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Acupuncture in the Public Health Setting

By Kristen Porter, MS, MAc, LAc

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Helping to Create the Healthiest Generation

The imperative to create the "Healthiest Generation by 2030," envisioned by the American Public Health Association (APHA), was in full force at the APHA's 142nd Annual Meeting held in New Orleans from November 15-19, 2014. More than 12,500 delegates attended, representing the U.S. as well as many countries from around the world. The meeting offered moer than 1,000 scientific sessions that addressed the meeting's theme: Healthography: Where you Live Affects your Health and Well-Being.

APHA has a long history of promoting community and global health and has become the pre-eminent public health body in the world. Current campaigns address issues of importance to a number of aspects of health. APHA's "Facts over Fear" efforts address the importance of having scientific information influence health policy related to the Ebola epidemic.

More than 30 groups within APHA reflect the spectrum of public health professions and interests. These include maternal and child health, aging, alcohol, tobacco and other drugs, community health workers, food and nutrition and environment.

One of the component groups is the Integrative, Complementary and Traditional Health Practices Section (ICTHP). This group is comprised of more than 450 members who represent the diverse backgrounds of practitioners, researchers, health policy-makers, students and community health advocates. Members are involved in an array of disciplines including massage, yoga, homeopathy, Ayurvedic Medicine and Traditional Hawaiian Healing. Of particular interest to readers of Acupuncture Today are the areas of acupuncture, Traditional Chinese or Asian Medicine, acupressure, Qi Gong, Tai Qi and herbal medicine.

APHA's Annual Meeting featured scientific sessions focusing on ICTHP issues including panel discussions, poster presentations and round-table gatherings. Presenters reported on clinical trials, comparative effectiveness research, economic evaluations and work-in-progress.

ICTHP's keynote panel featured Dr. Stephen Ezeji-Okoye, of the California Veterans Administration and Gillian Sealy and Rain Henderson of the Clinton Foundation. Dr. Ezeiji-Okoye is the Chief of Staff for the VA Palo Alto Health Care System and is a visionary committed to changing the culture of the VA from being disease-centric to becoming focused on health and well-being. Ms. Sealy is the Director of the Clinton Health Matters Initiative (CHMI). Their talks shared and emphasized a broad vision of community health and wellness that benefits from transdisciplinary and collaborative efforts. All the speakers emphasized the value of informing and educating the public about self-care and working with a healthcare team.

One of the scientific sessions was dedicated to research on acupuncture. Three speakers addressed the issue from a variety of perspectives. Annarose Mittelsteadt delivered a presentation entitled, "Increasing Acupuncture Utilization as an Adjunct Treatment in African American Breast Cancer Survivors." Her work is based at the UCLA Center for Bridging Research Innovation, Training and Education for Minority Health Disparities Solutions, University of California, Los Angeles. She and her group, including Victoria Mays conducted a survey in four Los Angeles County breast cancer survivor groups that examined participants' use of integrative approaches. When women become aware of the value of acupuncture and can access treatment, the power of the medicine becomes evident. Their work identified the importance of community education and the continuing need to ensure access to care by promoting third party coverage by insurers.

Anupama Kizhakkeveettill delivered her paper on "Integrative Acupuncture Care for Low Back Pain: A Systematic Review." Low-back pain (LBP) is one of the most significant healthcare challenges affecting modern society, yet its most effective management approach remains unclear. Previous reviews have evaluated the use of single complementary and alternative medicine therapies for LBP, but in practice it is common for patients to seek care from practitioners of different disciplines and to receive a combination of therapies.

Her systematic review high-lighted three high quality studies examined the combination of acupuncture with conventional medicine for chronic LBP, and all found this treatment to be clinically effective, yielding the highest level of best evidence. Another high quality study found that acupuncture combined with exercise was also effective for chronic LBP. This systematic review found that acupuncture combined with conventional medicine or exercise seems to be effective for treating chronic LBP. Results from her study highlight the need for further research on integrated care for LBP.

In my (Sommers) presentation, "Integrating Acupuncture into a Community Health Center: Evaluating Clinical Outcomes, Patient Satisfaction, and Costs of Care," data were collected from 580 individuals who were referred for acupuncture treatment. Eighty percent were female, 47% were Hispanic/Latino, 10% were African-American, and mean age was 38 years; 71% were referred for pain and 18% were referred for headache. Mean reduction in pain based on a 10-point Likert scale was -2.3 (p < 0.0001) and mean reduction in days/month affected by pain was 12.8 (p < 0.0001). Duration of painful episodes decreased (p = 0.0003) and quality of life improved as indicated by the SF1 (p < 0.0001).

Headache intensity levels were significantly reduced (p < 0.0002) as was headache frequency (p = 0.03). Preliminary cost estimates suggested a moderate decrease in other healthcare costs. These preliminary results indicate that offering acupuncture in a community health setting can be acceptable, desirable and cost-effective.

Dr. Sivarama Prasad Vinjamury of the College of Acupuncture and Oriental Medicine, Southern California University of Health Sciences, described his work on "Determining differences in perceptions of students of acupuncture and chiropractic programs regarding knowledge and use of research literacy skills." He feels that the, "APHA has been helpful in enhancing my knowledge of public health issues and also understanding the natural strength of TCM, as part of Integrative Medicine, in addressing these issues." He goes on to say that, "from a TCM perspective, disease prevention and health promotion are more important than disease management. TCM advocates healthy diet and lifestyle for maintaining good health. Qi gong, tai chi and a diet that is warm and light in property are suggested for health promotion, which is an important tenet in public health. Current efforts of public health agencies/ organizations/professionals' focus is on promoting healthy diet and lifestyle to promote wellness and prevent lifestyle disorders."

Dr. Paul Kadetz, the director of a bachelors' program in public health at Xi'an Jiaotang-Liverpool University, has a global focus on public health and acupuncture practice. He explains that, "...in TCM, a good practitioner will consider the entire picture of their patient's health. Concepts central to public health, such as the social determinants of health, can be understood in the context of TCM frameworks."

Helen Ye MS, LAc, is the founding executive director of the Rising Phoenix Integrative Medical Center in San Francisco. She led round-table discussions addressing barriers and enablers to accessible integrative medical services. Ye's appreciation of the open environment and networking possibilities associated with integrative care are reflected in the resulting "richness of practice." She feels that clinicians also serve as "ambassadors to promote the best effects of our medicine" and appreciates the inter-disciplinary nature of comprehensive approaches.

The future of health and healthcare in the U.S. depends on our work today. As acupuncture practitioners we can offer a unique approach to care that synthesizes patient empowerment, community education and cost-effective treatment. These are the challenges and rewards that face us.

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