Enhancing Patient Satisfaction Through the Use of Complementary Therapies

In October 1998, the National Center for Complementary and Alternative Medicine (NCCAM) was funded and established. This center is the federal government’s lead agency for scientific research on complementary and alternative medicine (CAM) and is 1 of the 27 institutes and centers that make up the National Institutes of Health. The mission of the NCCAM is to define, through rigorous scientific investigation, the usefulness and safety of CAM interventions and roles in improving health and health care.

Although a significant number of adults in the U.S. use some form of CAM, physicians rarely recommend these therapies to their patients, and their use is limited in conventional medical settings.^1-3 This is often attributed to a lack of knowledge or scientific evidence, despite a belief by many providers of the potential positive effects.³

In an attempt to disseminate knowledge about various CAM therapies investigated by NCCAM, the Complementary and Alternative Resources to Enhance Satisfaction (CARES) program was organized as a resource center at the Louis Stokes Cleveland VA Medical Center (VAMC). It was anticipated that increasing knowledge about CAM and offering these therapies in conjunction with the conventional medical practices at the VAMC would lead to a more comprehensive, patient-centered system of care. In this way, the goal was to transform current thinking from a focus solely on treating the patient’s disease to a holistic approach, which encompassed comfort, family support, and quality of life (QOL).

Background
The number of veterans with chronic illnesses and pain continues to rise. While aggressive efforts have been aimed at safely decreasing pain and discomfort, many veterans report dissatisfaction with traditional treatment methods, which focus on drug therapy and have little emphasis on preventive or holistic care.⁴ Health care providers often share patients’ frustrations regarding the use of medications that have varying degrees of efficacy and multiple adverse effects. Innovative approaches to improving health and decreasing pain and stress have focused on more holistic and patient-centered philosophies of care. However, there have been few studies to assess feasibility, implementation, and outcomes within an established medical center.

As an ideal goal among patients, families, and HCPs in all care settings, patient-centered care has become a more prominent focus of the VA health care system (VAHCS). The incorporation of patient-centered care, along with an electronic medical record, structural transformation, and greater focus on performance accountability have contributed to dramatic improvements in care within the VAHCS in the past decade.^5,6 Mounting evidence continues to validate the positive health outcomes of models of care that engage patients and families with valuable roles in the healing process.^7,8 Professional caregiver satisfaction has also been linked to increased patient satisfaction.⁹

Integral to patient-centered care is the ability of caregivers to see the whole person—body, mind, and soul. The implementation of therapies or environments that complement traditional medicine and provide for physical comfort and pain management can be important in achieving this form of holistic medicine.^1,10 By definition, CAM is any method used outside of and in addition to conventional medicine to prevent or treat disease.⁶ As CAM takes a holistic approach to healing, most therapies involve not only the treatment of the symptoms of the illness, but also the development of a method of healing that focuses on the spiritual and emotional origins from which the illness arises.¹¹

According to the National Health Interview Survey, complementary and alternative therapies were used by one-third of adults in the U.S. in 2002 and by 4 in 10 adults in 2007.¹¹ However, these estimates may be conservative, as other studies have found that at least the majority of adults had used some form of CAM at one time.¹ The most common CAM therapies used by adults in 2007 were nonvitamin, nonmineral, natural products, such as fish oil or ginseng; deep breathing exercises; meditation; chiropractic or osteopathic manipulation; massage; and yoga.¹¹ In 2007, adults most commonly used CAM to treat a variety of musculoskeletal problems (ie, back, neck, or joint pain).¹¹

As a patient-centered philosophy, the most general benefit of the use of CAM involves the idea of patient empowerment and participation in the healing process. Many therapies, such as tai chi, meditation, and guided imagery, require active patient involvement, which can encourage feelings of self-control over the disease process. Complementary and alternative medicine has been shown to be effective in decreasing pain, anxiety, stress, and nausea.^10,12-14 Increasing evidence supports an association between stress or negative emotions and health outcomes, such as hypertension, diabetes, and heart disease.^15,16 When used in conjunction with traditional medical treatment, CAM can help patients cope with devastating symptoms of their disease processes or to avoid some symptoms altogether.