Understanding Primary Care Providers’ Decisions to Recommend Complementary and Integrative Health Therapies: A Qualitative Analysis

Background: Evidence-based complementary and integrative health (CIH) therapies are now in clinical practice guidelines for common pain and pain-related conditions. Primary care providers (PCPs) are often the first point of contact for discussing CIH therapies as non-pharmacological health management. Yet, little is known about their decisions to recommend CIH therapies. Objective: To understand: (1) which CIH therapies PCPs recommend and for what health conditions, (2) reasons for their recommendations or lack thereof, and (3) possible solutions to improve appropriateness of recommendations. Methods: Semi-structured qualitative interviews were conducted with 40 PCPs from eight Veterans Health Administration (VA) hospitals offering eight evidence-based CIH therapies (acupuncture, medical massage therapy, yoga, Tai Chi, meditation/mindfulness, biofeedback, clinical hypnosis, guided imagery). A rapid qualitative analysis was performed using a matrix approach. Results: PCPs recommended patients use acupuncture, medical massage therapy, yoga, Tai Chi, and meditation/mindfulness the most and biofeedback, clinical hypnosis, and guided imagery the least. Pain was the main condition for referrals to all CIH therapies except clinical hypnosis and guided imagery, which were most recommended for smoking cessation and mental health, respectively. Decisions to recommend were largely driven by PCP’s knowledge of CIH therapies’ effectiveness for particular health conditions. Other factors were PCP’s own beliefs about CIH therapies, their perceptions about patients’ beliefs, patients’ positive experiences, and organizational factors (e.g., understanding what therapies are covered for which conditions and the local referral process). PCPs wanted brief educational information containing many types of content, ranging from therapy descriptions to clinical practice guidelines and information on institutional policies on CIH therapy provision. Conclusions: Although some PCPs are appropriately recommending evidence-based CIH therapies, lack of knowledge is a critical barrier for many others. This could be addressed with the educational information tailored to the content and format that PCPs specifically requested.