Background:
Acupuncture offers an inexpensive and safe method for symptom relief and is widely used in the outpatient setting. Given the increased focus on pain control, safety and cost awareness in the inpatient setting, acupuncture is a potential therapy to include in the care of hospitalized patients. We conducted a qualitative study to explore facilitators and barriers to the operationalization of an inpatient acupuncture service.
Methods:
Our study took place at three academic hospitals within one health system. Acupuncture is currently only available in the outpatient setting. Through nominated expert sampling, we identified key informants such as physicians, nurses, surgeons, administrators who represented different roles in our organization to participate in focus groups or interviews. Twelve interview questions guided by the Promotion Action on Research Implementation in Health Services (PARiHS) framework explored three domains of barriers and facilitators of implementation – evidence, context, and facilitation. Data were analyzed using content analysis.
Results:
Twenty-two health professionals participated in interviews or a focus group. We identified 12 codes describing facilitators and barriers which were categorized into three higher order categories: (1) personal or clinical evidence and preferences; (2) patient and clinical context; (3) operationalizing within the health system. Selected codes, code definitions and representative quotes from participants are shown in Table 1. Participants’ awareness and experience of acupuncture was high, largely positive and focused on personal and professional experiences. Opinions varied on the appropriateness, and timing, of acupuncture in patients’ disease or care trajectory with most participants believing that acupuncture was an adjunct to more traditional treatment. Despite this, many felt that in order to provide comprehensive care, acupuncture should be available to inpatients as a treatment option. Many participants felt that an inpatient acupuncture service would add institutional value by enhancing the reputation of the health system. However, many were concerned about the out-of-pocket expenses patients may incur given inconsistencies in insurance coverage. A number of specific challenges to implementation, and strategies to overcome these were described. Examples included ensuring buy-in, collaborating with existing services (e.g. palliative care), setting appropriate expectations of the benefits of acupuncture, and educating patients and providers.
Conclusions:
This study has provided information to facilitate the development and implementation of an acupuncture service for hospitalized inpatients.
