Evaluation of a New Integrative Health and Wellness Clinic for Veterans at the San Francisco VA Health Care System: A Mixed-Methods Pilot Study

Francesca M Nicosia; Natalie Purcell; Dan Bertenthal; Hajra Usman; Ilana Seidel; Sarah McGrath; Caitlin Hildebrand; Brittan McCarthy; Karen H Seal

doi:10.1177/27536130241260034

Evaluation of a New Integrative Health and Wellness Clinic for Veterans at the San Francisco VA Health Care System: A Mixed-Methods Pilot Study

Glob Adv Integr Med Health. 2024 Jun 11:13:27536130241260034. doi: 10.1177/27536130241260034. eCollection 2024 Jan-Dec.

Authors

Francesca M Nicosia^{1

2}, Natalie Purcell^{1

3}, Dan Bertenthal¹, Hajra Usman¹, Ilana Seidel¹, Sarah McGrath¹, Caitlin Hildebrand¹, Brittan McCarthy¹, Karen H Seal^{1

4}

Affiliations

¹ San Francisco VA Healthcare System, San Francisco, CA, USA.
² Institute for Health & Aging, University of California, San Francisco, CA, USA.
³ Departments of Social & Behavioral Sciences, University of California, San Francisco, CA, USA.
⁴ Departments of Medicine & Psychiatry, University of California, San Francisco, CA, USA.

Abstract

Objective: The Integrative Health and Wellness Clinic (IHWC), established in 2019 at the San Francisco VA Health Care System, is an interdisciplinary clinic consisting of a medical provider, dietician, physical therapist, and psychologist trained in complementary and integrative health (CIH) following the VA Whole Health model of care. Veterans with complex chronic conditions seeking CIH and nonpharmacologic approaches are referred to the IHWC. This study evaluated the clinic's acceptability and feasibility among veteran patients and its preliminary impact on health and wellbeing, health-related goals, and use of CIH approaches.

Methods: Mixed methods were used to assess patient-reported outcomes and experiences with the IHWC. Participants completed surveys administered at baseline and 6-months and a subset completed a qualitative interview. Pre- and post-scores were compared using t-tests and chi-square tests.

Results: Thirty-five veterans completed baseline and 6-month follow up surveys. Of these, 13% were women; 24% < 50 years of age, and 44% identified as racial/ethnic minorities. Compared to baseline, at 6 months, there were significant (P < .05) improvements in overall health, physical health, perceived stress, and perceived helpfulness of clinicians in assisting with goal attainment; there was a trend toward improved mental health (P = .057). Interviews (n = 25) indicated satisfaction with the interdisciplinary clinical model, support of IHWC providers in goal attainment, and positive impact on physical and mental health. Areas for improvement included logistics related to scheduling of multiple IHWC providers and referrals to other CIH services.

Conclusion: Results revealed significant improvement in important clinical domains and satisfaction with interprofessional IHWC clinic providers, but also opportunities to improve clinic processes and care coordination. An interdisciplinary clinic focused on CIH and Whole Health is a feasible and acceptable model of care for veterans with complex chronic health conditions in the VA healthcare system.

Keywords: integrative medicine; veterans; whole health.