Our study is among the first to describe patient experiences with community acupuncture, a model that has been growing in popularity in the U.S. for the past decade. We identified patient-reported components of access, costs, and quality of community acupuncture. This preliminary investigation has identified a number of areas for future investigation, including further assessment of holistic outcomes of group acupuncture in community settings.
Assessment of the quality of CAM systems of care requires a holistic worldview of the system, encompassing the patient-provider relationship, the treatment provided within that system, and the philosophical context of care . Consistent with this holistic worldview, there are structural and practical aspects of community acupuncture that support patient-centered outcomes. Our findings can be contextualized within Donabedian’s health care quality framework, which describes that high-quality care results when structures, processes, and outcomes of health care are sufficient and functional . This self-selected sample of survey respondents described structural factors of WCA, including affordable payment and ease of scheduling. These structural factors are perceived by patients to improve access to regular and frequent acupuncture treatments, and to increase their control over how and when they access care. Study findings suggest that patients at community acupuncture clinics have a high level of engagement in care. The physical environment and communal setting, along with the enthusiasm garnered by the clinic philosophy and business model, contribute to activation and empowerment among this group of Portland community acupuncture patients. Structures enhancing financial and temporal access serve as facilitating factors of acupuncture use within this model.
In addition, many aspects of the community acupuncture model exemplify a patient-centered approach to care, which is increasingly recognized as a primary dimension of quality and optimal health care delivery [32, 33]. Consistent with previous research on patient-centered outcomes associated with CAM [34–36], patients in our study reported benefits such as empowerment, hope, relaxation, mental, emotional and physical health, and improved quality of life. Patients expressed value for practitioners, suggesting that the therapeutic relationship is not compromised despite the fact that verbal communication is kept to a minimum in the community acupuncture model.
The generalizability of these analyses is limited by the convenience sample employed for the study. A known limitation of qualitative research is that findings may be unique to the persons included in the research study, and may not generalize to other populations . The sampling method that we used did not allow for accessing patients who initiated, but did not continue receiving acupuncture at WCA clinics. As a result, our sample is more likely to represent individuals who are satisfied with the care they received at community acupuncture clinics. Additionally, data analyzed in this paper were limited to responses to a single open-ended survey item. Nevertheless, this collection of comments from a sample of satisfied community acupuncture patients provides insight into the unique dimensions of care at Portland community acupuncture clinics, reasons for choosing to receive care within this acupuncture delivery model, and patient perspectives on quality of care. While there are limitations to using open-ended questions on surveys, including the lack of specificity in responses and analytic challenges, these do not outweigh the benefits of inviting individuals’ unique perspectives and experiences in their own words . Future studies using our instrument should include explicit plans to optimize the value of data provided in written responses.
The generalizability of our findings may also be limited by the study setting, where the use of acupuncture and other CAM are relatively accepted in the sociocultural context of Portland. Nonetheless, our analyses identified structural and practical aspects of the community acupuncture model – including low cost treatments, ease of scheduling, and community-based locations – that may be useful to improve access to acupuncture in areas where it is less prevalent.
Importantly, patients’ perceptions that quality is not compromised through community acupuncture are relevant to the discussion of CAM models that may address gaps in health care. In the United States, CAM utilization is associated with poor health status and with having unmet health care needs or delayed care due to cost [38, 39]. One out of four WCA survey respondents was uninsured; a factor known to be associated with having unmet health care needs . The community acupuncture model, while not a full substitute for basic healthcare, is potentially filling an important gap for uninsured, underinsured, and medically underserved populations in Portland.