The BraveNet prospective observational study on integrative medicine treatment approaches for pain

BACKGROUND: Chronic pain affects nearly 116 million American adults at an estimated cost of up to $635 billion annually and is the No. 1 condition for which patients seek care at integrative medicine clinics. In our Study on Integrative Medicine Treatment Approaches for Pain (SIMTAP), we observed the impact of an integrative approach on chronic pain and a number of other related patient-reported outcome measures. METHODS: Our prospective, non-randomized, open-label observational evaluation was conducted over six months, at nine clinical sites. Participants received a non-standardized, personalized, multimodal approach to chronic pain. Validated instruments for pain (severity and interference levels), quality of life, mood, stress, sleep, fatigue, sense of control, overall well-being, and work productivity were completed at baseline and at six, 12, and 24 weeks. Blood was collected at baseline and week 12 for analysis of high-sensitivity C-reactive protein and 25-hydroxyvitamin D levels. Repeated-measures analysis was performed on data to assess change from baseline at 24 weeks. RESULTS: Of 409 participants initially enrolled, 252 completed all follow-up visits during the 6 month evaluation. Participants were predominantly white (81%) and female (73%), with a mean age of 49.1 years (15.44) and an average of 8.0 (9.26) years of chronic pain. At baseline, 52% of patients reported symptoms consistent with depression. At 24 weeks, significantly decreased pain severity (−23%) and interference (−28%) were seen. Significant improvements in mood, stress, quality of life, fatigue, sleep and well-being were also observed. Mean 25-hydroxyvitamin D levels increased from 33.4 (17.05) ng/mL at baseline to 39.6 (16.68) ng/mL at week 12. CONCLUSIONS: Among participants completing an integrative medicine program for chronic pain, significant improvements were seen in pain as well as other relevant patient-reported outcome measures. TRIAL REGISTRATION: ClinicalTrials.gov, NCT0118634

Patient Perspectives on Tobacco Use Treatment in Primary Care

INTRODUCTION: Evidence-based tobacco cessation interventions increase quit rates, yet most smokers do not use them. Every primary care visit offers the potential to discuss such options, but communication can be tricky for patients and provider alike. We explored smokers’ personal interactions with health care providers to better understand what it is like to be a smoker in an increasingly smoke-free era and the resources needed to support quit attempts and to better define important patient-centered outcomes. METHODS: Three 90-minute focus groups, involving 33 patients from 3 primary care clinics, were conducted. Participants were current or recent (having quit within 6 months) smokers. Topics included tobacco use, quit attempts, and interactions with providers, followed by more pointed questions exploring actions patients want from providers and outcome measures that would be meaningful to patients. RESULTS: Four themes were identified through inductive coding techniques: 1) the experience of being a tobacco user (inconvenience, shame, isolation, risks, and benefits), 2) the medical encounter (expectations of providers, trust and respect, and positive, targeted messaging), 3) high-value actions (consistent dialogue, the addiction model, point-of-care nicotine patches, educational materials, carbon monoxide monitoring, and infrastructure), and 4) patient-centered outcomes. CONCLUSION: Engaged patient-centered smoking cessation counseling requires seeking the patient voice early in the process. Participants desired honest, consistent, and pro-active discussions and actions. Participants also suggested creative patient-centered outcome measures to consider in future research

A method to determine the impact of patient-centered care interventions in primary care

INTRODUCTION: The implementation of patient-centered care (PCC) innovations continues to be poorly understood. We used the implementation effectiveness framework to pilot a method for measuring the impact of a PCC innovation in primary care practices. METHODS: We analyzed data from a prior study that assessed the implementation of an electronic geriatric quality-of-life (QOL) module in 3 primary care practices in central North Carolina in 2011–12. Patients responded to the items and the subsequent patient-provider encounter was coded using the Roter Interaction Analysis System (RIAS) system. We developed an implementation effectiveness measure specific to the QOL module (i.e., frequency of usage during the encounter) using RIAS and then tested if there were differences with RIAS codes using analysis of variance. RESULTS: A total of 60 patient-provider encounters examined differences in the uptake of the QOL module (i.e., implementation-effectiveness measure) with the frequency of RIAS codes during the encounter (i.e., patient-centeredness measure). There was a significant association between the effectiveness measure and patient-centered RIAS codes. CONCLUSION: The concept of implementation effectiveness provided a useful framework determine the impact of a PCC innovation. PRACTICE IMPLICATIONS: A method that captures real-time interactions between patients and care staff over time can meaningfully evaluate PCC innovations

Systematic review and meta-analysis of randomised controlled trials on the effectiveness of school-based dental screening versus no screening on improving oral health in children

OBJECTIVES: The current study aimed to evaluate the effectiveness of school-based dental screening versus no screening on improving oral health in children aged 3-18 years by a systematic review and meta-analysis of randomised controlled trials. SOURCES AND STUDY SELECTION: Three sets of independent reviewers searched MEDLINE, EMBASE, Web of Science and other sources through April 2016 to identify published and nonpublished studies without language restrictions and extracted data. DATA: Primary outcomes included prevalence and mean number of teeth with caries, incidence of dental attendance and harms of screening. Cochrane's criteria for risk of bias assessment were used. RESULTS: A total of five cluster RCTs (of unclear or high risk of bias), including 28,442 children, were meta-analysed. For an intracluster correlation coefficient of 0.030, there was no statistically significant difference in dental attendance between children who received dental screening and those who did not receive dental screening (RR 1.11, 95% 0.97, 1.27). The Chi-square test for heterogeneity and the Higgin's I(2) value indicated a substantial heterogeneity. Only one study reported the prevalence and mean number of deciduous and permanent teeth with dental caries and found no significant differences between the screening and no screening groups. CONCLUSIONS: There is currently no evidence to support or refute the clinical benefits or harms of dental screening. Routine dental screening may not increase the dental attendance of school children, but there is a lot of uncertainty in this finding because of the quality of evidence. CLINICAL SIGNIFICANCE: Evidence from the reviewed trials suggests no clinical benefit from school-based screening in improving children's oral health. However, there is a lot of uncertainty in this finding because of the quality of evidence. There is a need to conduct a well-designed trial with an intensive follow-up arm and cost-effectiveness analysis