Vol. 19; no. 5; p. e0303651
• Main Authors: O'Hanlon, Claire E, Zeliadt, Steven B, DeFaccio, Rian, Gaj, Lauren, Bokhour, Barbara G, Taylor, Stephanie L
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 15.05.2024; Public Library of Science (PLoS)
• Subjects: Acupuncture; Acupuncture Therapy; Adult; Aged; Alternative medicine; Care and treatment; Chiropractic; Chiropractic medicine; Clinical outcomes; Comparative analysis; Electronic health records; Electronic medical records; Evidence-based medicine; Female; Health aspects; Health care access; Hospitals, Veterans; Humans; Male; Manipulation, Chiropractic - statistics & numerical data; Medical records; Medicine and Health Sciences; Mental health; Middle Aged; Multivariate analysis; Narcotics; Observational studies; Opioids; Pain; Pain clinics; Pain Management - methods; Patient outcomes; Patient Reported Outcome Measures; Patients; Primary care; Regression analysis; Research and Analysis Methods; Statistics; Surveys; United States; United States Department of Veterans Affairs; Veterans; United States
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0303651

Acupuncture and chiropractic care are evidence-based pain management alternatives to opioids. The Veterans Health Administration (VA) provides this care in some VA facilities, but also refers patients to community providers. We aimed to determine if patient-reported outcomes differ for acupuncture and chiropractic care from VA versus community providers. We conducted an observational study using survey outcome data and electronic medical record utilization data for acupuncture and chiropractic care provided in 18 VA facilities or in community facilities reimbursed by VA. Study participants were users of VA primary care, mental health, pain clinic, complementary and integrative therapies, coaching or education services in 2018-2019. Patients received 1) 4+ acupuncture visits (N = 201) or 4+ chiropractic care visits (N = 178) from a VA or community provider from 60 days prior to baseline to six-months survey and 2) no acupuncture or chiropractic visits from 1 year to 60 days prior to baseline. Outcomes measured included patient-reported pain (PEG) and physical health (PROMIS) at baseline and six-month surveys. Multivariate analyses examined outcomes at six months, adjusting for baseline outcomes and demographics. In unadjusted analyses, pain and physical health improved for patients receiving community-based acupuncture, while VA-based acupuncture patients experienced no change. Unadjusted analyses also showed improvements in physical health, but not pain, for patients receiving VA-based chiropractic care, with no changes for community-based chiropractic care patients. Using multivariate models, VA-based acupuncture was no different from community-based acupuncture for pain (-0.258, p = 0.172) or physical health (0.539, p = 0.399). Similarly, there were no differences between VA- and community-based chiropractic care in pain (-0.273, p = 0.154) or physical health (0.793, p = 0.191). Acupuncture and chiropractic care were associated with modest improvements at six months, with no meaningful differences between VA and community providers. The choice to receive care from VA or community providers could be based on factors other than quality, like cost or convenience.