Bell IR, Caspi O, Schwartz GE, et al. Integrative medicine and systemic outcomes research: issues in the emergence of a new model for primary health care

Program in Integrative Medicine, The University of Arizona Health Sciences Center, 1501 N Campbell Ave, Tucson, AZ 85724, USA.
Archives of Internal Medicine (Impact Factor: 17.33). 02/2002; 162(2):133-40.
Source: PubMed


Clinicians and researchers are increasingly using the term integrative medicine to refer to the merging of complementary and alternative medicine (CAM) with conventional biomedicine. However, combination medicine (CAM added to conventional) is not integrative. Integrative medicine represents a higher-order system of systems of care that emphasizes wellness and healing of the entire person (bio-psycho-socio-spiritual dimensions) as primary goals, drawing on both conventional and CAM approaches in the context of a supportive and effective physician-patient relationship. Using the context of integrative medicine, this article outlines the relevance of complex systems theory as an approach to health outcomes research. In this view, health is an emergent property of the person as a complex living system. Within this conceptualization, the whole may exhibit properties that its separate parts do not possess. Thus, unlike biomedical research that typically examines parts of health care and parts of the individual, one at a time, but not the complete system, integrative outcomes research advocates the study of the whole. The whole system includes the patient-provider relationship, multiple conventional and CAM treatments, and the philosophical context of care as the intervention. The systemic outcomes encompass the simultaneous, interactive changes within the whole person.

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    • "Different complex systems within the world (organisms, social groups, economies, ecologies and so on) generate different kinds of behaviours and rules, and therefore cannot be reduced to a single disciplinary or professional model (Anderson 1972; Newell 2001; McMurtry 2011). Healthcare, for example, is often depicted as being concerned with various levels of nested living systems relevant to patient health: Systems ranging the micro (cellular) level, to the meso (cells, organs, bodily systems), to the personal (patient as a 'whole', autonomous, learning person), to macro level factors such as the social, economic and ecological contexts in which a patient is embedded (McMurtry 2009; Bell et al. 2002; Leischow et al. 2008). This latter source of professional differences seems more applicable to the present study. "
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    ABSTRACT: An important influence on parents' decisions about pediatric vaccination (children under 6 years of age) is the attitude of their health care providers, including complementary and alternative medicine (CAM) providers. Very limited qualitative research exists, however, on how attitudes towards vaccination develop among healthcare professionals in-training. We explored perspective development among three groups of students: medical, chiropractic, and naturopathic. We conducted focus group sessions with participants from each year of study at three different healthcare training programs in Ontario, Canada. Semi-structured and open-ended questions were used to elicit dynamic interaction among participants and explore how they constructed their attitudes toward vaccination at the beginning and part way through their professional training. Analyses of verbatim transcripts of audio-taped interviews were conducted both inductively and deductively using questions structured by existing literature on learning, professional socialization and interprofessional relations. We found five major themes and each theme was illustrated with representative quotes.
    Advances in Health Sciences Education 03/2015; DOI:10.1007/s10459-015-9602-4 · 2.12 Impact Factor
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    • "Many definitions also included other elements which commonly define conventional medicine and so are not included in our definition of IM. These were: patient–practitioner relationship (12/17) [1] [2] [45] [47] [48] [57] [58] [80] [82] [83] [86] [88], evidencebased (9/17) [2] [45] [48] [58] [80] [81] [84] [85] [87], effectiveness (5/17) [1] [58] [63] [80] [88], safety (4/17) [57] [58] [80] [88], and low cost (2/17) [57] [87]. "
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    ABSTRACT: The term, integrative medicine (IM), has evolved over time to describe treatment which uses both CAM (complementary and alternative medicine) and conventional approaches. Drawing from the experience of experts in different geographical areas, including USA, UK, Australia, and China, this review aimed to identify key elements which could be used to define IM and to develop a checklist for reporting IM in clinical trials. Method A total of 54 sources were searched (including websites of governments, key authorities, representative clinical sites, academic journals, relevant textbooks) to identify definitions of IM from the four countries from 1990 - 2014. Key elements characterizing IM were extracted and categorized in a thematic approach in order to identify items to consider when reporting IM in research studies. Results Seventeen definitions were identified and extracted from 17 sources. The remaining thirty seven sources did not provide a definition of IM. The most common key elements which defined IM were: practitioner-patient relationship; using aspects of both CAM and conventional medicine; goals of health and healing; holistic approach; and optimum treatment. Integration was also defined at three levels: theoretical, diagnostic and therapeutic. A potential check list of items is proposed for reporting IM in clinical studies. Conclusion This paper identifies the key elements which define IM and provides a potential reporting guide for developing IM clinical trials which could be used in narrative/systematic reviews. Further debate, discussion and input is now needed from the research and clinical IM communities to further advance this agenda.
    European Journal of Integrative Medicine 01/2015; DOI:10.1016/j.eujim.2014.11.006 · 0.78 Impact Factor
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    • "It also emphasizes the importance of wellness and healing of the whole person and developing an effective 1876-3820/© 2015 Published by Elsevier GmbH. practitioner–patient relationship, all of which is informed by evidence [3] [4]. Traditional Chinese medicine (TCM) is one of the oldest and most frequently used complementary medicines worldwide and has influenced various other Asian medical systems [5] [6]. "
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    ABSTRACT: Although Traditional Chinese medicine (TCM) has been practiced for centuries, its acceptance within an integrative framework is hindered by conventional scientific research methodology. How can we optimize research to support the integration of TCM into mainstream medicine? The aim of this paper was to propose priority areas for future TCM research by characterizing the literature contributing to published articles resulting from the three year project “Good Practice in TCM Research (FP7 GP-TCM) in the Post-genomic Era”. Methods All references were extracted from the 20 papers published as a direct result of the GP-TCM project. The main themes of the papers were categorized and the distribution of articles referring to each research topic calculated. Results The nine main themes that were identified included: Chinese materia medica (CMM) quality, CMM toxicity/safety, in silico, in vivo, in vitro, clinical trials (CMM), clinical trials (acupuncture), regulation and future direction. In addition, three extra research topics (authorization, research methodology and others) were identified. Of these, the most frequently reported themes were CMM toxicity/safety, quality and in vivo research. Conclusion Within this framework, the quality control of CMM products, network pharmacology, biomedical studies using systems biology and the adaptation of Western clinical research methods were supported by advances in research and technology. Combined with international collaboration, these provide vital directions for research and development in TCM to validate integrative approaches for mainstream medicine and health care models for the future.
    European Journal of Integrative Medicine 01/2015; 7(1). DOI:10.1016/j.eujim.2014.12.006 · 0.78 Impact Factor
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