Patient perspectives on care received at community acupuncture clinics: a qualitative thematic analysis

Tippens et al. BMC Complementary and Alternative Medicine 2013, 13:293 http://www.biomedcentral.com/1472-6882/13/293 RESEARCH ARTICLE Open Access Patient perspectives on care received at community acupuncture clinics: a qualitative thematic analysis Kimberly M Tippens1*, Maria T Chao2, Erin Connelly1 and Adrianna Locke3 Abstract Background: Community acupuncture is a recent innovation in acupuncture service delivery in the U.S. that aims to improve access to care through low-cost treatments in group-based settings. Patients at community acupuncture clinics represent a broader socioeconomic spectrum and receive more frequent treatments compared to acupuncture users nationwide. As a relatively new model of acupuncture in the U.S., little is known about the experiences of patients at community acupuncture clinics and whether quality of care is compromised through this high-volume model. The aim of this study was to assess patients’ perspectives on the care received through community acupuncture clinics. Methods: The investigators conducted qualitative, thematic analysis of written comments from an observational, cross-sectional survey of clients of the Working Class Acupuncture clinics in Portland, Oregon. The survey included an open-ended question for respondents to share comments about their experiences with community acupuncture. Comments were received from 265 community acupuncture patients. Results: Qualitative analysis of written comments identified two primary themes that elucidate patients’ perspectives on quality of care: 1) aspects of health care delivery unique to community acupuncture, and 2) patient engagement in health care. Patients identified unique aspects of community acupuncture, including structures that facilitate access, processes that make treatments more comfortable and effective and holistic outcomes including physical improvements, enhanced quality of life, and empowerment. The group setting, community-based locations, and low cost were highlighted as aspects of this model that allow patients to access acupuncture. Conclusions: Patients’ perspectives on the values and experiences unique to community acupuncture offer insights on the quality of care received in these settings. The group setting, community-based locations, and low cost of this model potentially reduce access barriers for those who might not otherwise consider using acupuncture. In addition, the community acupuncture model may offer individuals the opportunity for increased frequency of treatments, which raises pertinent questions about the dose–response relationship of acupuncture and health outcomes. This study provides preliminary data for future evaluations of the quality and effectiveness of community acupuncture. Future studies should include the perspectives of patients who initiated, and subsequently, discontinued community acupuncture treatment. Keywords: Acupuncture therapy, Complementary therapies, Access to health care, Community acupuncture, Group acupuncture * Correspondence: 1 Helfgott Research Institute, National College of Natural Medicine, Portland, OR, USA Full list of author information is available at the end of the article © 2013 Tippens et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Tippens et al. BMC Complementary and Alternative Medicine 2013, 13:293 http://www.biomedcentral.com/1472-6882/13/293 Background Over two-thirds of the United States population has used complementary and alternative medicine (CAM) at least once [1]. Acupuncture is a widely recognized system of CAM, used by over 14 million Americans [2]. Despite increasing interest in acupuncture and a growing evidence base for its efficacy in the management of various chronic conditions [3-6], access to providers and the expense of treatment are factors that limit utilization of acupuncture services for many, especially low income and medically underserved populations [7,8]. Acupuncture treatments in the U.S. typically involve 45–60 minute individual consultations and range in cost from $60 to $100 per visit [9]. In 2007, the median out-of-pocket cost per acupuncture visit nationwide was $48, and at least 25% of acupuncture users paid $75 or more per visit [10]. The community acupuncture model aims to directly address economic and other barriers to access through low-cost group-based treatments. Practitioners of this model promote affordable and accessible acupuncture in community settings. Acupuncture is offered in groups for a sliding scale fee of $15-$50. Proof of income is not required or requested. All patients pay cash for their treatments; health insurance is not accepted. Community acupuncture clinics utilize a common space with multiple reclining chairs, which enable practitioners to treat multiple patients at the same time. Patients are encouraged to keep their needles in for as long as they like, leaving the determination of treatment length to the patient. Potential advantages of this group treatment model are increased frequency of visits, a sense of community and empowerment, affordability for the patient, and a sustainable business model for the practitioner [11]. This low-cost, high volume, fee-for-service business model, is designed to allow patients to receive frequent affordable care without reliance on subsidies or practitioner volunteerism. Currently, 192 clinics in North America are members of a multi-stakeholder cooperative of community acupuncture [12]; and an additional 50–100 nonmember acupuncture clinics use a similar group-based model [personal communication, Skip VanMeter, POCA Board of Directors]. Recent descriptive studies indicate that, compared to individual acupuncture treatments, the lower costs of the community acupuncture model broaden socioeconomic access [8,13]. The quality of community acupuncture treatments, however, has been questioned because group-based delivery may shorten the length of consultations and limit the acupuncture points and techniques used to treat patients [14]. A growing body of literature suggests that group treatments in conventional health care settings improve access, affordability and quality of care for a number of conditions [15-18]. Additionally, studies from the United Kingdom have assessed the feasibility of group acupuncture Page 2 of 8 treatments in clinical settings, and reported preliminary evidence of effectiveness and acceptability among patients with pain conditions [19-22]. Community acupuncture clinics in the U.S. may accomplish similar outcomes. However, the specific aspects of the community acupuncture model that affect the quality of treatment, from the patient perspective, are unknown. The current study evaluates patient perspectives on the treatme (...truncated)