Prior descriptive research of acupuncture in the United States has characterized utilization nationally,10,11
in regional private practices,21,22
and at teaching clinics.23
This study is the first to characterize clients of community acupuncture clinics, a recent trend in the provision of acupuncture in the United States through affordable treatments using a group-based model. The authors sought to ascertain whether there are differences between community acupuncture clients in Portland, Oregon and a nationally representative sample of acupuncture users in the United States. Study findings suggest that, relative to national acupuncture trends, local community acupuncture clinics have a broader reach to those with limited income; nearly half of the Portland community acupuncture clients surveyed have an annual household income of less than $35,000.
Despite greater economic diversity among community acupuncture clients, the vast majority of clients were non-Hispanic white. Portland has a smaller proportion of minority residents than the United States as a whole, which is likely reflected in the racial/ethnic demographics of the community acupuncture clients in the present study.24
In addition, as with other types of complementary and alternative medicine, differences in sociocultural exposure to and perceptions of acupuncture, such as knowledge, beliefs, and expectations of treatment, are likely to play a role in limited utilization among certain racial/ethnic minorities.25
Factors such as limited English proficiency, health literacy, and structural barriers that impede access to conventional health care services may also create barriers to acupuncture use.
The low-cost fee structure of the community acupuncture model may allow for higher frequency of treatment, as supported by data of this study. The frequency of acupuncture treatments was assessed among the national sample and Portland community acupuncture clients. The findings indicate that Portland community acupuncture clients are more likely than national acupuncture users to receive frequent acupuncture treatments (defined as 10 or more treatments in the prior 12 months), regardless of age, sex, income, education, and health status. While recommended frequency of treatments is individual and condition specific, it is notable that weekly or monthly visits are more typical of American acupuncture practice, whereas daily treatments of acupuncture therapy are commonplace in China.26
While both samples had similar health status and medical reasons for using acupuncture, the extent to which frequency of treatment affects clinical outcomes is an important area for future investigation.
Study limitations and future research
Study findings are limited by a number of factors. The surveys were distributed using a convenience sample and therefore may not be fully representative of the clients at Portland community acupuncture clinics. The survey instrument was self-administered and only available in English. Thus, potential respondents with limited literacy or English proficiency may not have completed the survey. In addition, the sampling method did not allow for accessing clients who were dissatisfied with care and do not continue seeking care at Portland community acupuncture clinics. As a result, this sample is more likely to represent individuals who are satisfied with Portland community acupuncture clinics, which may have resulted in an overestimation of frequency of acupuncture treatments. The objective was to compare individuals who sought care at community acupuncture clinics versus other types of acupuncture provision. Unfortunately, data on the specific types of acupuncture utilized by the nationally representative sample is not available from the NHIS. Despite this limitation, NHIS provides a useful comparative sample given the high average cost of acupuncture reported and the fact that the majority of acupuncturists in the United States treat patients individually. A final limitation is that this study utilizes national data collected in 2007 and community-based data collected in 2009. Study findings may therefore be biased by differential time effects between these 2 years, such as inflation or other social influences that impact on the use of acupuncture. Based on analyses adjusting for inflation using the standard consumer price index,27
it was found that differences in the findings on household income and cost of acupuncture treatment were negligible.
Despite these limitations, the current study provides important preliminary information on local, community-based acupuncture clinics, including differences and similarities between community acupuncture and national acupuncture trends. Given the exponential growth of the community acupuncture movement in recent years, continued monitoring of community acupuncture clinics is warranted to examine issues of access, patient satisfaction, and clinical outcomes of affordable, frequent acupuncture. Currently, over 150 community acupuncture clinics exist but little is known about the health impact of this growing movement. A national study of community acupuncture clinics is needed in order to assess how community acupuncture complements other health behaviors, how community acupuncture is integrated into patients' overall self-management of health, and how frequency of treatment affects various health conditions, including preventive, chronic, and acute conditions.