Jeffrey Dusek, PhD.

1. Acupuncture in the ANW
Emergency Department:
Results from a Pilot Study
Jeffery Dusek PhD,
Penny George Institute for Health and
Healing - Director of Research
September 26, 2015

2. 2

3. 3

4. 4
Integrative Medicine in the ED
• Given the robust findings from provision of Integrative
Medicine for Abbott Northwestern Hospital inpatients, we
considered a pilot study in the Abbott Northwestern
Emergency Department.

5. 5
Integrative Medicine in the ED
• Given the robust findings from provision of Integrative
Medicine for Abbott Northwestern Hospital inpatients, we
considered a pilot study in the Abbott Northwestern
Emergency Department.
– Increased number of patients being seen in the ED.

6. 6
Integrative Medicine in the ED
• Given the robust findings from provision of Integrative
Medicine for Abbott Northwestern Hospital inpatients, we
considered a pilot study in the Abbott Northwestern
Emergency Department.
– Increased number of patients being seen in the ED.
– Some conditions in the ED are not completely treated with
pharmaceuticals.

7. 7
Integrative Medicine in the ED
• Given the robust findings from provision of Integrative
Medicine for Abbott Northwestern Hospital inpatients, we
considered a pilot study in the Abbott Northwestern
Emergency Department.
– Increased number of patients being seen in the ED.
– Some conditions in the ED are not completely treated with
pharmaceuticals.
– Anxiety and Pain can be impacted by integrative therapies such as
acupuncture.

8. 8
Integrative Medicine in the ED
• Given the robust findings from provision of Integrative
Medicine for Abbott Northwestern Hospital inpatients, we
considered a pilot study in the Abbott Northwestern
Emergency Department.
– Increased number of patients being seen in the ED.
– Some conditions in the ED are not completely treated with
pharmaceuticals.
– Anxiety and Pain can be impacted by integrative therapies such as
acupuncture.
– ED Leadership support: Medical Director (C. Kapsner), Director of
Nursing (T. LaCroix-Dalluhn), Manager of Patient Care (J. McAnnany).

9. 9
Integrative Medicine in the ED
• Given the robust findings from provision of Integrative
Medicine for Abbott Northwestern Hospital inpatients, we
considered a pilot study in the Abbott Northwestern
Emergency Department.
– Increased number of patients being seen in the ED.
– Some conditions in the ED are not completely treated with
pharmaceuticals.
– Anxiety and Pain can be impacted by integrative therapies such as
acupuncture.
– ED Leadership support: Medical Director (C. Kapsner), Director of
Nursing (T. LaCroix-Dalluhn), Manager of Patient Care (J. McAnnany).
– ANW Foundation provided the initial gift to support the pilot study.

10. 10
Integrative Medicine in the ED
• Given the robust findings from provision of Integrative Medicine
for Abbott Northwestern Hospital inpatients, we considered a
pilot study in the Abbott Northwestern Emergency Department.
– Increased number of patients being seen in the ED.
– Some conditions in the ED are not completely treated with
pharmaceuticals.
– Anxiety and Pain can be impacted by integrative therapies such as
acupuncture.
– ED Leadership support: Medical Director (C. Kapsner), Director of
Nursing (T. LaCroix-Dalluhn), Manager of Patient Care (J. McAnnany).
– ANW Foundation provided the initial gift to support the pilot study.
– Pilot study went live in 2013.
• Meetings in Q2
• Shadowing in Q3
• Services began in Q4

11. 11
• Study Goal: To assess acceptability and clinical
outcomes of acupuncture provided in the Abbott
Northwestern Hospital ED (open label).
11
Acupuncture in Abbott Northwestern
ED Pilot Study

12. 12
• Average acupuncture session lasted 23 minutes
(SD = 8.9) and ranged from 6 to 78 minutes.
• Patients presented with pain in a variety of
locations with the highest percentage (34.2%)
experiencing discomfort in his or her back.
• The second most common location reported was
the head (21.1%), which included headaches,
migraines, facial, and throat pain.
12
AQ Intervention

13. 13
• During the study period (13 months), 436 pts
were referred for AQ.
– 73.3% (55/75) of clinicians referred for AQ.
• 279 pts approached by the acupuncturist during
their ED visit.
– Consent was obtained from 89% (248/279).
13
Acupuncture in Abbott Northwestern
ED Pilot Study

14. 14
• Patients (n=182) had a mean pre-pain of 6.80
(2.58 sd) and reported an average decrease of
-2.52 with AQ + SC.
• Average 35% pain reduction
• More than 2 unit decrease in pain is clinically significant.
• Furthermore, 160 patients with high pain (pre-
pain ≥ 4) had a mean pre-pain of 7.47 (SD = 1.93)
and reported an average decrease of -2.71 (95%
CI: 2.36, 3.07).
14
Results: Pts pain>0 and anx pre/post

15. 15
• Half (94/182) did not receive analgesics before
or during AQ .
– Average decrease of -2.37 (95% CI 1.92, 2.83)
• Half (88/182) did receive analgesics
– Average decrease of -2.68 (95% CI 2.21, 3.15)
• No significant difference between the reduction
for AQ alone vs AQ + SC.
15
Results: Pts pain>0 and anx pre/post

16. 16
• Of the 182 subjects with non-missing pre- and post-
anxiety scores, 23% reported a score of 0.
• The mean pre-anxiety score was 4.73 (SD = 3.43)
and, on average, decreased by -2.27 (95% CI: 1.89,
2.66.
• A total of 101 reported high anxiety levels (pre-
anxiety ≥ 5) with a mean pre-anxiety of 7.37 (SD =
1.85) and an average decrease of -3.47 (95% CI:
2.92, 4.01).
16
Results: Pts pain>0 and anx pre/post

17. 17
• We found a positive correlation between pain
change and anxiety change (r = 0.186, N = 182, p
= 0.0117).
17
Pain and Anxiety Relationship

18. 18
• ED providers used opioids to treat acute pain.
• Pilot study funded by the National Institutes of Health, NCCIH to test the
feasibility and outcomes of providing acupuncture in the ANW ED.
• 279 patients were approached by the acupuncturist during their ED visit.
• Consent for acupuncture was obtained from 89% (248/279).
• A total of 182 patients, who presented with pain were included in analyses.
• The mean pre-pain score was 6.80 (SD = 2.58) and the average decrease was -
2.52 (95% CI: 2.20, 2.85). This is a 37% decrease in acute pain.
• Of the 52% (94/182) who did not have analgesics before or during the
acupuncture session, the average decrease of -2.37 (95% CI: 1.92, 2.83).
• The mean decrease for those receiving analgesics was 2.68 (95% CI: 2.21,
3.15). These changes were not significantly different (p>0.05).
18
SUMMARY of Acupuncture in the
Abbott Northwestern ED Pilot

19. 19
• Received Abbott Northwestern Innovation Grant to conduct a
small randomized controlled trial (RCT) comparing AQ alone to
Analgesics alone.
• Submitted a letter of Intent to the DoD to conduct a large RCT
comparing AQ + SC to SC.
• Submitted a letter of Intent to the PCORI to conduct a large RCT
comparing AQ alone to Analgesics alone
• Is successful, results from these studies could provide additional
empiric evidence supporting the use of AQ in the ED.
• Goal would be for 3rd party payors to cover the costs of AQ in the ED.
19
Next Steps

20. 20
• Chris Kapsner MD, ED Medical Director
• Adam Reinstein LAc, Acupuncturist
• Jill Johnson PhD, Epidemiologist
• Michael Finch PhD, Methodologist
• Desiree Trebesch MA, Study Coordinator
• Rachael Rivard MA©, Biostatistician
• Lauren Erickson MA, Biostatistician
The project was partially supported by:
• Abbott Northwestern Hospital Foundation
• National Institutes of Health (R01 AT006518 from NCCIH)
• Penny George Institute Foundation
20
Collaborators and Funding Sources