Outcome evaluation of the Veterans Affairs Salt Lake City Integrative Health Clinic for chronic pain and stress-related depression, anxiety, and post-traumatic stress disorder.
OBJECTIVE
The purpose of this longitudinal outcome research study was to determine the effectiveness of the Integrative Health Clinic and Program (IHCP) and to perform a subgroup analysis investigating patient benefit. The IHCP is an innovative clinical service within the Veterans Affairs Health Care System designed for nonpharmacologic biopsychosocial management of chronic nonmalignant pain and stress-related depression, anxiety, and symptoms of post-traumatic stress disorder (PTSD) utilizing complementary and alternative medicine and mind-body skills.


METHODS
A post-hoc quasi-experimental design was used and combined with subgroup analysis to determine who benefited the most from the program. Data were collected at intake and up to four follow-up visits over a 2-year time period. Hierarchical linear modeling was used for the statistical analysis. The outcome measures included: Health-Related Quality of Life (SF-36), the Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). Subgroup comparisons included low anxiety (BAI < 19, n = 82), low depression (BDI < 19, n = 93), and absence of PTSD (n = 102) compared to veterans with high anxiety (BAI > or = 19, n = 77), high depression (BDI > 19, n = 67), and presence of PTSD (n = 63).


RESULTS
All of the comparison groups demonstrated an improvement in depression and anxiety scores, as well as in some SF-36 categories. The subgroups with the greatest improvement, seen at 6 months, were found in the high anxiety group (Cohen's d = 0.52), the high-depression group (Cohen's d = 0.46), and the PTSD group (Cohen's d = 0.41).


CONCLUSIONS
The results suggest IHCP is an effective program, improving chronic pain and stress-related depression, anxiety, and health-related quality of life. Of particular interest was a significant improvement in anxiety in the PTSD group. The IHCP model offers innovative treatment options that are low risk, low cost, and acceptable to patients and providers.
Smeeding
Sandra J W
SJ
1 Department of Anesthesia, Veterans Affairs Health Care System, Integrative Health, Adjunct College of Nursing, University of Utah , Salt Lake City, UT.
Bradshaw
David H
DH
Kumpfer
Karol
K
Trevithick
Susan
S
Stoddard
Gregory J
GJ
D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities / Q000458:organization & administration; D001007:Anxiety / Q000453:epidemiology / Q000628:therapy*; D015897:Comorbidity; D000529:Complementary Therapies / Q000379:methods*; D003863:Depression / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006801:Humans; D055048:Integrative Medicine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000453:epidemiology; D059408:Pain Management; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000628:therapy*; D016896:Treatment Outcome; D014589:Utah; D014728:Veterans / Q000706:statistics & numerical data*