Does Offering Battlefield Acupuncture Lead to Subsequent Use of Traditional Acupuncture?

Abstract

Objectives: Veterans Health Administration encourages auricular acupuncture (Battlefield Acupuncture/BFA) as a nonpharmacologic approach to pain management. Qualitative reports highlighted a “gateway hypothesis”: providing BFA can lead to additional nonpharmacologic treatments. This analysis examines subsequent use of traditional acupuncture. Research Design: Cohort study of Veterans treated with BFA and a propensity score matched comparison group with a 3-month follow-up period to identify subsequent use of traditional acupuncture. Matching variables included pain, comorbidity, and demographics, with further adjustment in multivariate regression analysis. Subjects: We identified 41,234 patients who used BFA across 130 Veterans Health Administration medical facilities between October 1, 2016 and March 31, 2019. These patients were matched 2:1 on Veterans who used VA care but not BFA during the same period resulting in a population of 24,037 BFA users and a comparison cohort of 40,358 non-BFA users. Patients with prior use of traditional acupuncture were excluded. Results: Among Veterans receiving BFA, 9.5% subsequently used traditional acupuncture compared with 0.9% of non-BFA users ( P <0.001). In adjusted analysis, accounting for patient characteristics and regional availability of traditional acupuncture, patients who used BFA had 10.9 times greater odds (95% confidence interval, 8.67–12.24) of subsequent traditional acupuncture use. Conclusions: Providing BFA, which is easy to administer during a patient visit and does not require providers be formally certified, led to a substantial increase in use of traditional acupuncture. These findings suggest that the value of offering BFA may not only be its immediate potential for pain relief but also subsequent engagement in additional therapies.

Acupuncture for acute musculoskeletal pain management in the emergency department and continuity clinic: a protocol for an adaptive pragmatic randomised controlled trial

“… 16 45 Post-ED follow-up can be particularly challenging among ED patients due to cost and time constraints, so lowering these barriers are key to improving access to care. Furthermore, initial therapeutic experience with acupuncture has been shown to increase patient follow-through with continued acupuncture, 46 highlighting the benefit of combining ED with outpatient care. Goals of the study include reducing patient need for pain medications, particularly opioids, and return ED visits for pain control through use of acupuncture.…”

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

“…It is especially notable that differences in outcomes were not observed while utilization was higher for patients using community providers, which could mean that VA care is more efficient if the cost per visit is the same. There may be other distal benefits to having such care provided within VA, such as coordination and linkages with other kinds of care [18,41]. The use of such care within or outside the VA could also potentially result in different care utilization cascades downstream, such as for imaging, referrals to specialists, or prescriptions for opioids, which has important implications for costs and outcomes.…”

“…As such, VA has prioritized Veterans' access to evidence-based non-pharmacological pain management [7] including complementary and integrative medicine modalities [8] including acupuncture [9][10][11][12] and chiropractic care [13][14][15][16]. Many VA facilities provide this care in-house from dedicated providers, though use and availability vary widely [17,18]. VA often refers patients to community providers for acupuncture and chiropractic care when VAbased services are not available or easily accessible [19,20].…”

Society for Acupuncture Research Turning Point: Acupuncture in the Veterans Health Administration

“…Veterans exposed to BFA were 10 times more likely to engage in comprehensive acupuncture than matched controls who were not exposed to BFA. 8 BFA is proving to be very useful as one of the tools in the toolkit for providers to offer a CIH intervention themselves, without the barrier of requiring a referral to another practitioner. Provider interviews about their experiences with BFA revealed the technique helped them avoid opioid prescriptions and were a welcome pain control method during an opioid taper.…”