Patients' experiences and perceptions of integrative care for back and neck pain

Research Unit for Sudies of Integrative Health Care, Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Nursing, Huddinge, Sweden.
Alternative therapies in health and medicine (Impact Factor: 1.24). 05/2012; 18(3):25-32.
Source: PubMed


Conventional guidelines in Sweden recommend primary care management for back and neck pain, yet these two conditions are the most common ones for which patients use complementary therapies. Despite the recent growth of integrative medicine (IM) in different clinical, academic, and societal contexts, few studies have defined and investigated comprehensive models of integrative care as compared to conventional management, especially using randomized clinical trials.
The study explores patients' experiences and perceptions when receiving conventional or integrative care in the management of back and neck pain.
The research team conducted this study within a larger interventional study. In that study--a pragmatic randomized clinical pilot trial--the team developed a model for integrative medicine that combines complementary therapies that have an emerging evidence base and conventional treatments for patients with nonspecific back and neck pain. The research team implemented the model and compared the results for integrative care to results for conventional primary care. The current qualitative study included 11 focus-group discussions: conventional care (n= 5) and integrative care (n=6).
The research team implemented the interventional study in south suburban Stockholm, an area with higher unemployment, lower incomes, and receipt of more welfare support and sickness benefits compared to the average levels in Stockholm.
The participants in the focus-group discussions were volunteers drawn from the larger randomized clinical trial.
The research team transcribed all discussions from the focus groups verbatim and used latent content analysis to evaluate the data.
Receiving diagnostic support and excluding pathology were strong reasons for participants to seek conventional care. Participants reported that they found conventional management to be reductionistic, with a focus on disease, and a lack of accessibility, time, and guidance. In contrast, participants reported that integrative care was holistic, whole-person management and facilitated increased treatment response, support, empowerment, and self-help strategies. Participants, however, perceived integrative care to be challenging because of additional treatment costs with complementary therapies and collaborative shortcomings between integrative and conventional practitioners generally.
Integrative care represents a combination of valuable conventional medical diagnosis with empowering self-help strategies for some patients with nonspecific back and neck pain in Swedish primary care. Future studies should also investigate experiences and perceptions in the longer term from the perspective of patients, caregivers, and health systems.

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    • "Potentially fewer adverse drug events and cost-effective management due to less use of prescription analgesics with IC may indeed be of utter importance for safe and effective long-term care of patients suffering from pain conditions. Emerging evidence from a Swedish randomized controlled trial of another IC model, notably in the management of patients with chronic back/neck pain, showed that IC was feasible to implement, enabled patients to rely less on prescription and non-prescription analgesics compared to conventional care, and empowered patients towards increased self care strategies [29]–[31]. Lastly, recent registry analysis findings from the Netherlands attest to possible differences in resource use and health outcomes between conventional care and IC practice, where patients managed by physicians with training in anthroposophic IC or other complementary therapies, had lower health care utilisation and lived longer compared to patients that received care from conventionally trained doctors [32]. "
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    ABSTRACT: Pharmacotherapy may have a limited role in long-term pain management. Comparative trajectories of drug prescriptions and costs, two quality-of-care indicators for pain conditions, are largely unknown subsequent to conventional or integrative care (IC) management. The objectives of this study were to compare prescribed defined daily doses (DDD) and cost of first line drugs for pain patients referred to conventional or anthroposophic IC in Stockholm County, Sweden. In this retrospective high quality registry case-control study, IC and conventional care patients were identified through inpatient care registries and matched on pain diagnosis (ICD-10: M79), age, gender and socio-demographics. National drug registry data was used to investigate changes in DDD and costs from 90/180 days before, to 90/180 days after, index visits to IC and conventional care. The primary selected drug category was analgesics, complemented by musculo-skeletal system drugs (e.g. anti-inflammatories, muscle relaxants) and psycholeptics (e.g. hypnotics, sedatives). After index care visits, conventional care pain patients (n = 1050) compared to IC patients (n = 213), were prescribed significantly more analgesics. The average (95% CI) group difference was 15.2 (6.0 to 24.3), p = 0.001, DDD/patient after 90 days; and 21.5 (7.4 to 35.6), p = 0.003, DDD/patient after 180 days. The cost of the prescribed and sold analgesics was significantly higher for conventional care after 90 days: euro/patient 10.7 (1.3 to 20.0), p = 0.025. Changes in drug prescription and costs for the other drug categories were not significantly different between groups. Drug prescriptions and costs of analgesics increased following conventional care and decreased following IC, indicating potentially fewer adverse drug events and beneficial societal cost savings with IC.
    PLoS ONE 05/2014; 9(5):e96717. DOI:10.1371/journal.pone.0096717 · 3.23 Impact Factor
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    • "Examples may range from evidence derived from small clinical trials on the advantageous effects of intense lifestyle changes and even mindfulness-based meditation on gene expression, where disease-promoting genes are down regulated and disease-preventing genes are up regulated and where telomerase mediated genomic integrity improves [24] [25] [26], to large health economic registry studies, indicating that patients whose general practitioner knows CAM, tend to have lower costs and live longer [27]. Findings from our own extensive mixed methods clinical research in primary and emergency care suggest that IC services are feasible and effective [28] [29] [30] [31] with the results from primary care described in more detail in Box 2. On-going health registry studies in Sweden add to these trends by showing that chronically ill patients with pain or stress disorders seem to increase their quality of life and self-rated health after intensive periods of anthroposophic integrative care in a cost-effective manner at economic threshold levels likely to be compatible with implementing new health technologies in Sweden [32]. Indeed, the forecasted increase in chronic disease burden over the coming years has been recognized as a major incentive for developing and strengthening collaboration between the conventional and CAM health sectors [33] "
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    ABSTRACT: Introduction The concept of integrative medicine/care – often referred to as the new medicine – typically signifies a sound combination of safe and effective ancient traditional medicine or complementary and alternative medicine, and state-of-the-art conventional medicine. In this opinion article, we draw on a decade of research and development including our own experiences in low-, middle- and high-income countries, by means of qualitative and quantitative research approaches, and explore trends vital to the development of evidence-informed integrative care and communication systems. Discussion Proponents suggest that an integrative health care system with a diversity of therapeutic options – and no particular differentiation between any evidence-informed health care paradigms – might be the best way to revitalize health care and reduce societal health care costs. Opponents argue – based on reasoning common to followers of scientism – that such developments constitute pseudoscience and will effectively overburden the healthcare system. Integrating insights from medicine, the humanities, ethics and philosophy in a health care model, which combines high-tech conventional health care with ancient health care systems and therapies, with the aim to achieve a pluralistic, accessible, affordable, safe and effective health system is clearly a challenge, but one which in fact has been recommended by the Director General of the WHO. Conclusion To maintain a polarized situation in the light of the growing demand for person-centred health care services, is unhelpful to nations and patients alike, detrimental to therapeutic relationships and may even occasionally be dangerous.
    European Journal of Integrative Medicine 01/2013; 6(1). DOI:10.1016/j.eujim.2013.09.005 · 0.78 Impact Factor
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    ABSTRACT: Introduction Integrative medicine (IM), the integration of complementary therapies (CTs) and conventional care, is common despite a scarce evidence base of cost-effectiveness. Aim To explore the cost-effectiveness of IM from a healthcare perspective comparing conventional primary care to a comprehensive IM model in the management of 80 patients with chronic non-specific back/neck pain. Methods Data on clinical management (planning and delivering IM), resource use (conventional care, CTs, prescription and non-prescription analgesics) and outcome effectiveness (SF-6D) were derived alongside a pragmatic randomised clinical pilot trial with 16 weeks follow-up. Costs and effects, i.e. quality-adjusted life years (QALYs), were estimated over different time periods and willingness-to-pay thresholds. Net monetary benefit and bootstrapping methods were used to explore the level of cost-effectiveness. Results The IM model, on average integrating 7 CT sessions with conventional primary care over 10 weeks, resulted in increased QALYs, somewhat higher cost of health care provision but a reduced cost of using health care resources, including less use of analgesics compared to conventional primary care. The costs/QALY ranged between euro 24 000 and 41 000. Conclusion Given the threshold value of euro 50 000 per QALY gained, and a remaining effect of one year, it is indicated that IM might be cost-effective compared with conventional primary care. Future cost-effectiveness studies of IM should be carried out from a societal perspective and should be based on large scale randomised clinical trials.
    European Journal of Integrative Medicine 01/2013; 6(1). DOI:10.1016/j.eujim.2013.09.001 · 0.78 Impact Factor
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