Compendium on Use of Complementary and Integrative Health Therapies and Chiropractic Care at the VA

Taylor SL, Gelman H, DeFaccio R, Hawrilenko M, McGinty N, Resnick A, Thomas E, Tomlanovich NC, Toyama J, Kligler B, Jents M, Whitehead A, Zeliadt S. Compendium on Use of Complementary and Integrative Health Therapies and Chiropractic Care at the VA. Use and Characteristics of Users, Fiscal Years 2017-2019. Washington, DC: Office of Patient Centered Care & Cultural Transformation (OPCC&CT) Office of Patient Care Services, Veterans Health Administration Department of Veterans Affairs; 2020 Oct 1. 1-36 p.

Executive Summary As a part of Veteran Health Administration's (VA's) Whole Health System transformation, there has been a large-scale expansion of complementary and integrative health (CIH) therapies as part of standard medical care. This expansion is being driven by several factors, including: mounting evidence of the effectiveness of these therapies for many conditions1-11 that, in turn has led to their inclusion in national pain management guidelines and strategies, 12-13 increasing demand from Veterans, 14 increasing need to offer non-pharmacologic pain management strategies to counter the opioid epidemic, and significant support from Congress15 and VA leadership.16 The Data Nexus project of the VA Complementary and Integrative Health Evaluation Center (CIHEC) QUERI Partnered Evaluation Center was funded to conduct an analysis in partnership with the VA Office of Patient Centered Care and Cultural Transformation (OPCCandCT) in 2020 of data from VA electronic medical records and from community-based claims to examine Veterans' use of nine CIH therapies and chiropractic care from fiscal years (FY) 2017 to 2019. This Compendium on Use of Complementary and Integrative Health Therapies and Chiropractic Care at the VA: Part I reports on the results of those analyses, showing Veterans' use of these therapies over the past three years and the demographic and health characteristics of those Veterans. Our analyses of Veterans' use of nine CIH therapies and chiropractic care showed: · From FY17 to FY19, Veterans appeared to use traditional acupuncture and chiropractic care more than the other therapies we examined. · Veterans' use of each of the therapies increased substantively from FY17 to FY19. Also, both the number of Veteran using these therapies and the number of visits they made more than doubled over the three years for guided imagery, Battlefield Acupuncture, Tai Chi/Qigong, meditation, and yoga. · When we examined Veterans' use of CIH therapies and chiropractic care at the level of VA's healthcare networks, the Veteran Integrated Service Networks (VISNs), we found that traditional acupuncture and chiropractic care were the two most widely used therapies across all VISNs. Alternatively, biofeedback, guided imagery and clinical hypnosis were the least used therapies across all VISNs. · Veterans receiving care in VISNs 9, 20, and 21 appeared more likely than Veterans receiving care in other VISNs to use a CIH therapy or chiropractic care in FY19, with 7.1%, 8.3% and 8.8% of their respective patients using any therapy. · Visual maps showed that Veterans' use of traditional acupuncture appeared to have been more concentrated in the West Coast region of the U.S. in FY19, with the Texas region (VISN 17) reporting the least usage of traditional acupuncture. Alternatively, chiropractic care was most likely to be utilized by Veterans in the Northwest U.S. and least likely to be utilized in the Eastern U.S.