Complementary, integrative health services increasing in VA system

Use of complementary and integrative therapies, such as chiropractic care, acupuncture, massage therapy, and yoga, increased 70% over a three-year period in the Veterans Affairs (VA) health system after their availability was expanded.

Veterans increased their use of complementary and integrative therapies after availability of these treatments in the Veterans Affairs (VA) system expanded, a recent study found.

The VA began providing complementary and integrative therapies as part of medical benefits packages in 2016 and has provided chiropractic therapy as allopathic treatment for approximately two decades. VA researchers used electronic medical records to conduct a national three-year retrospective analysis of VA patients' use of complementary and integrative therapies covered by the VA: chiropractic care, acupuncture, Battlefield Acupuncture (a protocolized acupuncture treatment unique to the VA and military health care systems), biofeedback, clinical hypnosis, guided imagery, massage therapy, meditation, Tai Chi/Qigong, and yoga. They also looked at how these therapies were used by patients with moderate to severe chronic musculoskeletal pain, other chronic health conditions (diabetes, cardiovascular disease, or obesity), or mental health conditions (depression, anxiety, or post-traumatic stress disorder [PTSD]). The results were published Nov. 30 by the Journal of General Internal Medicine.

The cohort included 5,260,921 veterans who used VA health care from October 2016 to September 2019. Over the three-year period, use of complementary and integrative therapies increased 70.5% and the number of visits made for these therapies increased by 78.2%. The overall rate was 5.7% among all VA patients in 2019, with higher rates in patients with chronic musculoskeletal pain (13.9%), PTSD (10.6%), depression (10.4%), anxiety (10.2%), or obesity (7.8%). Women were more likely to use each of the therapies than men, while patients who lived in urban areas were more likely to use most of the therapies than those who did not. Use of certain therapies varied by age; for example, veterans ages 60 to 69 years were more likely to use Tai Chi/Qigong and those ages 50 to 59 years were more likely to use meditation. Black patients were more likely than White patients to use half of the therapy types, and Hispanic Latino patients were more likely to use acupuncture, massage, and meditation.

The growth in use of complementary and integrative therapies in the VA system may represent both increased interest and increased availability, the study authors noted. They pointed out that their study was limited by its retrospective design and by the difficulty of comparing VA patients to the general population and said that the data did not capture patients' use of these therapies outside the VA system.

“As the VA healthcare system implements CIH [complementary and integrative health] programs throughout the nation, veterans' use of VA-covered CIH approaches rapidly grew and was higher among populations with chronic musculoskeletal pain, depression, PTSD, and anxiety. Many of the CIH utilization patterns we demonstrated were similar to those among the general population, while others were dissimilar,” the researchers wrote. “These results might be helpful to other healthcare systems considering providing their constituents with these approaches.”