{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T16:46:20Z","timestamp":1790009180139,"version":"4.0.1"},"reference-count":53,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2025,1,31]],"date-time":"2025-01-31T00:00:00Z","timestamp":1738281600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Integrative and Complementary Medicine"],"published-print":{"date-parts":[[2025,2]]},"abstract":"\n Objective:<\/jats:title>\n Traumatic brain injury (TBI) clinical practice guidelines for pain management and rehabilitation support the use of nonpharmacologic complementary and integrative health (CIH) modalities, such as acupuncture for remediating pain. Barriers to delivering CIH modalities, such as acupuncture warrant examination. The objective of this study is to explore provider perspectives on challenges to accessing acupuncture treatment for chronic pain in persons with TBI and describe differences across health care settings.<\/jats:p>\n <\/jats:sec>\n \n Setting:<\/jats:title>\n Civilian, Veterans Affairs (VA), and Department of Defense health care systems.<\/jats:p>\n <\/jats:sec>\n \n Participants:<\/jats:title>\n \n Health care providers (\n n<\/jats:italic>\n = 145) were recruited from November 2022 to March 2023 via email through professional organizations and health care systems.\n <\/jats:p>\n <\/jats:sec>\n \n Design:<\/jats:title>\n Descriptive cross-sectional self-report online survey.<\/jats:p>\n <\/jats:sec>\n \n Main Measures:<\/jats:title>\n \n A survey assessed barriers using a 5-point Likert scale (\n always a barrier<\/jats:italic>\n to\n never a barrier<\/jats:italic>\n ) using the Levesque Access to Care framework.\n <\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n Of the 137 participants who provided information on setting, 86 (63%) worked in civilian health care; 47 (34%) worked in the Department of VA; and 4 (2.6%) in the Department of Defense (8 were missing data). Overall, providers endorsed all ten items as being barriers to accessing acupuncture treatment. However, these barriers were more statistically more frequently reported for civilian providers compared with VA providers for six of the 10 items, including lack of caregiver support (\n p<\/jats:italic>\n < 0.0001); own knowledge and understanding of the treatment (\n p<\/jats:italic>\n = 0.0025); health care setting culture discourages the treatment (\n p<\/jats:italic>\n = 0.0181); lack of qualified providers (\n p<\/jats:italic>\n = 0.0467); insurance does not cover (\n p<\/jats:italic>\n < 0.0001), and patient cannot afford (\n p<\/jats:italic>\n < 0.0001). VA provider respondents were more likely to answer all six items, as \u201cRarely\/Never a Barrier,\u201d while providers in a civilian setting were more likely to respond \u201cAlways\/Frequently\u201d or \u201cSometimes\u201d a barrier.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n Results reflect the cultural, organizational, and structural differences that make acupuncture more accessible within the VA. understanding barriers to delivering care is critical to inform implementation strategy mapping efforts, to tailor strategies that are aimed to increase access and engagement with acupuncture treatment in civilian health care settings.<\/jats:p>\n <\/jats:sec>","DOI":"10.1089\/jicm.2024.0486","type":"journal-article","created":{"date-parts":[[2024,11,19]],"date-time":"2024-11-19T03:35:10Z","timestamp":1731987310000},"page":"166-173","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":6,"title":["Provider Identified Access Barriers to Delivering Acupuncture to Persons with Traumatic Brain Injury and Chronic Pain: A Cross-Sectional Self-Report Survey"],"prefix":"10.1177","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4075-3763","authenticated-orcid":false,"given":"Jolie N.","family":"Haun","sequence":"first","affiliation":[{"name":"James A. Haley Veterans\u2019 Hospital, Tampa, Florida, USA."},{"name":"University of Utah, Salt Lake City, Utah, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Risa","family":"Nakase-Richardson","sequence":"additional","affiliation":[{"name":"James A. Haley Veterans\u2019 Hospital, Tampa, Florida, USA."},{"name":"University of South Florida, Tampa, Florida, USA."},{"name":"Tampa VA Research and Education Foundation, Tampa, Florida, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeanne M.","family":"Hoffman","sequence":"additional","affiliation":[{"name":"University of Washington School of Medicine, Seattle, Washington, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitch","family":"Sevigny","sequence":"additional","affiliation":[{"name":"Craig Hospital, Englewood, Colorado, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark D.","family":"Sodders","sequence":"additional","affiliation":[{"name":"Helfgott Research Institute, National University of Natural Medicine, Portland, Oregon, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flora M.","family":"Hammond","sequence":"additional","affiliation":[{"name":"Indiana University School of Medicine, Indianapolis, Indiana, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bridget A.","family":"Cotner","sequence":"additional","affiliation":[{"name":"University of South Florida, Tampa, Florida, USA."},{"name":"Edward Hines, Jr. Veterans Hospital, Hines, Illinois, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Tweed","sequence":"additional","affiliation":[{"name":"James A. 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