We Built it, But Did They Come: Veterans’ Use of VA Healthcare System-Provided Complementary and Integrative Health Approaches

Abstract

Background Interest in complementary and integrative health (CIH) approaches, such as meditation, yoga, and acupuncture, continues to grow. The evidence of effectiveness for some CIH approaches has increased in the last decade, especially for pain, with many being recommended in varying degrees in national guidelines. To offer nonpharmacological health management options and meet patient demand, the nation’s largest integrated healthcare system, the Veterans Health Administration (VA), greatly expanded their provision of CIH approaches recently. Objective This paper addressed the questions of how many VA patients might use CIH approaches and chiropractic care if they were available at modest to no fee, and would patients with some health conditions or characteristics be more likely than others to use these therapies. Design Using electronic medical records, we conducted a national, three-year, retrospective analysis of VA patients’ use of eleven VA-covered therapies: chiropractic care, acupuncture, Battlefield Acupuncture, biofeedback, clinical hypnosis, guided imagery, massage therapy, meditation, Tai Chi/Qigong, and yoga. Participants We created a national cohort of veterans using VA healthcare from October 2016–September 2019. Key Results Veterans’ use of these approaches increased 70% in three years. By 2019, use was 5.7% among all VA patients, but highest among patients with chronic musculoskeletal pain (13.9%), post-traumatic stress disorder (PTSD; 10.6%), depression (10.4%), anxiety (10.2%), or obesity (7.8%). The approach used varied by age and race/ethnicity, with women being uniformly more likely than men to use each approach. Patients having chronic musculoskeletal pain, obesity, anxiety, depression, or PTSD were more likely than others to use each of the approaches. Conclusions Veterans’ use of some approaches rapidly grew recently and was robust, especially among patients most in need. This information might help shape federal/state health policy on the provision of evidence-based CIH approaches and guide other healthcare institutions considering providing them.

Association Between Exposure to Complementary and Integrative Therapies and Opioid Analgesic Daily Dose Among Patients on Long-term Opioid Therapy

“…The wide range in rates of use across sites reflects differences described by Whole Health evaluators in rates of uptake of the WHS and individual modalities. Most patients who used CIH pursued acupuncture, chiropractic care, or meditation, a pattern consistent with national trends 25…”

“…Most patients who used CIH pursued acupuncture, chiropractic care, or meditation, a pattern consistent with national trends. 25 Interestingly, the effect of CIH exposure on tapering rate did not differ by level of exposure (any use vs. intensive use as defined by WHS). This apparent absence of "dose effect" may be accounted for statistically by the crude dichotomization of number of exposures, but also may speak to the documented effectiveness of a small number of sessions for the modalities commonly used by this cohort.…”

Racial and Ethnic Variation in Complementary and Integrative Health Therapy Use Among US Veterans

“…We used 20 codes in 3 data fields ( Current Procedural Terminology , “Char4”, and “stop” codes) and search terms to capture all CIH therapy utilization data from the VA EMR, the Corporate Data Warehouse. We also used Current Procedural Terminology codes from claims data to capture use of CIH therapies that were provided in the community but paid for by the VA, as described in detail elsewhere . Also, records were excluded if they were associated with no-show visits or did not include the provision of care (eg, referrals, consultations).…”

“…Although racial and ethnic differences in CIH therapy use are documented in national adult samples within and outside the VA, less is known about how these differences may vary by other patient characteristics and conditions or by medical facility location where the therapies are available . Thus, we examined racial and ethnic variation in the use of 5 of the most frequently used CIH therapies in the VA: yoga, meditation/mindfulness, massage therapy, chiropractic care, and acupuncture.…”

Examining the Veterans Health Administration whole health model of care within the context of posttraumatic stress disorder.

“…We examined use of CIH among veterans using Whole Health, which included chiropractic care, and the eight CIH therapies encompassed in the standard VA medical benefits package (U.S. Department of Veterans Affairs, 2017b). We utilized methods from VA's CIH Evaluation Center to identify CIH utilization in VA, which uses a combination of Current Procedural Terminology codes when available, including billing codes for therapies, including chiropractic care, acupuncture, and therapeutic massage received by community providers but paid for by VA, as well as specific WHOLE HEALTH AND POSTTRAUMATIC STRESS DISORDER coding practices and clinic location names developed by VA to capture CIH utilization (Taylor et al, 2020).…”