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Identifying Barriers to Implementing Complementary and Integrative Health Therapies in Rhode Island Health Care Systems: A Qualitative Approach.

Introduction: Complementary and integrative health (CIH) therapies are widely used and make up billions of dollars in out-of-pocket expenditures. This quality improvement project aimed to identify stakeholders' perceptions of implementing CIH therapies in health care systems to examine the barriers...

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Published in:Journal of Integrative & Complementary Medicine Vol. 31; no. 2; pp. 155 - 166
Main Authors: Comella, Nicole, Elwy, Rani A.
Format: research tables/charts Journal Article
Published: Mary Ann Liebert, Inc. Feb2025
Online Access:View this record in EBSCOhost
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      dt: Feb2025
      vid: 31
      iid: 2
      pid: 1365
      pub: Mary Ann Liebert, Inc.
      place: New Rochelle, New York
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        182796962
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        10.1089/jicm.2024.0370
        182796962
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        atl: Identifying Barriers to Implementing Complementary and Integrative Health Therapies in Rhode Island Health Care Systems: A Qualitative Approach.
      aug:
        au:
          Comella, Nicole
          Elwy, Rani A.
        affil: Warren Alpert Medical School of Brown University, Providence, RI, USA.
      sug:
        subj:
          Alternative Therapies
          Integrative Medicine
          Program Implementation
          Stakeholder Participation
          Attitude of Health Personnel Evaluation
          Quality Improvement
          Implementation Science
          Human
          Rhode Island
          Male
          Female
          Adult
          Qualitative Studies
          Semi-Structured Interview
          Health Facility Administrators
          Insurance, Health
          Acupuncture
          Massage Therapy
          Health Policy
          Health Care Costs
          Credentialing
          Funding Source
          Content Analysis
          Physicians
          Alternative Health Personnel
          Adult: 19-44 years
          Male
          Female
      ab: Introduction: Complementary and integrative health (CIH) therapies are widely used and make up billions of dollars in out-of-pocket expenditures. This quality improvement project aimed to identify stakeholders' perceptions of implementing CIH therapies in health care systems to examine the barriers and facilitators to CIH implementation in Rhode Island (RI). Methods: A qualitative approach guided by the Consolidated Framework for Implementation Research (CFIR) was used to conduct interviews with key stakeholder groups: health care administrators, health insurance administrators, physicians, and CIH practitioners. Interviews were analyzed by directed content analysis of transcripts with CFIR as the a priori coding framework. Results: Eleven subconstructs within four major domains were most prominent in interviews across all stakeholder groups. Key barriers in the "innovation" domain include a perceived lack of evidence and credibility of CIH therapies, logistical and administrative complexity of implementation, high costs to patients, and little financial incentive for hospitals and insurance companies. The "outer setting" domain highlights the utility of market pressure in decision making to implement CIH and the role of health policy. The "inner setting" domain demonstrates the varied personal beliefs about CIH, credentialing challenges, and the dissonance between medical system priorities and patient needs. Positive facilitation of implementation is marked by personal exposure to CIH and provider satisfaction in the "implementation process" domain. Conclusion: CIH therapies offer the medical system low risk and effective interventions that meet patient needs not currently met by Western medicine. However, implementation is difficult due to poor perception of evidence and lack of financial gain for the medical system. Acupuncture and massage may be modalities better situated for implementation in the RI medical system. Further education, awareness, and advocacy for CIH therapies would help meet patients' needs for CIH availability.
      pubtype: Academic Journal
      doctype:
        research
        tables/charts
        Journal Article
      ougenre: Article
    language: English
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