Medical Care Supplement Highlights Complementary and Integrative Medicine Use among Veterans and the Military
In an editorial written by HSR&D investigators Stephanie Taylor and Rani Elwy, the authors provide an overview of the Medical Care Supplement: "Building the Evidence Base for Complementary and Integrative Medicine Use among Veterans and Military Personnel," which was supported by VA's Office of Patient Centered Care and Cultural Transformation and the VA Greater Los Angeles Healthcare System. In 2011, almost all (89%) VA medical facilities offered at least 1 of 31 types of complementary and alternative medicine, or CAM, (e.g., acupuncture, massage, biofeedback, meditation, guided imagery), while 29% of military treatment facilities offered 275 CAM programs in 2012. In addition to 13 articles in this Supplement, there are two commentaries that describe efforts within VA and the Department of Defense (DoD) to understand and foster the use of CAM among Veterans and active duty military personnel. The first commentary reports on VA efforts by the Office of Patient Centered Care and Cultural Transformation to foster the use of evidence-based CAM, as CAM's philosophical approach aligns with VA's "number one strategic priority to provide personalized, proactive, patient-driven healthcare to Veterans." The second commentary draws on DoD surveys of CAM use, and notes that the vast majority occurs outside the military healthcare system. A recurring theme throughout many of the articles is the extent to which Veterans and active military seek CAM and pay out-of-pocket for some of it due to current VA and military healthcare policies. The articles in this supplement, several written by HSR&D investigators, provide much needed information regarding the promise of CAM to improve the health of Veterans and active military personnel. Following are some of their findings.
- Bormann and colleagues explored the effects of a mantram repetition program compared with usual treatment for Veterans with PTSD, with mantram being "a sacred word or phrase that is silently repeated for cultivating mindfulness." They found that program recipients experienced higher levels of mindfulness and its treatment effects on depression and psychological well-being.
- Goldstein and colleagues assessed the extent to which Veterans substitute vitamins and supplements for prescription medications by conducting a cross-sectional survey of primary care VA patients. They found that 75% used vitamins and nutritional supplements, whereas almost half regularly substituted them for prescription medications.
- Serpa and colleagues examined what some consider the gold standard of mindfulness – mindfulness-based stress reduction (MBSR). They found that the MBSR program not only increased mindfulness among Veterans, but mindfulness mediated the program effects to improve mental health, including significant reductions in anxiety, depression, and suicidal ideation.
- Elwy and colleagues reviewed 89 studies of CAM mind and body-practice interventions conducted in eight countries with Veterans and military personnel. Meditation practices, relaxation techniques, spinal manipulation, and acupuncture were the most frequently studied practices, whereas yoga, one of the most offered CAM practices within VA, is relatively understudied.
- Reinhardt and colleagues studied differences in CAM usage between OEF/OIF Veterans who were deployed and those who were not deployed, and found no significant association between CAM use and deployment. They did find that Veterans who used VA healthcare after military separation were more likely to be CAM users than those who did not use VA care. However, the majority of Veterans using CAM are using it outside the VA healthcare system, providing more evidence for the need for VA to offer within-system CAM services.
Medical Care Supplement. December 2014;52(12, Suppl 5).