Implementing a Toolkit for Improved Management of Complementary and Alternative Medicine in the Primary Care Setting

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Halbur, Kaysha
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Purpose: The purpose of this DNP quality improvement project was to implement a toolkit to assist with the assessment, management, and education of Complementary and Alternative Medicine (CAM) in the primary care setting.|Background/Significance: Similar to Western medicine, CAM is associated with health benefits but also carries significant risks, including increasing healthcare costs or mortality. As of June 2019, the FDA had 18,086,403 reports of adverse biologic product and or drug interactions, resulting in 1,779,247 deaths in the United States over six months. U.S. citizens spend approximately $30.2 billion out of pocket annually on CAM, with 59 million citizens utilizing at least one form. Study findings show that 54.9% of practitioners do not inquire about patients’ CAM usage and 95.8% reported not having a standard intake form to collect a CAM history.|Sample/Setting: This quality improvement project participants included two patient rooming staff and a nurse practitioner. The project setting was a rural primary care clinic in Northeast Iowa.|Methods: Participants underwent a pre-implementation educational session about CAM clinical significance and available resources. Posters were displayed in each exam room, providing patients with a definition of CAM and the importance of disclosure. A suggestive, keyword CAM screening survey was administered to patients following the current rooming process, which did not include asking about specific CAM usage. Following CAM survey completion, the provider reviewed and indicated whether additional patient education and management adjustments were needed. A post-implementation survey of participants was conducted to determine the usefulness and sustainability of the toolkit.|Results: Toolkit took disclosure rates from 7% to 90%. Management changes were required for 7% of patients. Participants scored toolkit components 4-4.66 (good-very good) on 1-5 Likert.|Conclusion: Participants drastically improved CAM disclosure success, noted educational improvement, and found management change opportunities.
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