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Does Offering Battlefield Acupuncture Lead to Subsequent Use of Traditional Acupuncture?

  • Thomas, Eva R.1
  • Zeliadt, Steven B.1, 2
  • Coggeshall, Scott1
  • Gelman, Hannah1
  • Resnick, Adam3, 4
  • Giannitrapani, Karleen5
  • Olson, Juli6
  • Kligler, Benjamin7, 8
  • Taylor, Stephanie L.3, 4
  • 1 Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System
  • 2 Department of Health Services, School of Public Health, University of Washington, Seattle, WA
  • 3 Center for the Study of Healthcare Innovation, Implementation and Policy, Greater Los Angeles VA Health Care System
  • 4 Department of Health Policy and Management, UCLA School of Public Health, Los Angeles
  • 5 Center for Innovation to Implementation, Palo Alto VA Health Care System, Palo Alto, CA
  • 6 VA Central Iowa Health Care System, Des Moines, IA
  • 7 Integrative Health Coordinating Center, Veterans Health Administration
  • 8 Office of Patient-Centered Care and Cultural Transformation, Veterans Health Administration, Washington, DC
Published Article
Medical Care
Lippincott Williams & Wilkins
Publication Date
Aug 13, 2020
2 9 Suppl
DOI: 10.1097/MLR.0000000000001367
PMID: 32826780
PMCID: PMC7497608
PubMed Central


Veterans Health Administration encourages auricular acupuncture (Battlefield Acupuncture/BFA) as a nonpharmacologic approach to pain management. Qualitative reports highlighted a “gateway hypothesis”: providing BFA can lead to additional nonpharmacologic treatments. This analysis examines subsequent use of traditional acupuncture. Research Design: Cohort study of Veterans treated with BFA and a propensity score matched comparison group with a 3-month follow-up period to identify subsequent use of traditional acupuncture. Matching variables included pain, comorbidity, and demographics, with further adjustment in multivariate regression analysis. Subjects: We identified 41,234 patients who used BFA across 130 Veterans Health Administration medical facilities between October 1, 2016 and March 31, 2019. These patients were matched 2:1 on Veterans who used VA care but not BFA during the same period resulting in a population of 24,037 BFA users and a comparison cohort of 40,358 non-BFA users. Patients with prior use of traditional acupuncture were excluded. Results: Among Veterans receiving BFA, 9.5% subsequently used traditional acupuncture compared with 0.9% of non-BFA users ( P <0.001). In adjusted analysis, accounting for patient characteristics and regional availability of traditional acupuncture, patients who used BFA had 10.9 times greater odds (95% confidence interval, 8.67–12.24) of subsequent traditional acupuncture use. Conclusions: Providing BFA, which is easy to administer during a patient visit and does not require providers be formally certified, led to a substantial increase in use of traditional acupuncture. These findings suggest that the value of offering BFA may not only be its immediate potential for pain relief but also subsequent engagement in additional therapies.

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