Ariana Lauren Thompson-Lastad

• PhD
• Professor (Assistant) at University of California, San Francisco

In this article, I examine group medical visits, a clinic-based intervention that aims to improve patient health by combining clinical care, health education and peer support. Research shows that health care inequalities are reproduced through the interplay of interpersonal, institutional, and structural factors. I examine changing social relations...

Introduction: Research on disparities in health and health care has demonstrated that social, economic, and political factors are key drivers of poor health outcomes. Yet the role of such structural forces on health and health care has been incorporated unevenly into medical training. The framework of structural competency offers a paradigm for tr...

Amidst a national crisis of opioid overdose, substantial uncertainty remains over how to safely and effectively address chronic pain. In response to this crisis, safety-net primary care clinics are instituting integrative group medical visits (IGMVs) for chronic pain management. Through two qualitative studies of IGMVs, we found that these groups a...

There is strong evidence for clinical benefits of group medical visits (GMVs) (also known as shared medical appointments) for prenatal care, diabetes, chronic pain, and a wide range of other conditions. GMVs can increase access to integrative care while providing additional benefits including increased clinician-patient contact time, cost savings,...

This work calls on healthcare institutions and organizations to move toward inclusive recognition and representation of healthcare practitioners whose credibility is established both inside and outside of professional licensure mechanisms. Despite professional licensure’s advantages, this credentialing mechanism has in many cases served to reinforc...

Background The COVID-19 pandemic exacerbated pain care inequities for low-income people. The Telehealth Integrative Pain Management Program (t-IPMP) was developed to provide pain management services for patients in public health clinics of the San Francisco Health Network (SFHN). Adapted from an existing program, t-IPMP delivered multimodal pain tr...

Background Food as Medicine is a rapidly developing area of health care in the United States, aimed at concurrently addressing nutrition-sensitive chronic conditions and food and nutrition insecurity. Recipe4Health (R4H) is a Food as Medicine program with an integrative health equity focus. It provides prescriptions for locally grown produce (‘Food...

Inclusive research is needed to understand how contemplative practices are used by people of diverse identities. Metta meditation—also known as loving-kindness meditation—may be particularly relevant for people committed to equity and justice because of the social nature of the practice. Using community-based participatory research and an intersect...

Objective To assess mental health related outcomes of Recipe4Health, a multisectoral social care partnership implementing produce prescriptions with or without group medical visits (GMVs). Study Setting and Design Recipe4Health was implemented at five community health centers from 2020 to 2023. Primary care teams referred patients with food insecu...

This article focuses on an empirical setting that upends the clinician–patient dyadic norm: group medical visits (GMVs), in which multiple patients gather in the same space for medical care, health education and peer support. Our grounded theory analysis draws on participant observation and interviews ( N = 53) with patients and staff of GMVs at fo...

Background Socioeconomically disadvantaged populations have a high prevalence of chronic pain, exacerbated by social isolation, intersectional stigma, and disparities in pain assessment and treatment. Effective interventions using a multilevel, biopsychosocial approach are needed to decrease the unequal burden of pain. Group-based integrative pain...

Background Mindfulness-based interventions (MBIs) are supported by clinical practice guidelines as effective non-pharmacologic interventions for common symptoms experienced by cancer patients, including anxiety, depression, and fatigue. However, the evidence predominately derives from White breast cancer survivors. Racial and ethnic minority patien...

e13717 Background: The 2023 Society for Integrative Oncology-ASCO joint guideline recommends mindfulness-based interventions (MBIs) as the non-pharmacologic therapy with the highest level of evidence to improve anxiety and depression symptoms experienced by adults with cancer. However, the evidence predominately derives from White breast cancer sur...

Background Despite the critical need for comprehensive and effective chronic pain care, delivery of such care remains challenging. Group medical visits (GMVs) offer an innovative and efficient model for providing comprehensive care for patients with chronic pain. The purpose of this systematic review was to identify barriers and facilitators (deter...

Introduction Postpartum health is in crisis in the United States, with rising pregnancy‐related mortality and worsening racial inequities. The World Health Organization recommends four postpartum visits during the 6 weeks after childbirth, yet standard postpartum care in the United States is generally one visit 6 weeks after birth. We present commu...

Introduction: The recent White House Conference on Hunger, Nutrition, and Health in October 2022 made it a national priority to address food and nutrition insecurity and reduce inequities in nutrition-related chronic conditions such as heart diease. ‘Food as Medicine’ is increasing implemented to address the dual challenge of food/nutrition insecur...

Given the persistence of health inequities in the United States, scholars and health professionals alike have turned to the social determinants of health (SDH) framework to understand the overlapping factors that produce and shape these inequities. However, there is scant empirical literature on how frontline health and social service workers perce...

Introduction Chronic conditions, such as diabetes, obesity, heart disease and depression, are highly prevalent and frequently co-occur with food insecurity in communities served by community health centres in the USA. Community health centres are increasingly implementing ‘Food as Medicine’ programmes to address the dual challenge of chronic condit...

Objectives: Inclusive research is needed to understand how contemplative practices are used by people across a range of identities. Lovingkindness meditation (LKM) may be particularly relevant for people to committed to equity and justice because of the social nature of the practice. Using community-based participatory research and an intersectiona...

Health care systems in the United States are experimenting with a form of surveillance and intervention known as “hot spotting,” which targets high‐cost patients—the so‐called “super‐utilizers” of emergency departments—with intensive health and social services. Through a calculative deployment of resources to the costliest patients, health care hot...

As medicine integrates social and structural determinants into health care, some health workers redefine housing as medical treatment. This article discusses how health workers in two U.S. urban safety‐net hospitals worked with patients without stable housing. We observed ethnographically how health workers helped patients seek housing in a sharply...

Objectives: As part of a pragmatic effectiveness trial of integrative pain management among inpatients with cancer, the authors sought to understand the clinical context and adaptations to implementation of two study interventions, acupuncture and pain counseling (i.e., pain education and coping skills). Design: The larger study uses a 2 × 2 facto...

Background: Complex Care Management (CCM) programs record patients’ progress toward health and healthcare utilization goals using a tracking tool in order to ascertain whether the patient is ready to transition to routine primary care. High-need, high-cost (HNHC) patients enrolled in CCM programs make progress, but existing tracking tools do not re...

We share findings from a larger ethnographic study of two urban complex care management programs in the Western United States. The data presented stem from in-depth interviews conducted with 17 complex care management RNs and participant observations of home visits. We advance the concept of social literacy as a nursing attribute that comprises an...

To explore the experiences of Latina immigrants with advanced breast cancer and their support networks. We conducted semi-structured interviews with low-income Latina immigrants with advanced breast cancer and their support networks (informal caregivers, physicians, and complementary medicine (CM) practitioners). Patient interviews explored patient...

In the United States, in the wake of health care reform, health care systems have been subject to intensifying demands to increase patient engagement, a term that refers broadly to participation in care. We draw from ethnographic research in urban health care safety-net settings in California to examine efforts to increase patient engagement among...

https://scholars.org/contribution/improving-chronic-pain-care-through-integrative-medicine

Integrative group medical visits (IGMVs) are a compelling health service delivery innovation, which create an opportunity to expand access to complementary and integrative health care (CIH). IGMVs add CIH to existing group medical visit (GMV) models, in response to CIH's inaccessibility to many people due to limited insurance coverage and high out-...

Purpose: Acupressure and therapeutic touch may be beneficial for symptom management and increasing general well-being for children undergoing cancer treatment. Acupressure has the benefit of stimulating targeted acupuncture points while providing therapeutic touch. We sought to explore the relationship between acupressure and the experience of wel...

Objectives: To use a psychosocial framework to examine the pain experiences of low-income, ethnically diverse patients before and after an Integrative Pain Management Program (IPMP). Design and methods: IPMP is a 12-week, multimodal pain group incorporating mindfulness, acupuncture, massage, education, movement, and health coaching. The authors co...

Objectives: This article describes the implementation of a group medical visit (GMV) model to increase access to integrative oncology (IO) care. The most challenging and critical time to access high-quality IO care is while patients are receiving conventional cancer therapy. Often demand for individual IO clinic consultations precludes this from oc...

Purpose: Integrative group medical visits (IGMVs) aim to increase access to complementary and integrative health care, which is particularly relevant for low-income people. We sought to describe IGMV programs in US safety-net clinics through a survey of providers. Methods: An online and paper survey was conducted to collect data on the use of compl...

In the United States and around the world, social, political, and economic structures are hugely determinant of the distribution of illness and health. Structural competency is a promising framework to help clinicians recognize, analyze, ameliorate, and hopefully alter these harmful inequities. To bring this framework to health professionals, the S...

This is an illustrated booklet that I created to share with the patient participants in my research. There is also a Spanish version.

This article explores the complicated and often-contradictory notions of choice at play in complex care management (CCM) programmes in the US healthcare safety net. Drawing from longitudinal data collected over two years of ethnographic fieldwork at urban safety-net clinics, our study examines the CCM goal of transforming frequent emergency departm...

In this paper, we delineate how staff of two complex care management (CCM) programs in urban safety net hospitals in the United States understand trauma. We seek to (1) describe how staff in CCM programs talk about trauma in their patients' lives; (2) discuss how trauma concepts allow staff to understand patients’ symptoms, health-related behaviors...

We examined the birth experience of immigrant and minority women and how CenteringPregnancy (Centering), a model of group prenatal care and childbirth education, influenced that experience. In-depth interviews and surveys were conducted with a sample of racially diverse Centering participants about their birth experiences. Interview transcripts wer...

Increasing “patient engagement” has become a priority for health care organizations and policy-makers seeking to reduce cost and improve the quality of care. While concepts of patient engagement have proliferated rapidly across health care settings, little is known about how health care providers make use of these concepts in clinical practice. Thi...

Objective: Insufficient sleep is a risk factor for pediatric obesity. Latino children are among those groups in which both short sleep duration and obesity are prevalent. Therefore, this study sought to explore Latino parents' views about ideal sleep duration and sleep-related practices for their preschool-age children in an urban setting. Method...