Listening to Their Words: A Qualitative Analysis of Integrative Medicine Group Visits in an Urban Underserved Medical Setting

Danielle Dresner MPH, Katherine Gergen Barnett MD,  Kirsten Resnick BS, Lance Laird ThD, Paula Gardiner MD, MPH


Chronic pain is a pervasive and costly health issue in the United States today, affecting up to 100 million individual Americans, and costing up to $635 billion in health care dollars [1]. Even with the billions of dollars being spent, current medical treatments for chronic pain in primary care settings are still often limited to pharmaceuticals such as narcotics and non-steroidal anti-inflammatory drugs [NSAIDS] [2]. Furthermore, primary care physicians who are concerned about chronic pain patients being narcotic seeking, having poor self-management skills, and potentially poor medical compliance, often undertreat chronic pain [3]. Current evidence suggests that chronic pain is consistently undertreated in patients of low socioeconomic and minority status [4].

Group medical visits (GMVs)—a model where patients get medical care together—are gaining national attention as an effective treatment for some patients with chronic illnesses, such as chronic pain [5]. The GMV helps address some of the barriers to effectively treating chronic pain in patients of low socioeconomic and minority status by improving quality of care, access to physicians, and thus, health outcomes [6–7]. Research on GMVs for the management of chronic disease suggests that this model improves health status indicators such as health-related quality of life, patient satisfaction, and coordination of care [8–10]. There are many theories as to why GMVs are successful including improved social support, enhanced self-efficacy, and increased perceived benefits to the participant—all of which increase the likelihood of initiating and sustaining behavior change [11–13].

Integrative medicine, an approach to care that emphasizes the mind-body connection and views the patient as a whole person, rather than a set of diagnoses, is another growing trend in chronic pain management [14–19]. Integrative medicine emphasizes the importance of a patient’s self-management skills and incorporates lifestyle changes, complementary and alternative medicine (CAM), and mind-body techniques to both prevent and treat chronic diseases [20]. Integrative medicine is well-aligned with the principles of the GMV, focusing on simple self-management skills including nutrition, physical activity, and stress management, as a way of maintaining or restoring health.

Finally, mindfulness-based stress reduction (MBSR) is another promising intervention that has been applied to patients suffering from a number of chronic illnesses, including pain [21–25]. The 8-week group curriculum draws on the principles of MBSR and includes didactic discussions and experiential practices such as sitting meditation, body scan, walking meditation, and yoga.

Integrative medicine group visits (IMGVs) combine a group medical visit, integrative medicine techniques, and MBSR (see Figure 1). The IMGV curriculum includes health education, stress management (through the principles of mindfulness-based stress reduction: yoga, meditation, and body scan), and health self-management in a “toolkit” of techniques including healthy eating, acupressure, and self-massage (see Table 1). We have previously published a peer-reviewed paper on the curriculum, recruitment methods, and quantitative improvements in pain and depression [26].

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