Healthcare professionals attitudes towards acupuncture: an analysis of barriers and enablers to its integration

Transcription

1 Healthcare professionals attitudes towards acupuncture: an analysis of barriers and enablers to its integration Zhang, M, N 1,2 ; Zheng, Z 1 ; Vesty, G 1 1. School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia 2. School of Nursing, Midwifery and Paramedicine, ACU, Melbourne, Australia

2 My Research / Thesis Australian doctors and nurses or midwives attitudes and perceptions of acupuncture and acupressure practice in Perioperative Care- National Survey 17_ jpg Figure 1. Matthews (2017), Figure 2. Acupressure. n.d. RMIT University 2

3 Definition of terms Acupuncture: needles Acupressure: pressure Complementary and Alternative Medicine (CAM) broad set of health care practices conventional medicine RMIT University 3

4 Side Effects after operations/ga Figure 3. Gayer (2014), Figure 4. Boy in hospital bed (2016), PONV (Post Operative Nausea and Vomiting) Pain RMIT University 4

5 Aims and Study Design Study 1 Literature Review Aim 1 Purposive literature review to identify key themes associated with barriers, enablers and acceptance of acupuncture use in perioperative care Study 2 National Survey Aim 2 Examine the beliefs, attitudes, perceptions, clinical use, knowledges and perceptions of Australian doctors and nurses toward the use of acupuncture and acupressure in perioperative care Further analysis of Study 2 Aim 3 Identify any potential barriers that may impact on the implementation of the use of acupuncture / acupressure in perioperative care RMIT University 5

6 Why examine attitudes? Proven Effectiveness Cochrane review: compared PC 6 stimulation with sham treatment PC6 acupoint stimulation significantly the incidence of nausea, vomiting and the need for rescue antiemetics (Lee, Chan & Fan, 2015). Acupuncture (Level I), specifically auricular acupuncture (Level I [PRISMA] postoperative pain, opioid requirements as well as opioid-related adverse effects compare to a variety of controls (Schug et al., 2015). RMIT University 6

7 Why examine attitudes? (Continued) Attitudes of physicians 80% considered it is effective & safe Current literature focuses on CAM in general High referral rate of acupuncture Australia: 70-80% (Easthope et al., 2000; Wardle et al., 2013) International: 50-94% (Chen et al., 2010) RMIT University 7

8 Literature Search Strategies To explore the attitudes and perceptions of acupuncture use in peri-operative care Integrative Review Broadest type of research review method inclusion of experimental and non-experimental research Study selection-purposive sampling PRISMA flowchart of study selection process followed - 12 studies selected RMIT University 8

9 PRISMA Flowchart RMIT University 9

10 Literature Review Findings Perceptions and attitudes Overall positive attitudes and perception among surveyed health care professionals despite low knowledge of and exposure to acupuncture. GPs took a favourable view towards both the efficacy and cost effectiveness of acupuncture among other physicians (Wardle, Sibbrit & Adams, 2013; Norheim & Fonnebo, 1998; Lipman, Dale & MacPherson, 2003; Czarnawska-Illiev & Robinson, 2016). Who referred patients and to whom GPs, Age groups, Sex RMIT University 10

11 Literature Review: Findings (Continued) Barriers and enablers of integrating acupuncture into conventional medicine (Manias et al, 2015) Three themes identified Intrapersonal Interpersonal Environmental & External RMIT University 11

12 Findings (Continued) 1. Intrapersonal barriers +/- enablers - Knowledge of and exposure to acupuncture - Personal use - Prior positive experiences - Prescribed CAM previously and comfortable with referral to acupuncture - Belief in the efficacy of acupuncture - Perceived lack of evidence - Scepticism and Prejudice RMIT University 12

13 Findings (Continued) 2. Interpersonal barriers +/- enablers -Patients own request -Number of patients asking about acupuncture -Using CAM practitioners for source of information -Direct interactions with the acupuncturists to build trust -Patient feedback and refusal -Different medical paradigms of Western Medicine and Traditional Chinese Medicine RMIT University 13

14 Findings (Continued) 3. Environmental/External barriers +/- enablers -Lack of options -Side effects from conventional therapies -Availability of credentialed providers -Difficulty in finding a practitioner -Lack of reimbursement & insurance coverage -Lack of regulation -Logistical (facility, issues with administration such as frequency, timing, length of time, hospital setting, body parts, number of needles) RMIT University 14

15 Limitations of prior research: areas to further explore Low response rate associated with large online studies Bias with regional/small number of participants/single site study limits the generalisability of results Cultural diversity and geographical differences Missing data from nurses!!! RMIT University 15

16 Implications for future clinical practice Change in patient and societal interest in CAM. Healthcare professionals must be well informed about acupuncture and the potential benefits and limitation. Attitudes are important to this integration. Knowledge shapes attitudes. Education is the key!!! RMIT University 16

17 Overcoming Barriers Figure 2: A conceptual framework for translating evidence into practice adapted from Gonales et al (2012) RMIT University 17

18 Key Points The national survey (Study 2) focuses on the GAP between translating evidence into practice Participants including nurses/midwives (whom spend most of our time with our patients during their hospitalization!!!) First nationwide survey in Australia Willingness of receiving further education has been included in the survey questionnaire. Provide the foundation for further studies RMIT University 18

19 Quote Innovation is taking two things that already exist and putting them together in a new way. Tom Freston RMIT University 19

20 References Chen, L., Houghton, M., Seefeld, L., Malarick, C., & Mao, J. (2010). A survey of selected physician views on acupuncture in pain management. Pain Medicine, 11, Czarnawska-Iliev, I., & Robinson, N. (2016). General Practitioners use of and attitudes to acupuncture in relation to the UK s National Institute for Health and Care Excellence (NICE) clinical guidelines a pilot study. European Journal of Integrative Medicine, 8, Retrieved from: Donald, G.K., Mackeret, P., & Tobin, I. (2010). Medical students and acupuncture: a short sharp placement experience. Acupuncture Medicine, 28(1), doi: /aim PubMed PMID: Easthope, G., Tranter, B., & Gill, G. (2000). Normal medical practice of referring patients for complementary therapies among Australian general practitioners. Complementary Therapies in Medicine, 8, Retrieved from: Faircloth, A. (2014). Perceptions of acupuncture and acupressure by Anaesthesia provider (VCU Theses and dissertation). Paper 3586 Fries, C. J. (2008). Classification of complementary and alternative medical practices. Canadian Family Physicians, 54, PubMed PMID: Giordano, J., Boatwright, D., Stapleton, S., & Huff, L. (2002). Blending the boundaries: steps toward an integration of Complementary and Alternative Medicine into mainstream practice. Journal of Alternatively and Complementary Medicine, 8, doi: / PubMed PMID: Gonzales, R., Handley, M.A., Ackerman, S., & O Sullivan P.S. (2012). Increasing the translation of evidence into practice, policy, and public health improvements: a framework for training health professionals in implementation and dissemination science. Academic Medicine, 87, doi: /ACM.0b013e d33. PMCID: PMC RMIT University 20

21 References (Continued) Johnston, M.F, Hui, K. K., & Bastani, R. (2005). Incorporating acupuncture into oncologic practice: how clinical need shapes physicians acceptance. Journal of Cancer, 3, Scopus ISSN: Lee, A., Chan, S,K,C., Fan, L, T, Y. (2015). Stimulation of the wrist acupuncture point PC6 for preventing postoperative nausea and vomiting. Cochrane. Retrieved from: Lipman, L., Dale, J., & MacPherson, H. (2003). Attitudes of GPs towards the provision of acupuncture on the NHS. Complementary Therapies in Medicine, 11, doi: /S ) Manias, E., Rixon, S., Williams, A., Liew, D., & Braaf, S. (2015). Barriers and enablers affecting patient engagement in managing medications with specialty hospital settings. Health Expectations, 18(6), doi: /hex Moher,D., Liberati, A,, Tetzlaff, J., & Altman, D.G, (2009). The PRISMA Group. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Medicine, 6(7):e Retrieved from: Norheim, A. J., & Fonnebo, V. (1998). Doctors attitudes to acupuncture-a Norwegian study. Social Science & Medicine, 47(4), Retrieved from PubMed. Schug, S.A., Palmer, G. M., Scott, D. A., Halliwell, R., & Trinca, J. (2015). Acute Pain Management: Scientific Evidence (4th ed.). Melbourne: Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine. Shao, J, Y, J., Borthwick, A, M., Lewith, G, T., & Hopwood, V. (2005). Attitudes towards traditional acupuncture in the UK. Evidence Based Integrative Medicine, 2(1), Retrieved from AMED. RMIT University 21

22 References (Continued) Wardle, J.L., Sibbrit, D., & Adams, J. (2013). Acupuncture referrals in rural primary healthcare: a survey of general practitioners in rural and regional New South Wales Australia. Acupuncture in Medicine, 31, doi: /acupmed Whittemore, R., & Knafl, K. (2005). The integrative review: updated methodology. Journal of Advanced Nursing, 52, World Health Organization (WHO). (n.d). Acupuncture: review and analysis of reports on controlled clinical trials. Retrieved from apps.who.int/medicinedocs/pdf/s4926e/s4926e.pdf Ytrehus, I. A., Norheim, A J., Emaus, N., & Fonnebo, V. (2010). Physicians become acupuncture patients-not acupuncturists. The Journal of Alternative and Complementary Medicine, 16(4), doi: /acm RMIT University 22

23 Thank you RMIT University 23