Paula Gardiner

Boston Medical Center · Department of Family Medicine

BACKGROUND Group-based diabetes care, both technology-enabled and in-person, can improve diabetes outcomes in low-income minority women, but the mechanism remains unclear. OBJECTIVE We tested whether diabetes medical group visits (DMGVs) reduced hemoglobin A1c (A1c) by mitigating diabetes distress, an emotional response affecting nearly half of ad...

Background: Medically underserved people with type 2 diabetes mellitus face limited access to group-based diabetes care, placing them at risk for poor disease control and complications. Immersive technology and telemedicine solutions could bridge this gap. Objective: The purpose of this study was to compare the effectiveness of diabetes medical...

BACKGROUND Medically underserved people with type 2 diabetes mellitus face limited access to group-based diabetes care, placing them at risk for poor disease control and complications. Immersive technology and telemedicine solutions could bridge this gap. OBJECTIVE The purpose of this study was to compare the effectiveness of diabetes medical grou...

Purpose: Chronic pain experienced by children and adolescents represents a significant burden in terms of health, quality of life, and economic costs to U.S. families. In 2015, the Boston Medical Center (BMC) Interdisciplinary Pain Clinic initiated an Integrative Medicine (IM) team model to address chronic pain in children. Team members included a...

Background: Comorbid depression is associated with poor diabetes control. DMGVs improve glycemic control and depressive symptoms among patients with type 2 diabetes (T2DM). The WIC2 study compared the effectiveness of an eight-week DGMV conducted in a virtual world platform vs. an in-person format to improve diabetes outcomes for 288 minority women...

Introduction: Immersive online technologies, such as virtual world (VW) platforms, can increase patient engagement in DSME/S. The Women in Control 2.0 (WIC2) trial compared DSME/S delivered in a VW vs. in-person for minority women with uncontrolled type 2 diabetes (HbA1c ≥8.0). We hypothesize the sense of presence afforded by a VW platform fosters...

Objective: We aim to explore how users' experience of presence in a virtual world (VW) learning environment enhanced patient engagement in DSME/S programs conducted in an online VW platform with minority women with type 2 diabetes. Methods: We conducted an embedded, mixed methods study, using a convergent study design to analyze qualitative fiel...

BACKGROUND: The development of evidence-based care geared towards Black and Latina women living with uncontrolled type 2 diabetes is contingent upon their active recruitment into clinical interventions. Well-documented impediments to recruitment include a historical mistrust of the research community and socioeconomic factors that limit awareness a...

Importance Healthy nutrition and appropriate supplementation during preconception have important implications for the health of the mother and newborn. The best way to deliver preconception care to address health risks related to nutrition is unknown. Methods We conducted a secondary analysis of data from a randomized controlled trial designed to...

BACKGROUND Background: The development of evidence-based care geared towards Black/African American and Latina women living with uncontrolled type 2 diabetes is contingent upon their active recruitment into clinical interventions. Well-documented impediments to recruitment include a historical mistrust of the research community and socioeconomic fa...

Background The development of evidence-based care geared towards Black and Latina women living with uncontrolled type 2 diabetes is contingent upon their active recruitment into clinical interventions. Well-documented impediments to recruitment include a historical mistrust of the research community and socioeconomic factors that limit awareness an...

Purpose: Chronic pain is a growing problem among children and adolescents, and is more prevalent in low-income families. This observational study was conducted to describe the demographics and various descriptors, complementary medicine therapy (CMT) use, and lifestyle factors (i.e., food habits and supplement use) of pediatric patients with chroni...

Purpose: To characterize Latina experiences of a Spanish-language DSME program delivered in the VW versus a F2F format. Methods: Qualitative analysis of transcripts from three semi-structured focus groups conducted with 22 randomly selected Latina women enrolled in the Women in Control (WIC) DSME comparative effectiveness study. Two researchers cod...

Background: DSME improves diabetes outcomes, however participation is low. Virtual world (VW) technology is a scalable and engaging platform for DSME. The WIC study compared the effectiveness of DSME Medical Group Visits conducted in a VW platform vs. in-person to improve diabetes outcomes for minority women with uncontrolled type 2 diabetes (T2DM)...

Background: Research is needed to improve diabetes care of minority women who are disproportionately affected by type 2 diabetes. Yet, barriers exist that hinder efforts to include minority women in research. Evidence suggests that successful study enrollment requires multiple recruitment strategies. Little is known about the correlation between re...

Background Chronic pain affects millions of Americans. Our Whole Lives, an electronic health (eHealth) toolkit for Chronic Pain (Our Whole Lives for Chronic Pain [OWLCP]), is a mind-body chronic pain management platform that teaches self-management strategies to reduce pain impact and pain medication use. Objective The primary goal of this study w...

Background Current treatment options for chronic pain and depression are largely medication-based, which may cause adverse side effects. Integrative Medical Group Visits (IMGV) combines mindfulness techniques, evidence based integrative medicine, and medical group visits, and is a promising adjunct to medications, especially for diverse underserved...

Background: Traditional Indian cosmetics and Ayurvedic medicines may contain lead. Previous studies have shown a relationship between eye cosmetic use (kohl) in children and elevated blood lead levels (BLLs) > 10 µg/dL. However, an association between Ayurvedic use and elevated BLLs in children is unknown and understudied. Methods: We assessed t...

Objective Description of recruitment methods and lessons learned in a randomized controlled trial of underserved patients using an integrative medical group visits intervention. Methods Comparison of the demographic characteristics of participants screened and consented to the study as well as description of recruitment methods used. Outcome Meas...

Objectives: Chronic pain is a common problem in the United States, one for which there is a dearth of effective treatments. Nonpharmacological options are a promising alternative, especially for Spanish-speaking Latinos. This pilot study would like to assess the feasibility of an adapted Integrative Medical Group Visit (IMGV) curriculum for a Span...

Objectives Little is known about the acceptance of non-pharmacological group strategies delivered to low income racially diverse patients with chronic pain and depression. This paper examines how the Integrative Medical Group Visit (IMGV) addresses many of the deficits identified with usual care. Design and setting Six IMGVs cohorts were held at a...

Background: Yoga is effective for mild to moderate chronic low back pain (cLBP), but its comparative effectiveness with physical therapy (PT) is unknown. Moreover, little is known about yoga's effectiveness in underserved patients with more severe functional disability and pain. Objective: To determine whether yoga is noninferior to PT for cLBP....

Individuals with chronic stress can improve their overall wellness by making lifestyle changes. We describe the design and evaluation of a computer-animated conversational agent that is used in conjunction with Integrative Medical Group Visits (IMGV) to help individuals with chronic pain and depression manage their stress. The agent coaches patient...

Background: This abstract will report on the feasibility of introducing an innovative eHealth technology called an Embodied Conversational Agent (ECA) into a diverse patient population with chronic pain and depression. Objective: The Integrative Medical Group Visit (IMGV) is a 9-week curriculum designed for patients with chronic pain and depression...

Background: Given the public health crisis of opioid overprescribing for pain, there is a need for evidence-based non pharmacological treatment options that effectively reduce pain and depression. We aim to examine the effectiveness of the Integrative Medical Group Visits (IMGV) model in reducing chronic pain and depressive symptoms, as well as in...

In a patient-centered care era, rehabilitation can benefit from researcher-clinician collaboration to effectively and efficiently produce the interdisciplinary science that is needed to improve patient centered outcomes. The authors propose use of the Forging Alliances in Interdisciplinary Rehabilitation Research (FAIRR) logic model to provide guid...

In this paper we describe a conversational virtual agent that is designed to be used in conjunction with group medical visits to help treat individuals with chronic pain and depression using non-medical treatments including yoga, meditation, and self-massage. Results from two rounds of pilot testing indicate that patients like the virtual agent and...

Background: The current state of diabetes self-management (DSM) education and support for diabetic patients is inadequate, especially for minority women who experience disproportionately high rates of diabetes mellitus (DM) in the US. While DSM education and support enables individuals with diabetes to make positive lifestyle choices and achieve cl...

Introduction: Little is known about the changes in prevalence of dietary supplement use in pregnancy, postpartum, and in a comparison group of nonpregnant women. Methods: We conducted a secondary analysis of the Infant Feeding Practices II study. The purpose of this study is to report the prevalence of herbal or botanical and nonvitamin, nonmine...

Objective. Integrative Medicine Group Visits (IMGVs) are an 8-week outpatient medical group visit program for chronic pain patients combining mindfulness-based stress reduction (MBSR), integrative medicine, and patient education. The authors conducted a qualitative study with IMGV participants to better understand the effects of IMGVs on patients’...

Natural health products (NHPs), such as herbal medicines, probiotics, vitamins and minerals, are used regularly by 73% of Canadians.1 Many consumers believe that NHPs derived from plants (such as herbal medicines) are safe because they are “natural.”1 However, some plant-derived NHPs can interact with pharmaceutical medications, potentially resulti...

Although dietary supplement use is common, its assessment is challenging, especially among ethnic minority populations such as Hispanics/Latinos. Using the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) (n = 16,415), this report compares two strategies for capturing dietary supplement use over a 30-day period: a medication-based invent...

Objectives: Little is known about Traditional Vietnamese Medicine (TVM) and its use among Vietnamese immigrants in the United States. This study aimed to characterize TVM and improve understanding of its use among Vietnamese outpatients attending an urban clinic. Methods: This cross-sectional observation study was performed by mailing bilingual...

Purpose: The Integrative medicine group visits program (IMGV) is a 9-week intensive outpatient medical group visit program for chronic pain patients combining principles of mind-body techniques with group discussions on wellness topics. Methods: We conducted three focus groups (N=20) with participants with chronic pain and depression who had partic...

Purpose: The purpose of this pilot study is to evaluate the feasibility of introducing a tablet computer with an Embodied Conversational Agent (ECA) into an integrative medical group visit (IMGV) for patients with chronic pain and depression. Methods: This prospective observational cohort study enrolled 20 participants who were attending an integr...

The Preventive Medicine Residency Program collaborated with the Department of Family Medicine's Program for Integrative Medicine and Health Disparities at Boston Medical Center to create a new rotation for preventive medicine residents starting in autumn 2012. Residents participated in integrative medicine group visits and consults, completed an on...

Little is known about the feasibility of online education in improving communication and documentation of dietary supplements (DS) among clinicians. This prospective educational study included clinicians at an urban teaching hospital. The curriculum included video streams, didactics, and interactive case presentations to discuss (1) DS safety and e...

Systems and tools are needed to identify and mitigate preconception health (PCH) risks, particularly for African American (AA) women, given persistent health disparities. We developed and tested "Gabby," an online preconception conversational agent system. One hundred nongravid AA women 18-34 years of age were screened for over 100 PCH risks and ra...

Little is known regarding complementary and alternative medicine (CAM) use during pregnancy and the preconception period. Since half of all pregnancies in the United States are unintended, understanding the patterns of CAM use among women of childbearing age has implications for fetal and maternal health. Descriptive statistics were generated from...

Purpose. To identify characteristics associated with the use of potentially harmful combinations of dietary supplements (DS) and cardiac prescription medications in an urban, underserved, inpatient population. Methods. Cardiac prescription medication users were identified to assess the prevalence and risk factors of potentially harmful dietary sup...

Residents' stress and burnout is a concern among family medicine residency programs. Our objective is to assess stress management options available to family medicine residents. In 2012, the Council of Academic Family Medicine Educational Research Alliance (CERA) e-mailed a survey to US residency directors. Questions were asked on four types of str...

Introduction: Complementary and alternative medicine (CAM) is commonly used among women, but few national data exist regarding CAM use during pregnancy or the postnatal period. Methods: Data from the 2007 National Health Interview Survey were analyzed for women ages between the ages of 18 and 49 years who were pregnant or had children less than...

Background: Chronic pain affects millions of racially diverse Americans. Evidence suggests that group medical visits are effective for treating chronic pain; similarly, a number of studies demonstrate the effectiveness of certain evidence-based complementary therapies in managing pain. Objectives: The primary goal of this study is to evaluate th...

To report on the incidence and use of kelp among patients with thyroid cancer. Data were collected using a web-based online anonymous survey under Institutional Review Board approval from Boston University. This report is based on 27 responses from subjects with thyroid cancer who use kelp. Demographic factors and complementary and alternative use...

Little is known about the relationship between health literacy and complementary and alternative medicine (CAM) use in low-income racially diverse patients. The authors conducted a secondary analysis of baseline data from 581 participants enrolled in the Re-Engineered Discharge clinical trial. The authors assessed sociodemographic characteristics,...

The burden of chronic illness, increasing cost of health care, and fragmentation of health care delivery are critical problems facing the U.S. health care system. Despite advances in science and medical technology, patients continue to experience suffering from chronic health conditions. Integrative Medicine Group Visits (IMGVs) are an innovation i...

Use of complementary and alternative medical (CAM) therapies is common among adults with mental health concerns, but little is known about CAM use among adolescents with mental health concerns. Data from the 2007 National Health Interview Survey were analyzed for youth from 7 to 17 years old. The study focused on 3 common mental health conditions:...

Patient activation is linked to better health outcomes and lower rates of health service utilization. The role of patient activation in the rate of hospital readmission within 30 days of hospital discharge has not been examined. A secondary analysis using data from the Project RED-LIT randomized controlled trial conducted at an urban safety net hos...

Little is known about the incorporation of integrative medicine (IM) and complementary and alternative medicine (CAM) into family medicine residency programs. The Society for Teachers of Family Medicine (STFM) approved a set of CAM/IM competencies for family medicine residencies. We hope to evaluate whether residency programs are implementing such...

The use of complementary and alternative medicine (CAM) and Integrative Medicine (IM) has grown steadily over the past decade. Patients seek physician guidance, yet physicians typically have limited knowledge and training. There is some coverage of IM/CAM topics in medical schools and residencies but with little coordination or consistency. In 2008...

The use of herbal remedies is a tradition held in many cultures throughout the world, and women may use herbal remedies during lactation. Because of the limitations of the current literature, it is difficult to develop accurate information on the safety and efficacy of specific herbs used during breastfeeding. It is critical that more research is c...

Complementary and integrative medicine (CIM) is defined by the National Institutes of Health as a group of diverse medical and health care systems, practices, and products not generally considered part of conventional medicine. CIM practices are grouped into 4 categories: natural products, mind and body medicine practices, manipulative practices, a...

Introduction: Little is known about herb use among underserved postpartum women and their patterns of communication about herb use with prenatal providers. Methods: We interviewed women from the postpartum unit at an urban hospital about herb use during pregnancy, socioeconomic factors, prenatal vitamin use, and diet. We asked women if they disc...

Information about the safety of herbal medicine often comes from case reports published in the medical literature, thus necessitating good quality reporting of these adverse events. The purpose of this study was to perform a systematic review of the comprehensiveness of reporting of published case reports of adverse events associated with herb use...

Background: To report on the incidence and predictors of use of complementary and alternative medicine (CAM) among patients with thyroid cancer. Methods: Data were collected using a web-based online anonymous survey under Institutional Review Board approval from Boston University. This report is based on 1327 responses from subjects with thyroid...

Context: Despite major advances in cancer treatment, many patients undergo painful procedures during treatment and suffer debilitating side effects as well as report a decrease in quality of life (QOL). This problem is exacerbated for low-income, racial, and ethnic minorities with cancer. Minority cancer patients often enter care with larger tumor...

Purpose: The Centers for Disease Control and Prevention have endorsed the concept of preconception care (PCC). New tools must be developed to promote PCC. Design: Development and testing of a health information technology system to provide PCC. Setting: An urban safety net hospital and an urban university. Subjects: Community recruitment of...

We report on the safety of non-insertive acupuncture (NIA) in 54 newborns diagnosed with Neonatal Abstinence Syndrome (NAS) in a busy inner city hospital. For this case series, a retrospective chart review was conducted. Data on participant demographics, number of NIA treatments, provider referrals, and outcomes of interest (sleeping, feeding, and...

Integrative medicine is defined as relationship-centered care that focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare professionals and disciplines to achieve optimal health and healing, including evidence-based complementary and alternative medicine. Pediatric integrative medic...

Clinical studies display a wide range of herb use prevalence among racial/ethnic minorities in the United States. We searched databases indexing the literature including CINAHL, EMBASE, Global Health, CAB Abstracts, and Medline. We included studies that reported herbal medicine prevalence among ethnic minorities, African American, Hispanic, or Asia...

Objectives: Despite popular and historical use, there has been little modern research conducted to determine the safety and efficacy of herb use during breastfeeding. The purpose of this study was to systematically review the clinical literature on herbal medicine and lactation. Methods: The databases PubMed, CAB Abstracts, Cochrane Central Regi...

Purpose Traditional Indian or Ayurvedic medicines and cosmetics may contain lead. The relationship between cosmetic use (e.g. kohl) and blood lead levels (BLLs) in children has been well documented; however the impact of Ayurvedic use on BLL remains unclear. To begin to address this question, we conducted a pilot study to assess the feasibility of...

Purpose Little is known about the use of herbs in low income underserved mothers and patterns of communication about herb use to prenatal providers. We sought to examine these issues among women delivering at Boston Medical Center (BMC), an urban medical center serving many of the low income and underserved populations of Boston, Massachusetts. Met...