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Integrative medicine models in contemporary primary health care
Abstract
To determine what models of integrative medicine (IM) are being employed in contemporary health care settings, and how and which factors affect and facilitate the success of IM in terms of the integration of complementary and alternative medicine (CAM) and conventional medicine in primary health care (PHC).
Literature review.
Australian and international PHC settings, and hospitals.
Australian and international peer-reviewed literature identified from database searches, reference lists, desktop searches, texts, and relevant website searches (e.g., government and health-related departments and agencies). Focus was literature with the keywords 'integrative' or 'integrated' in conjunction with 'medicine' or 'health care'. Articles were analysed for descriptions of continuous and integrative services involving contemporary IM practices, their background, characteristics, and implementation.
Classifications of IM in the literature present various ways that IM can be implemented, and it appears that strategies have been successfully developed to facilitate integration. Although few of the barriers to the integration of CAM and conventional medicine have been resolved, concerns over the legitimacy of CAM in health care (e.g., safety, biomedical evidence, and efficacy) are being overcome by the use of evidence-based practice in IM delivery. There are two dominant models of IM that have been developed. One is the selective combination of both biomedical evidence and experience-based evidence of both CAM and conventional medicine. The other is the selective incorporation of exclusively evidence-based CAMs into conventional medicine. The two model types signify different levels of equity between CAM and conventional medicine in regard to the power, autonomy, and control held by each. However, the factors common to all IM models, whether describing CAM as supplementary (and subordinate) or complementary (and partnered) to conventional medicine, is the concept of a health care model that aspires to be client-centred and holistic, with focus on health rather than disease as well as mutual respect among peer practitioners.
The growth and viability of IM will depend on evidence-based practices, non-hierarchal IM practices, and identifying the successful influences on the integration of CAM and conventional medicine for recognition of its inherent value in PHC.
... Majority (n=5) described integrative medicine in the context of oncology (3,13,14,17,18). There was one each for lower back pain (20), allergy and immunology (21), and acupuncture (22), while three papers described integrative medicine models/approaches in unspecified context (15,16,19). Described integrative medicine models/approaches from the included articles encompassed primary care, hospital/centre-level inpatient and outpatient services, and community-based programmes (three papers did not specify setting). ...
... Eight key elements were identified -setting, initial assessment, treatment approach, communication/interaction, shared treatment plan, shared decision-making, training/education and research. Definition of each identified key element is presented in Table 2. Initial assessment was done in various ways, either through conventional medicine (13)(14)(15)(16)(17)(19)(20)(21), an integrative team (18,19), self-referral (13-15), or CAM practitioner (16). ...
... Eight key elements were identified -setting, initial assessment, treatment approach, communication/interaction, shared treatment plan, shared decision-making, training/education and research. Definition of each identified key element is presented in Table 2. Initial assessment was done in various ways, either through conventional medicine (13)(14)(15)(16)(17)(19)(20)(21), an integrative team (18,19), self-referral (13-15), or CAM practitioner (16). ...
Findings from a rapid review commissioned by the Traditional and Complementary Division, Ministry of Health Malaysia; aimed at exploring integrative medicine approaches published in literature.
... In medical settings, IM has been applied in some nations, for example, in the USA [4,7], Australia [8,9], China and India [1,10], and European nations such as the UK, Sweden, and Denmark [9]. IM has also been applied for particular health services such as chronic disease management and palliative care [8,9,11]. ...
... In medical settings, IM has been applied in some nations, for example, in the USA [4,7], Australia [8,9], China and India [1,10], and European nations such as the UK, Sweden, and Denmark [9]. IM has also been applied for particular health services such as chronic disease management and palliative care [8,9,11]. ...
... In medical settings, IM has been applied in some nations, for example, in the USA [4,7], Australia [8,9], China and India [1,10], and European nations such as the UK, Sweden, and Denmark [9]. IM has also been applied for particular health services such as chronic disease management and palliative care [8,9,11]. The implementation of IM in these conventional health services followed various models or frameworks, and were dominated with general practitioners (GPs) as the gatekeepers [8,9]. ...
Background: Integrative medicine (IM), which is the integration of complementary and alternative medicine (CAM) into conventional health services, has been applied in some nations. Despite its highly relevant holistic approach with the improvement of mental health care using person-centred approach, there are limited studies that discuss IM, specifically in clinical psychology. Therefore, this qualitative study aimed to explore the perspectives of Indonesian clinical psychologists (CPs) on the possibilities and challenges of IM implementation in clinical psychology.
Methods: Semi-structured interviews with 43 CPs who worked in public health centres were conducted between November 2016 and January 2017. A maximum variation sampling was used. Thematic analysis of interview transcripts was applied considering its flexibility to report and examine explicit and latent contents.
Results: Three themes were identified from the analysis. First, the possibility of IM implementation in clinical psychology, which revealed two possible options that were centred on creating co-located services. Second, the challenges that covered (a) credibility, (b) acceptance, (c) procedure and facility, and (d) understanding and skill. Lastly, participants proposed four strategies to overcome these challenges, including: (a) certification, (b) facilities, (c) dialogue, and (d) regulations.
Conclusion: Participants recognised the possibility of IM implementation in clinical psychology, particularly in clinical psychology services. This IM implementation may face challenges that could be overcome by dialogue between CPs and CAM practitioners as well as clear regulation from the government and professional psychology association.
... We found multiple studies in both HIEs and LMIEs that addressed the dynamics of marginalization and exclusion and the structural and other barriers to recognition and integration of T&CM practices and practitioners. 119,130,174,183,187,188,216,228,255,395,399,479,505 In a study of complementary and alternative medicine (CAM) regulation in 39 European countries, Wiesener & colleagues 551 concluded that the variation in regulation of CAM may represent a substantial lack of common risk understandings between health policymakers in Europe and that the discrepancies in regulation are to a considerable degree also based on factors unrelated to patient risk. They propose that to address patient safety, policy makers should apply the WHO patient safety definitions and EU's policy to facilitate access to "safe and high-quality health care", and regulate CAM accordingly. ...
... • studies that applied evidence-informed policy making and regulatory impact assessment processes to determine whether to regulate a T&CM profession 66,119(pp186-202), 237,304,305,364,527 • studies of the outcomes of complaints-handling and disciplinary processes conducted by statutory regulators in Australia and New Zealand 305,471 • studies that described some of the challenges associated with regulation of T&CM professions within a dominant Western biomedical paradigm [254][255][256][257][258]395,399,467,505,551 For those T&CM professions already subject to statutory registration (for example, chiropractic, osteopathy and traditional Chinese medicine in the US, Canada and Australia), the literature suggests that this model of regulation can work just as well for the T&CM professions as for other professions. 305,471,482 The literature shows a typical range of research concerns such as the content of accreditation standards, 261,262 evidence based national examinations 13,111,464,496 and the effectiveness of complaint handling and disciplinary processes. ...
Health systems worldwide face considerable challenges in recruiting, training, distributing and retaining a sufficiently skilled and competent workforce when and where it is needed. Brought into sharp focus by the COVID-19 pandemic, these challenges are compounded by the myriad of changes to health systems and workforces – increasing volume and privatization of health practitioner education; accelerating health workforce international mobility and cross-border service delivery; more team-based models of care; and the growing importance of unregulated health workers, such as in community support and traditional and complementary medicine (T&CM).
In response to these complex demands, some governments have reformed health practitioner regulation (HPR) systems to better serve the public interest. 8,47,118,119,128,189 Strengthening the way health practitioners are regulated can help to assure the safety and effectiveness of the health workforce and foster the flexibility and innovation needed to better meet population needs.
There is increasing recognition that HPR systems have an essential role to play in supporting health workforce availability, accessibility, acceptability, quality, and sustainability that is fundamental to achieving Universal Health Coverage (UHC) and the Sustainable Development Goals (SDGs). 541,541 HPR can optimize the capability of the existing health workforce and assist in better aligning health workforce investments with health system needs. 128,189,541 There are significant gaps in our knowledge about leading HPR policy and practice, such as which regulatory models, institutional governance and core regulatory functions work best in different contexts, particularly in low and lower-middle income economies (LMIEs).
This large-scale rapid review examines the diversity of regulatory principles, elements, and approaches to developing, implementing, and strengthening HPR. The aim is to identify the evidence base around HPR design and delivery, to help governments, regulators and other stakeholders better achieve health workforce and health system goals. The World Health Organization (WHO) commissioned this review to assist in the preparation of new global guidance on HPR.
... 7 Refining competencies in the provision of IM within general practice is an advanced skill, however relatively little is known about how GPs acquire this advanced skill. While some Australian studies have explored GPs' IM attitudes, knowledge, and information sources, 3,5,[8][9][10][11][12][13] there have been few studies published since 2010. To understand the current IM education needs of GPs and GPs in training in Australia, we conducted a mixed-methods study. ...
... The findings expand upon and update the pre-existing literature on GPs' attitudes, information sources, and provision of IM services in Australia. 3,5,[8][9][10][11][12][13] The importance of establishing national IM education and accreditation pathways that promote safe, evidence-based use of IM was identified. This included support for post-fellowship specialty recognition by the RACGP of GPs who have attained advanced skills in IM. ...
Background
Globally, a substantial proportion of general practitioners (GPs) incorporate integrative medicine (IM) into their clinical practice.
Objective
This study aimed to map the IM education and training pathways and needs of a cohort of Australian GPs who are members of the Royal Australian College of General Practitioners’ IM Specific Interest Network, which is a group of GPs with interest in IM.
Methods
We conducted a mixed-methods study comprising of an online, cross-sectional survey supplemented with in-depth semi-structured interviews. Data from the survey and interviews were initially analysed separately and then combined.
Results
Eighty-three (83) of 505 eligible GPs/GPs in training (16.4%) participated in the survey, and 15 GPs were interviewed. Results from the two datasets either converged or were complementary. Almost half (47%) of survey respondents had undertaken formal undergraduate or postgraduate IM education, a short course (63%), informal education (71%) or self-education (54%), in at least one of 20 IM modalities listed. Interviewees affirmed there was no single education pathway in IM. Survey respondents who identified as practicing IM were significantly more likely to have IM education, positive attitudes towards IM, particularly natural products, and higher self-rated IM knowledge and competencies. However, knowledge gaps were identified in professional skills domains of population health and context, and organisational and legal dimensions of applied IM practice. Interviewees also highlighted a range of professional and systemic barriers to the practice of IM, education, and training. There was broad support for recognition of IM as a sub-specialty through formalised post-graduate training and accreditation. Most survey respondents (62%) expressed interest in post-fellowship recognition of GPs with advanced skills in IM.
Conclusion
Our findings demonstrate that it is important to define best practice in IM for GPs in Australia and provide a standardised pathway towards recognition of advanced skills in IM.
... Many practitioners reported non-integration through referral pathways into health care settings. Barriers to interprofessional referrals have been cited as being due to biomedical dominance and a lack of clarity about each other's roles [54][55][56]. Cross-professional education and training about practices, mutual understanding of responsibilities and limitations, and processes including formal correspondence may assist overcoming these barriers, which is important because failures in interprofessional communication are a leading cause of patient harm [29,54,56]. As TCM represents 11% of primary care capability in rural areas of Australia [57] and acupuncturists up to 8.8% of services for women with other reproductive needs, [58] improved integration and shared care could improve safety as well as continuity of care and the healthcare experiences of women with CPP. ...
... Barriers to interprofessional referrals have been cited as being due to biomedical dominance and a lack of clarity about each other's roles [54][55][56]. Cross-professional education and training about practices, mutual understanding of responsibilities and limitations, and processes including formal correspondence may assist overcoming these barriers, which is important because failures in interprofessional communication are a leading cause of patient harm [29,54,56]. As TCM represents 11% of primary care capability in rural areas of Australia [57] and acupuncturists up to 8.8% of services for women with other reproductive needs, [58] improved integration and shared care could improve safety as well as continuity of care and the healthcare experiences of women with CPP. ...
Background
Chronic pelvic pain (CPP) in women is persistent, intermittent cyclical and non-cyclical lower abdominal pain, lasting for more than 6 months. Traditional Chinese Medicine (TCM) is a popular treatment option for women’s health conditions, but little is known about how treatment for CPP is delivered by TCM practitioners. The aim of this survey was to explore practitioners understanding and treatment of women with CPP, and how they integrate their management and care into the health care system.
Method
An online cross-sectional survey of registered TCM practitioners in Australia and New Zealand between May and October 2018. Survey domains included treatment characteristics (e.g. frequency), evaluation of treatment efficacy, referral networks, and sources of information that informed clinical decision making.
Results
One hundred and twenty-two registered TCM practitioners responded to this survey, 91.7% reported regular treatment of women with CPP. Treatment decisions were most-often guided by a combination of biomedical and TCM diagnosis (77.6%), and once per week was the most common treatment frequency (66.7%) for acupuncture. Meditation (63.7%) and dietary changes (57.8%) were other commonly used approaches to management.
The effectiveness of treatment was assessed using multiple approaches, most commonly pain scales, (such as the numeric rating scale) and any change in use of analgesic medications. Limitations to TCM treatment were reported by over three quarters (83.7%) of practitioners, most commonly due to cost (56.5%) and inconvenience (40.2%) rather than safety or lack of efficacy. Sources informing practice were most often Integration within the wider healthcare system was common with over two thirds (67.9%) receiving referrals from health care providers.
Conclusion
TCM practitioners seeing women with various CPP symptoms, commonly incorporate both traditional and modern diagnostic methods to inform their treatment plan, monitor treatment progress using commonly accepted approaches and measures and often as a part of multidisciplinary healthcare for women with CPP.
... Barriers to interprofessional referrals have been cited as being due to biomedical dominance and a lack of clarity about each other's roles. (56)(57)(58) Cross-professional education and training about practices, mutual understanding of responsibilities and limitations, and processes including formal correspondence may assist overcoming these barriers, which is important because failures in interprofessional communication are a leading cause of patient harm. (30,56,58) As TCM represents 11% of primary care capability in rural areas of Australia (59) and acupuncturists up to 8.8% of services for women with other reproductive needs,(60) improved integration and shared care could improve safety as well as continuity of care and the healthcare experiences of women with CPP. ...
... (56)(57)(58) Cross-professional education and training about practices, mutual understanding of responsibilities and limitations, and processes including formal correspondence may assist overcoming these barriers, which is important because failures in interprofessional communication are a leading cause of patient harm. (30,56,58) As TCM represents 11% of primary care capability in rural areas of Australia (59) and acupuncturists up to 8.8% of services for women with other reproductive needs,(60) improved integration and shared care could improve safety as well as continuity of care and the healthcare experiences of women with CPP. TCM as part of multidisciplinary clinical care for women with CPP due to endometriosis, has been shown to improve women's self-e cacy by cultivating con dence and resilience, relieving social isolation and improving quality of life. ...
Background Chronic pelvic pain (CPP) in women is persistent, intermittent cyclical and non-cyclical lower abdominal pain, lasting for more than 6 months. Traditional Chinese Medicine (TCM) is a popular treatment option for women’s health conditions, but little is known about how treatment for CPP is delivered by TCM practitioners. The aim of this survey was to explore practitioners understanding and treatment of women with CPP, and how they integrate their management and care into the health care system.
Method An online cross-sectional survey of registered TCM practitioners in Australia and New Zealand. Survey domains included treatment characteristics (e.g. frequency), evaluation of treatment efficacy, referral networks, and sources of information that informed clinical decision making.
Results One hundred and twenty-two registered TCM practitioners responded to this survey, 91.7% reported regular treatment of women with CPP. Treatment decisions were most-often guided by a combination of biomedical and TCM diagnosis (77.6%), and once per week was the most common treatment frequency (66.7%) for acupuncture. Meditation (63.7%) and dietary changes (57.8%) were other commonly used approaches to management.
The effectiveness of treatment was assessed using multiple approaches, most commonly pain scales, (such as the numeric rating scale) and any change in use of analgesic medications. Limitations to TCM treatment were reported by over three quarters (83.7%) of practitioners, most commonly due to cost (56.5%) and inconvenience (40.2%) rather than safety or lack of efficacy. Integration within the wider healthcare system was common with over two thirds (67.9%) receiving referrals from health care providers.
Conclusion TCM practitioners seeing women with various CPP symptoms, commonly incorporate both traditional and modern diagnostic methods to inform their treatment plan, monitor treatment progress using commonly accepted approaches and measures and often as a part of multidisciplinary healthcare for women with CPP.
... This model is more common in the USA than the UK -see Vohra et al [11]. In the UK the 'additive' model is more likely, including conventional medical practitioners practising CAM, CAM practitioners delivering treatments on NHS premises [12][13][14], or referral from NHS to CAM, similar to social prescribing [15]. ...
... At three sites, GPs referred to the broader service e.g. social prescribing [15], physiotherapy or pain clinic. Three sites accepted other NHS professional' referrals and one (York Learning mindfulness) accepted non-NHS referrals (e.g. ...
Introduction: Complementary and alternative medicine (CAM), often accessed privately, can be integrated with conventional care. Little is known about current integration in the UK National Health Service (NHS). We provide an overview of integrated CAM services accessed from UK primary care for musculoskeletal and mental health conditions, to identify key features and barriers and facilitators to integration. Methods: Descriptive analysis of integrated services accessed from primary care providing CAM alongside conventional NHS care for musculoskeletal and/or mental health problems. A purposive sample was identified through personal contacts, social media, literature/internet searches, conferences, and patient/professional organisations. Questionnaires, documentary analysis and stakeholder meetings collected data on the service's history, features, integration, success and sustainability. Data was tabulated. Results: From 38 sites identified, twenty sites were selected. Acupuncture and homeopathy were most common, followed by massage, osteopathy and mindfulness. GPs were often instrumental initiating services. NHS staff enthusiasm facilitated integration, as did an NHS setting, patient/public support, and being adjunctive to an NHS service. The main barriers to integration were funding, negative perceptions of CAM from the clinicians, funders and lobby groups, and local NHS staff attitudes/lack of knowledge. Reduced funding was often why services closed. Conclusions: Various models for integrating CAM with UK primary care were identified. Social prescribing and NHS/patient co-funded CAM may be potentially sustainable models for future integration. Lack of funding and negative perceptions of CAM remain the primary challenge to integration. Evaluating effectiveness and cost-effectiveness of integrated services is vital to ensure sustainability.
... [18][19][20] Integrative medical research, like stem cell research, human leukocyte antigen and tissue typing, molecular and cytogenetics, etc., are also experiencing continuous growth and evolution, driven by advancements in technology, increased understanding of diseases at the molecular level, and it is now the gateway to the global collaboration of researchers. 21 Technological advancements such as high-throughput technologies, such as genomics, proteomics, and imaging, have revolutionized medical assessments and examinations to more practical and clinicalbased knowledge and performance. 6 At the lowest level of the pyramid is "knowledge," tested by traditional examinations, multiple-choice questions, etc. ...
... A similar range of research concerns was found, such as the content of accreditation standards [309,310], implementing evidence-based national examinations [24,[311][312][313], regulatory strengthening [314,315], and regulating scopes of practice [297,304,[316][317][318][319]. Studies note some of the policy challenges and adjustments required when applying statutory registration to the T&CM occupations, such as evaluating risk, protecting traditional knowledge, applying flexible language requirements, or delivering care to underserved populations [291,297,[316][317][318][320][321][322][323][324][325][326]. ...
Background
Health practitioner regulation (HPR) systems are increasingly recognized as playing an important role in supporting health workforce availability, accessibility, quality, and sustainability, while promoting patient safety. This review aimed to identify evidence on the design, delivery and effectiveness of HPR to inform policy decisions.
Methods
We conducted an integrative analysis of literature published between 2010 and 2021. Fourteen databases were systematically searched, with data extracted and synthesized based on a modified Donabedian framework.
Findings
This large-scale review synthesized evidence from a range of academic (n = 410) and grey literature (n = 426) relevant to HPR. We identified key themes and findings for a series of HPR topics organized according to our structures–processes–outcomes conceptual framework. Governance reforms in HPR are shifting towards multi-profession regulators, enhanced accountability, and risk-based approaches; however, comparisons between HPR models were complicated by a lack of a standardized HPR typology. HPR can support government workforce strategies, despite persisting challenges in cross-border recognition of qualifications and portability of registration. Scope of practice reform adapted to modern health systems can improve access and quality. Alternatives to statutory registration for lower-risk health occupations can improve services and protect the public, while standardized evaluation frameworks can aid regulatory strengthening. Knowledge gaps remain around the outcomes and effectiveness of HPR processes, including continuing professional development models, national licensing examinations, accreditation of health practitioner education programs, mandatory reporting obligations, remediation programs, and statutory registration of traditional and complementary medicine practitioners.
Conclusion
We identified key themes, issues, and evidence gaps valuable for governments, regulators, and health system leaders. We also identified evidence base limitations that warrant caution when interpreting and generalizing the results across jurisdictions and professions. Themes and findings reflect interests and concerns in high-income Anglophone countries where most literature originated. Most studies were descriptive, resulting in a low certainty of evidence. To inform regulatory design and reform, research funders and governments should prioritize evidence on regulatory outcomes, including innovative approaches we identified in our review. Additionally, a systematic approach is needed to track and evaluate the impact of regulatory interventions and innovations on achieving health workforce and health systems goals.
... Complementary Medicine (T&CM) involves a variety of different medical therapies that are mainly used outside conventional healthcare. However, T&CM and modern medicine are now offered together in an integrative healthcare approach in many modern medicine centers [1,2]. Traditional medicine refers to practices based on the indigenous culture. ...
Background: Traditional medicine is an ancient nonconventional method of treating a variety of diseases in diverse cultures of the Eastern world, and currently its potential value has been recognized around the world. Objective: The aim of this study was to evaluate the current use of traditional and complementary Original Research Article Al-Bedah et al.; JOCAMR, 4(1): 1-10, 2017; Article no.JOCAMR.36711 2 medicine (T&CM) in Qassim province and to determine the users' profile and the most common T&CM therapies used in Saudi Arabia. Methods: A cross-sectional study of primary healthcare (PHC, n=16) attendees (n=285, response rate=71.3%) using a self-designed reliable questionnaire concerning their sociodemographic variables and T&CM use. Results: Besides revealing some sociodemographic characteristics and associations with traditional medicine, about 62% of participants used T&CM and 57.5% of participants reported T&CM as part of their indigenous inherited tradition. The main traditional practices including religious and spiritual healings, herbs, cupping (Al-Hijamah), cautery and honey and bee products were used most importantly for the treatment of diverse chronic health conditions by females, the two predictors of T&CM use. Ministry of Health (MOH) should offer T&CM in all public healthcare settings and should regulate its practice in private sector in order to safeguard patient affairs including holistic care and patient-centered medicine. Conclusion: Traditional indigenous therapies especially culture-based are widely used by PHC patients in Qassim province. The National Survey is needed to draw a more comprehensive epidemiological trend of T&CM use in Saudi Arabia and by extension in other Gulf countries.
... Complementary Medicine (T&CM) involves a variety of different medical therapies that are mainly used outside conventional healthcare. However, T&CM and modern medicine are now offered together in an integrative healthcare approach in many modern medicine centers [1,2]. Traditional medicine refers to practices based on the indigenous culture. ...
Background: Traditional medicine is an ancient nonconventional method of treating a variety of diseases in diverse cultures of the Eastern world, and currently its potential value has been recognized around the world. Objective: The aim of this study was to evaluate the current use of traditional and complementary Original Research Article Al-Bedah et al.; JOCAMR, 4(1): 1-10, 2017; Article no.JOCAMR.36711 2 medicine (T&CM) in Qassim province and to determine the users' profile and the most common T&CM therapies used in Saudi Arabia. Methods: A cross-sectional study of primary healthcare (PHC, n=16) attendees (n=285, response rate=71.3%) using a self-designed reliable questionnaire concerning their sociodemographic variables and T&CM use. Results: Besides revealing some sociodemographic characteristics and associations with traditional medicine, about 62% of participants used T&CM and 57.5% of participants reported T&CM as part of their indigenous inherited tradition. The main traditional practices including religious and spiritual healings, herbs, cupping (Al-Hijamah), cautery and honey and bee products were used most importantly for the treatment of diverse chronic health conditions by females, the two predictors of T&CM use. Ministry of Health (MOH) should offer T&CM in all public healthcare settings and should regulate its practice in private sector in order to safeguard patient affairs including holistic care and patient-centered medicine. Conclusion: Traditional indigenous therapies especially culture-based are widely used by PHC patients in Qassim province. The National Survey is needed to draw a more comprehensive epidemiological trend of T&CM use in Saudi Arabia and by extension in other Gulf countries.
... A similar range of research concerns was found, such as the content of accreditation standards (306,307), implementing evidence-based national examinations (20,(308)(309)(310), regulatory strengthening (311,312), and regulating scopes of practice (294,301,(313)(314)(315)(316). Studies note some of the policy challenges and adjustments required when applying statutory registration to the T&CM occupations, such as evaluating risk, protecting traditional knowledge, applying exible language requirements, or delivering care to underserved populations (288,294,(313)(314)(315)(317)(318)(319)(320)(321)(322)(323). ...
Background: In addition to promoting patient safety, health practitioner regulation (HPR) systems are increasingly recognized as playing an important role in supporting health workforce availability, accessibility, quality, and sustainability. This review aimed to identify the evidence on the design, delivery and effectiveness of HPR systems to inform policy decisions by policymakers and regulators.
Methods: A rapid review approach was adopted to conduct an integrative analysis of literature published between 2010 and 2021. Fourteen databases were searched according to a standardized strategy. Data were extracted and synthesized through an integrative approach and categorized according to a modified Donabedian framework.
Results We identified 410 academic and 426 grey literature sources. Key themes included HPR structures (regulatory governance systems, regulatory institutions, and system linkages), processes (registration and monitoring of continuing competence of practitioners, accreditation of entry-to-practice education programs, regulating scopes of practice, managing complaints and discipline, and regulating traditional and complementary medicine) and outcomes (impact of HPR structures and processes on health system and workforce outcomes). More evidence was found on HPR structures and processes than outcomes, though over 99% of studies were descriptive (and evidence, accordingly, of very low certainty). Synthesis was constrained by the lack of common terminology.
Discussion: Trends on regulatory structures and processes emerged from this analysis. The evidence base limitations, particularly on HPR outcomes, warrant caution in the interpretation, generalizability, and applicability of these findings. Standardized terminology and more evidence on regulatory outcomes (on both workforce and health systems) could inform decisions on regulatory design and implementation.
... Esto puede depender de la selección de evidencia que, por un lado, puede ser una combinación entre evidencia basada en criterios biomédicos más la integración de evidencia basada en experiencia, tanto de los practicantes biomédicos como de las medicinas no convencionales. Por otro lado, puede presentarse una incorporación selectiva de las prácticas terapéuticas no convencionales que han sido avaladas exclusivamente por los criterios de la biomedicina (Templeman & Robinson, 2011). ...
Existe una demanda de una diversidad de sistemas y modelos terapéuticos que se muestran subordinados ante el modelo médico hegemónico, como eje rector de la eficacia y seguridad. En la mayoría de los discursos internacionales e investigaciones se plantea una disputa entre dos sistemas: el biomédico o convencional y las denominadas medicinas no convencionales. Este artículo tiene como objetivo discutir los términos relacionados con las denominadas medicinas no convencionales y las implicaciones de establecer las prácticas biomédicas como mecanismo de validación en la articulación de las medicinas no convencionales en el sistema de salud. Para dicho propósito, el estudio se basa de fuentes documentales. Se consultaron metabuscadores y buscadores genéricos como Google Scholar para la exploración de artículos originales y de revisión elaborados en el periodo 2002 y 2020 en español, inglés y portugués. En primer lugar, se describe la incorporación de las medicinas no convencionales en los discursos de la OMS y la OPS como actores relevantes que alinean las políticas nacionales sobre las medicinas no convencionales; en segundo lugar, se presenta una discusión sobre las principales diferencias en el uso de los términos relacionados con las medicinas no convencionales: alternativa, complementaria e integrativa y, finalmente, se exponen las implicaciones de establecer los criterios metodológicos de la biomedicina como elemento de validación de las medicinas no convencionales.
... 14 Thus the integration of CIH in primary care -whether that involves a team-based care approach within a clinic, CIH offerings by a dually-trained primary care provider, or referral to a CIH provider in the community -can increase patients' access to these important services and potentially improve health outcomes. 15 To promote CIH within the context of primary care in the United States, it is critical that providers have sufficient knowledge of complementary therapies, access to CIH providers (whether in local community or within the clinic), are comfortable co-managing patient care with a CIH provider, and feel supported to move forward in this aspect of care delivery. 16 This study was designed to explore current aspects of CIH among primary care providers in a northwestern region of the U.S. where there is significant regional diversity in order to guide future next steps in these realms of education, co-management among CIH colleagues, and CIH integration into care. ...
Background
The demand for complementary and integrative health (CIH) is increasing by patients who want to receive more CIH referrals, in-clinic services, and overall care delivery. To promote CIH within the context of primary care, it is critical that providers have sufficient knowledge of CIH, access to CIH-trained providers for referral purposes, and are comfortable either providing services or co-managing patients who favor a CIH approach to their healthcare.
Objective
The main objective was to gather primary care providers’ perspectives across the northwestern region of the United States on their CIH familiarity and knowledge, clinic barriers and opportunities, and education and training needs.
Methods
We conducted an online, quantitative survey through an email invitation to all primary care providers (n = 483) at 11 primary care organizations from the WWAMI (Washington, Wyoming, Alaska, Montana and Idaho) region Practice and Research Network (WPRN). The survey questions covered talking about CIH with patients, co-managing care with CIH providers, familiarity with and training in CIH modalities, clinic barriers to CIH integration, and interest in learning more about CIH modalities.
Results
218 primary care providers completed the survey (45% response rate). Familiarity with individual CIH methods ranged from 73% (chiropracty) to 8% (curanderismo). Most respondents discussed CIH with their patients (88%), and many thought that their patients could benefit from CIH (41%). The majority (89%) were willing to co-manage a patient with a CIH provider. Approximately one-third of respondents had some expertise in at least one CIH modality. Over 78% were interested in learning more about the safety and efficacy of at least one CIH modality.
Conclusion
Primary care providers in the Northwestern United States are generally familiar with CIH modalities, are interested in referring and co-managing care with CIH providers, and would like to have more learning opportunities to increase knowledge of CIH.
... In most countries around the world, CAM services is often integrated as a mechanism for addressing therapeutic gaps in the management of chronic and acute illnesses, maintaining health and improving the quality of health care [7,8,9,10,11,12,13,14,15,16,17,18,19], to deliver a client-centred and holistic primary health care service, and promote mutual respect among practitioners of CAM and conventional medicine [20]. In sum, proponents have noted that integration creates better health care experience, is culturally acceptable, improves accessibility and availability of services, decreases the cost of health care delivery and promotes better health outcomes. ...
Background This study explores healthcare managers’ perspective of integration of CAM service into Ledzorkuku Krowor Municipal (LEKMA) Hospital in Ghana.
Methods A questionnaire on CAM services integration was constructed and distributed to all 9 healthcare managers at the Ledzorkuku Krowor Municipal (LEKMA) Hospital.
Results The level of integration of CAM services into the health care system was good. The overall self-reported depth of integration was found to be good (2.23), the self-reported extent of was 100% and perceived scope of integration was classified as excellent (90.1%). The drivers of integration process were made up of 7 (19.1%) of the elements of integration functions (47) assessed.
Conclusion The drivers of integration were mainly the elements of integration functions of patient satisfaction, right of patients to use other services, interpersonal systems, monitoring and supervision systems, nature of working relationship among staff, reporting, and financial management.
... So far, however, established IHC units seem to lack standardization [13]. The CAM therapies offered by IHC units are, furthermore, not always based on patients' needs and wishes but on the CHC staff´s limited knowledge of existing CAM therapies [14][15]. One possible reason is that most medical and nursing schools in most countries do not offer courses on CAM knowledge [3,16]; a potential consequence is that uninformed CHC staff are unlikely to choose CAM therapies for integration if they do not know the way the treatment processes work and are unaware of existing evidence about them. ...
Introduction
: This study focuses on Rosen Method Bodywork, which consists of gentle body touching. Contemporary scientific knowledge focuses on how the treatments work or on clients’ perceptions; practitioners’ experiences are quite unexplored. In order to reach a better understanding of the therapy their opinion is important. The aim of this study was to describe practitioners’ views on client interaction and the treatments, and how they regard client safety and protect their clients.
Method
: The study was qualitative and descriptive. Data was collected by semi-structured interviews with ten private-practicing certified Swedish Rosen Method Bodywork practitioners and analyzed by content analysis.
Results
: Rosen Method Bodywork training was described to develop trainee practitioners’ interactive skills, self-knowledge and an embodied awareness of what future clients may experience. Before treatment, practitioners perform risk assessments as touching may release demanding responses in clients. Clients were regarded as co-equal with own responsibility for the treatment. In treatment, it was considered important to create a supportive environment and adapt touching to each client´s individual condition and responses, and by this balancing and controlling the client´s process. Clients are not followed up regularly during the post-treatment phase.
Conclusion
: The client interaction resonates with the principles of person-centred healthcare. The practitioners showed consciousness of potential risks although some critical aspects, due to contextual ruling principles, that might affect client safety or well-being are identified. Collaboration between conventional health care providers and Rosen Method Bodywork practitioners might benefit clients concerning risk assessments or other client safety related issues.
... One of the main objectives to look for a new model of IM that could be successfully applied to goal #3 of SDG of UN 2030 Agenda [33] is to find a cheaper and more effective method of diagnosis and treatment for the patient and therefore be a value-based medicine (complementing evidence-based medicine) [34], as well as, providing a scientific explanation for "spontaneous" cures [35], and a philosophical perspective on "life after death" [36]. In this regard, it should be mentioned that an essential factor in the models of IM is the emphasis on the patient's self-awareness for the success of the healing process (described in Figure 1), whereas the conventional Cartesian model of health care, it heals only the patient´s physical body, without changing the patterns that gave rise to the disease [37]. ...
This article on models of integrative medicine (IM) for health care in contemporary
society aims to address the various factors that could contribute more effectively to
address goal # 3 (“Ensure healthy lives and promote well-being for all at all ages”) of
Sustainable Development Goals (SDG) of United Nations (UN) 2030 Agenda.
... 6 Despite this demand, IHC remains a peripheral healthcare model that has been described as mixed-level integration. 7 Most IHC services are provided by the private sector in the primary care setting, 8,9 with limited provision of IHC in hospital environments. 10 In contrast, other Asian/Western Pacific countries such as the People's Republic of China, Japan and the Republic of Korea, have well-established integration. ...
Objectives
This qualitative study aimed to explore medical specialists’ perspectives on a proposed academic integrative healthcare (IHC) centre to be established in their local district.
Methods
A convenience sample of medical specialists were recruited via direct email invitations that was augmented with snowball sampling until data saturation was reached. The in-depth, semi-structured interviews were conducted via telephone, audio recorded and transcribed verbatim, followed by a thematic analysis.
Results
Eight participants took part in the study. Three main themes emerged: 1) the benefits of an academic setting, 2) sound clinical governance, and 3) specialists in the field of TCIM. Underpinning the three themes was the belief that patients were at risk of harm due to haphazard, unsupervised use of unproven traditional, complementary and integrative medicine (TCIM). It was anticipated that an academic centre would address these issues with appropriate risk management protocols, effective interprofessional communication and by upholding the principles of evidence-based practice to ensure safe and coordinated patient-centered care. Opportunities from collaborations within secondary care included centre being recognized as specialists in the field of TCIM, conducting research and bidirectional learning.
Conclusions
The findings demonstrated that medical specialists acknowledged the need for a TCIM model of care that interfaces with the local secondary care landscape through the implementation of sound safeguards, credentialed practitioners, and evidence-based practice to adequately protect patients and clinicians. The findings will be amalgamated with the input from other stakeholder groups via a community-based participatory research framework to refine the model of care.
... 54,55 Several authors have focussed on this theme and others around the inequality within the interprofessional partnerships that dominate integrative approaches. [56][57][58] The traditional Chinese medicine (TCM) approach, or eastern style of acupuncture, is based on concepts such as yin and yang, qi theory, five element theory, meridian theory and traditional diagnostic methods of oriental medicine, including tongue and pulse diagnosis. The acupuncture participants in this study all practised eastern style acupuncture and directly related to these concepts. ...
Background
In recent years more health service users are utilising complementary and alternative medicine (CAM), including acupuncture, for the management of their health. Currently general practitioners (GPs), in most cases, act as the primary provider and access point for further services and also play an important role in integrated care management. However, the interaction and collaboration between GPs and acupuncturists in relation to shared care has not been investigated.
This research explored interprofessional communication between GPs and acupuncturists in New Zealand. This article reports specifically the acupuncturists’ viewpoints.
Methods
This study formed part of a larger mixed methods trial investigating barriers and facilitators to communication and collaboration between acupuncturists and general practitioners in New Zealand. Semi structured interviews of 13 purposively sampled acupuncture participants were conducted and analysed using thematic analysis.
Results
The data analysis identified both facilitators and barriers to integrative care. Facilitators included a willingness to engage, and the desire to support patient choice. Barriers included the limited opportunities for sharing of information and the lack of current established pathways for communication or direct referrals. The role evidence played in integrative practice provided complex and contrasting narratives.
Conclusions
This research contributes to the body of knowledge concerning communication and collaboration between GPs and acupuncturists, and suggests that by facilitating communication and collaboration, acupuncture can provide a significant component of integrated care packages. This research provides context within a New Zealand health care setting, and also provides insight through the disaggregation of specific provider groups for analysis, rather than a grouping together of CAM as a whole.
... These finding are consistent with other research which have explored the use of CAM and biomedicine. [12,54,55], and oppose the popular notion of "us versus them" when describing CAM and biomedicine, when, in fact, the reality reflects a more integrated approach by parents of children with ARTI. ...
Background
Acute respiratory tract infection (ARTI) is a prevalent condition associated with serious health and economic implications. A range of strategies is used to manage ARTI in children, including complementary and alternative medicines (CAM). There has been little investigation into this area, and this study aims to address this knowledge gap.
Methods
Primary carers of children aged from 0 to 12 years that utilised CAM for ARTI were invited to participate in the online survey in 2019. Survey data were analysed descriptively.
Results
The 246 surveyed parents specified the types of CAM frequently used to manage ARTI in their children were home-remedies. Reasons parents reported using CAM were personal-beliefs and positive past-experience with CAM practitioners. Information sources that parents consulted when decision-making were education, naturopaths, and journals.
Conclusion
Parents utilised diverse interventions, with home-remedies dominating the choice. Parents were most likely well-informed. Notably, parents indicated a preference for an integrative healthcare approach.
... Integrative medicine treatments for medical and psychiatric conditions are a rapidly growing area of research [1,2]. For example, recent reviews of meditation therapies report evidence of efficacy for improving conditions ranging from cardiovascular disease (CVD) to posttraumatic stress disorder (PTSD), along with a surge in interventional meditation research [3][4][5]. ...
... The Korean healthcare system has used Korean medicine and Western medicine treatment for a long time. Recently, not only has there been an increasing interest in integrative medicine from patients and the medical community in Korea, but also from around the globe [10][11][12][13][14][15], and these preferences may reduce the social costs, and complement limitations in both approaches to medicine [2]. An integrative healthcare system can also promote patients' autonomy in medical decision-making, and improve the quality and convenience of medical services [1,16]. ...
This review examined recently published (July 2014 to June 2017), randomized controlled trials (RCTs) which investigated the safety and effectiveness of combined Korean medicine/complementary alternative medicine (CAM) and Western medicine, to indicate the direction for integrative medical practice. The Korean Medicine Convergence Research Information Center evidence-based medicine database (KMCRIC EBM DB) was used to retrieve relevant RCTs indexed in the last 3 years. Study design, country, sample size, disease/condition with the Korean Standard Classification of Diseases code, interventions, direction of outcomes, and adverse events were extracted and summarized. A total of 93 RCTs were included in this review. Acupuncture/moxibustion was the most commonly used intervention ( n = 47; 51%), and 19% ( n = 18) of the studies treated musculoskeletal disorders, followed by circulatory disorders ( n = 16; 17%), and mental and behavioral disorders ( n = 9; 10%). Integrative treatment was reported as more effective than monotherapy in approximately 83% of these studies. Adverse events were poorly reported in most studies. This review suggests that integrative treatments are feasible, effective, and safe for various diseases/conditions, based on the evidence from recently published RCTs. Future studies on integrative healthcare are warranted.
... 20 However, the influence of medical dominance persists. 13,14,42,43 The WSIH center will, therefore, need to find a balance between becoming an exemplar of ''truly'' integrative practice and the pragmatic reality of providing health care in Australia where medical dominance prevails. ...
Objectives:
To engage with local primary care stakeholders to inform the model of care for a proposed academic integrative health care center incorporating evidence-informed traditional, complementary, and integrative medicine (TCIM) in Sydney, Australia.
Design:
In-depth semistructured interviews, informed by community-based participatory research principles, were conducted to explore primary care stakeholder preferences and service requirements regarding the proposed Western Sydney Integrative Health (WSIH) center in their local district.
Setting:
Telephone and face-to-face interviews at primary care clinics in Sydney.
Subjects:
Thirteen participants took part in the study: eight general practitioners (GPs) and five primary care practice managers (PMs).
Methods:
GPs were recruited through local GP newsletters, closed GP Facebook groups, and snowballing. PMs were recruited through a national PM newsletter. The semistructured interviews were audiorecorded and transcribed verbatim before conducting a thematic analysis.
Results:
Three main themes emerged: (1) the rationale for "why" the WSIH center should be established, (2) "what" was most important to provide, and (3) "how" the center could achieve these goals. Participants were willing to refer to the service, acknowledging the demand for TCIM, current gaps in chronic disease care, and negligible Government funding for TCIM. They endorsed a model of care that minimizes out-of-pocket costs for the underserved, incorporates medical oversight, integrates evidence-informed TCIM with conventional health care, builds trust through interprofessional communication and education, and provides sound clinical governance with a strong focus on credentialing and risk management. It was proposed that safety and quality standards are best met by a GP-led approach and evidence-based practice.
Conclusions:
Our findings demonstrate that participants acknowledged the need for a model of care that fits into the local landscape through integrating conventional health care with TCIM in a team-based environment, with medical/GP oversight to ensure sound clinical governance. Findings will be used with input from other stakeholder groups to refine the WSIH model of care.
... The way in which integration of T&CM and conventional healthcare should be delivered is being explored both theoretically and in many emergent practices [50,[55][56][57]. Consistent throughout these definitions and perceptions, however, is a desire from healthcare consumers to experience the best of both worlds, as expressed by our study participants who held various IHC concepts that spanned a continuum of intensity. ...
Background:
In response to high demand and the growing body of evidence for traditional and complementary therapies, the practice of integrative medicine and integrative healthcare has emerged where these therapies are blended with conventional healthcare. While there are a number of academic integrative healthcare centres worldwide, there are none in Australia. Western Sydney University will soon establish an academic integrative healthcare centre offering evidence-informed traditional and complementary therapies integrated with conventional healthcare in a research-based culture. The aim of this study was to explore healthcare consumers' views about the perceived need, advantages, and disadvantages of the proposed centre and its relevance to community-defined problems and health and service needs.
Methods:
Qualitative methods, informed by community-based participatory research, were used during 2017. Focus groups supplemented with semi-structured interviews were conducted with healthcare consumers. Participants were recruited through paid advertisements on Facebook. Thematic coding, informed by an integrative healthcare continuum, was used to analyse and organise the data. Analysis was augmented with descriptive statistics of participant demographic details.
Results:
Three main themes emerged: (i) the integrative approach, (i) person-centred care, and (iii) safety and quality. Participants proposed a coordinated healthcare model, with perspectives falling along a continuum from parallel and consultative to fully integrative models of healthcare. The importance of multidisciplinary collaboration and culturally appropriate, team-based care within a supportive healing environment was emphasised. A priority of providing broad and holistic healthcare that was person centred and treated the whole person was valued. It was proposed that safety and quality standards be met by medical oversight, evidence-informed practice, practitioner competency, and interprofessional communication.
Conclusions:
Our findings demonstrate that participants desired greater integration of conventional healthcare with traditional and complementary therapies within a team-based, person-centred environment with assurances of safety and quality. Findings will be used to refine the model of care for an academic integrative healthcare centre in Western Sydney.
... Minimally invasive therapies have been already definitely recommended in practice guidelines for CNCP management. 41 Integrative medicine, a holistic model of care which aims to selectively combine the exclusively evidence-based complementary and alternative therapies into conventional medicine, 42 has risen in popularity in recent years among patients and medical providers for the relief of chronic or multifactorial conditions such as CNCP. 43 It is a combination of medical treatments such as acupuncture, massage relaxation techniques, healing touch, etc. 44,45 Clinical studies have shown that acupuncture is a reasonable effective option for multiple chronic pain conditions. ...
Introduction
From 1986, the World Health Organization (WHO) analgesic ladder has been used as the simple and valuable pain-relieving guidance in the pharmaceutical pain management, however, with the development of medical history, notions about pain physiology and pain management have already updated. Is the analgesic ladder still appropriate for chronic non-cancer pain (CNCP) patients? This study aims to analyse the current usage of the analgesic ladder in patients with CNCP by evaluating previously published pertinent studies.
Methods
Literature published in English from January 1980 to April 2019 and cited on PubMed database was included. Analysis on the analgesic ladder, current status of CNCP management, and a new revised ladder model were developed based on relevant literature.
Results
The WHO analgesic ladder for cancer pain is not appropriate for current CNCP management. It is revised into a four-step ladder: the integrative therapies being adopted at each step for reducing or even stopping the use of opioid analgesics; interventional therapies being considered as step 3 before upgrading to strong opioids if non-opioids and weak opioids failed in CNCP management.
Discussion
A simple and valuable guideline in past years, the WHO analgesic ladder is inappropriate for the current use of CNCP control. A revised four-step analgesic ladder aligned with integrative medicine principles and minimally invasive interventions is recommended for control of CNCP.
... 5,9 Moreover, parts of several CAM treatments (i.e., acupuncture) were already covered by insurance in Australia, indicating that health philosophy had already shifted to be more integrative in certain areas of healthcare. 18 Psychologists may also learn from their colleagues who already integrate CAM into their practices (i.e., hypnobirthing conducted by obstetricians). 16 In addition, participants -as health professionals -may feel the need to respect their clients if the clients choose CAM treatments over conventional psychotherapy or combine them together. ...
Background: The growth of complementary and alternative medicine (CAM) has been increasing, including amongst psychological clients. Therefore, it is important to investigate psychologists’ attitudes towards CAM. Negative attitudes towards CAM among psychologists could be a barrier to CAM integration into psychological services and may prevent clients to trust psychologists. This study aims to compare Indonesian and Australian psychologists’ attitudes towards CAM using the previously published study on Psychologists’ Attitudes Towards Complementary and Alternative Therapies (PATCAT) scale validation.
Methods: The PATCAT scale was adapted from an Australian study to an Indonesian version using backward-and-forward translation. This scale was used to investigate attitudes towards: (1) CAM knowledge;
(2) CAM integration; and (3) the risks associated with CAM. An online survey was sent to all Indonesian psychologists and completed by 247 participants. Afterward, the data were compared with the published data from 115 Australian psychologists.
Results: In general, psychologists in Indonesia and Australia showed relatively similar ambivalent attitudes towards CAM. This uncertainty may stem from the same Western psychology education, which is
a basis for the medical models in both nations. They also considered it somewhat important to have an understanding of CAM. Participants in both nations displayed positive attitude towards CAM integration
into psychological services. However, they felt that CAM usage for mental health holds some risks.
Conclusion: Australian and Indonesian psychologists reported ambivalent attitudes towards CAM that might be reduced with clear regulation of CAM integration into psychological services from the government and professional organizations.
... Present day chronic illness management is often integrative and may, for example, involve referral protocols for patients to access therapies other than biomedical, such as acupuncture, osteopathy, or homeopathy (for instance in the case of chronic musculoskeletal pain; Jong et al. 2016). Thus, chronic care today increasingly combines conventional treatments with alternative or traditional medicines (Molassiotis et al. 2005;Templeman and Robinson 2011;World Health Organization 2013), a model that could be beneficial also for SUD. The Takiwasi Addiction Treatment Center (Peru) offers an SUD treatment protocol that parallels this somatic chronic care framework, combining methods from traditional Amazonian medicine and modern psychotherapy. ...
Chronic illness management today commonly involves alternative medicines. Substance use disorder (SUD), as a chronic psychosomatic illness, might benefit from a similar approach. The accredited Takiwasi Center offers such an SUD treatment program involving Amazonian medicine combined with psychotherapy. The current study assessed this integrative program‘s short-term therapeutic effects. We measured baseline data from 53 dependence-diagnosed males admitted to treatment (T1) and repeated clinical outcome variables at treatment completion (T2). Paired samples t-tests were used to assess changes between T1 and T2 (n = 36). Nearly all participants (age M= 30.86, SD= 8.17) were dependent on multiple substances, most prominently cannabis, alcohol, and cocaine-related drugs. A significant decrease (T1 to T2) was found for addiction severity outcomes drug use (p < .001), alcohol use (p < .001), psychiatric status (p < .001), and social/familial relationships (p < .001). Emotional distress also diminished significantly (p < .001), as did substance craving (p < .001). Quality of life increased significantly from T1 to T2 (p < .001). Our results provide first indications for significantly improved SUD symptoms after the Amazonian medicine-based treatment. These findings are preliminary given the design, but strongly encourage further investigation of this therapy, which in the long term may open new therapeutic avenues for SUDs.
... the instantaneous communication between two quantum particles correlated by polarization, regardless of their distance (called "quantum nonlocality"), [40] and which Jacobo Grinberg-Zylberbaum and collaborators [41] repeated through an experiment of telepathic communication between two shamans' brains correlated through meditation. This type of nonlocal experiments are present in the "spontaneous cures" [42], [43] (which conventional medicine can not explain), but whose cause and explanation might be justified through a model of Integrative Medicine [44]. ...
In conventional medicine (Western medicine) the methods of healing are carried out
externally through allopathic medicines (with several side effects), surgery and radiation
(in the case of cancer) until the disease disappears - the biological dimension of
the human being. However, Ayurveda (Eastern medicine) and mind-body medicine
argues that the cause of some diseases, such as those in the psychiatric area (for
example, a depression), is due to an imbalance between the mind (our thoughts, feelings)
and the body, and so healing should also be done by the mind itself (through
meditation, psychotherapy, etc.) in order to change the pattern of behavior that led to
the disease (which is not relevant in Western and conventional medicine) – the psychological dimension of the human being . This “communication" is about the theme
of conventional medicine (curative medicine) versus Ayurveda (preventive medicine)
and mind-body medicine in order to describe the usefulness of integrative and transdisciplinary medicine – the bio-psycho-spiritual dimensions of the human being - that might contribute to goal #3 (“To ensure healthy lives and promoting well-being for
all, at all ages”) of the Sustainable Development Goals (SDG) of the United Nations
2030 Agenda.
... the instantaneous communication between two quantum particles correlated by polarization, regardless of their distance (called "quantum nonlocality"), [40] and which Jacobo Grinberg-Zylberbaum and collaborators [41] repeated through an experiment of telepathic communication between two shamans' brains correlated through meditation. This type of nonlocal experiments are present in the "spontaneous cures" [42], [43] (which conventional medicine can not explain), but whose cause and explanation might be justified through a model of Integrative Medicine [44]. ...
In conventional medicine (Western medicine) the methods of healing are carried out externally through allopathic medicines (with several side effects), surgery and radiation (in the case of cancer) until the disease disappears - the biological dimension of the human being. However, Ayurveda (Eastern medicine) and mind-body medicine argues that the cause of some diseases, such as those in the psychiatric area (for example, a depression), is due to an imbalance between the mind (our thoughts, feelings) and the body, and so healing should also be done by the mind itself (through meditation, psychotherapy, etc.) in order to change the pattern of behavior that led to the disease (which is not relevant in Western and conventional medicine) – the psychological dimension of the human being . This "communication" is about the theme of conventional medicine (curative medicine) versus Ayurveda (preventive medicine) and mind-body medicine in order to describe the usefulness of integrative and transdisciplinary medicine – the bio-psycho-spiritual dimensions of the human being - that might contribute to goal #3 («To ensure healthy lives and promoting well-being for all, at all ages») of the Sustainable Development Goals (SDG) of the United Nations 2030 Agenda.
... 19 The integration of CAM and conventional medicine indicates inherent value of CAM in primary healthcare needs. 20,21 Hydrolea glabra (fam. Hydrophyllaceae) Schum &Thonn, is an annual broadleaf herb, with thick, spongy hairless stem and leaves arranged throughout the stem. ...
The plant,Hydrolea glabra, is used in neurodegenerative disorders associated with dementia, where personality changes present as symptoms such as anxiety, depression and sleep changes. This notwithstanding, no pharmacological studies have been carried out on the anxiolytic and sedative properties of the plant. This research evaluated the anxiolytic effects of the extract of the plant, Hydrolea glabra, in order to validate the folkloric claims of its usefulness in the management of dementia. Methanol extract of the leaves of Hydrolea glabra was analysed for the phytochemical composition and the anxiolytic effect was evaluated, using the Elevated plus maze, Hole board and Phenobarbitone-induced sleeping time models in mice. Phytochemical screening showed the presence of alkaloids, terpenoids, saponins, phenolics, condensed tannins, cardiac glycosides and reducing sugars. There was significant percentage increase (48%) in the time spent in the open arms, by the rats given the extracts, which was comparable to 42% of the standard Diazepam (1 mg/kg b.w) in the elevated plus maze model. The extract at 200mg/kg, also had a sedative effect by prolonging the phenobarbitone-induced sleeping time by 45% when compared to the standard, Diazepam. The anxiolytic effect observed may substantiate the medicinal relevance of the plant, by providing the pharmacological basis for the use of this plant in folkloric medicine practice
... In this regard, I have to mention the emergence of a new paradigm in science and medicine that proposes an integrative medicine model that aims to see the patient as a whole: body/brain, mind and soul. This model intends to promote both the patient´s quality of life, as well as do justice (or give a "rational explanation") to the spiritual side of the human being [27]. Furthermore, I have to refer the Holographic Mind Theory [28] (proposed by the physician Karl Pribam and the scientist David Bohm) and the Mind-Brain Theory (proposed by physician Stuart Hameroff and the scientist Roger Penrose) because they have contributed to the study of the human brain. ...
This essay aims to be a summary of the main milestones of the history of the human brain through ages, highlighting the remarkable capabilities of this organ, such as telepathic communication and clairvoyance.
... In primary care, selectively incorporated CAM is more commonly delivered by CAM practitioners than conventional practitioners [21,22]. Selective incorporation, where patients are referred from conventional healthcare to an off-site CAM practitioner, is similar to social prescribing, a system enabling primary care clinicians to refer patients to a broad range of community services, for example an exercise class or gardening club [23]. ...
Background
Comorbidity of musculoskeletal (MSK) and mental health (MH) problems is common but challenging to treat using conventional approaches. Integration of conventional with complementary approaches (CAM) might help address this challenge. Integration can aim to transform biomedicine into a new health paradigm or to selectively incorporate CAM in addition to conventional care. This study explored professionals’ experiences and views of CAM for comorbid patients and the potential for integration into UK primary care.
Methods
We ran focus groups with GPs and CAM practitioners at three sites across England and focus groups and interviews with healthcare commissioners. Topics included experience of co-morbid MSK-MH and CAM/integration, evidence, knowledge and barriers to integration. Sampling was purposive. A framework analysis used frequency, specificity, intensity of data, and disconfirming evidence.
Results
We recruited 36 CAM practitioners (4 focus groups), 20 GPs (3 focus groups) and 8 commissioners (1 focus group, 5 interviews).
GPs described challenges treating MSK-MH comorbidity and agreed CAM might have a role. Exercise- or self-care-based CAMs were most acceptable to GPs. CAM practitioners were generally pro-integration.
A prominent theme was different understandings of health between CAM and general practitioners, which was likely to impede integration. Another concern was that integration might fundamentally change the care provided by both professional groups. For CAM practitioners, NHS structural barriers were a major issue. For GPs, their lack of CAM knowledge and the pressures on general practice were barriers to integration, and some felt integrating CAM was beyond their capabilities. Facilitators of integration were evidence of effectiveness and cost effectiveness (particularly for CAM practitioners). Governance was the least important barrier for all groups.
There was little consensus on the ideal integration model, particularly in terms of financing. Commissioners suggested CAM could be part of social prescribing.
Conclusions
CAM has the potential to help the NHS in treating the burden of MSK-MH comorbidity. Given the challenges of integration, selective incorporation using traditional referral from primary care to CAM may be the most feasible model. However, cost implications would need to be addressed, possibly through models such as social prescribing or an extension of integrated personal commissioning.
Electronic supplementary material
The online version of this article (10.1186/s12906-018-2349-8) contains supplementary material, which is available to authorized users.
... In summary, I should point out that there is an experiment that supports a model of Integrative medicine, namely, the experiment of Alain Aspect and collaborators on the instantaneous communication between two quantum particles correlated by polarization, regardless of their distance (called "quantum nonlocality"), [39] and which Jacobo Grinberg-Zylberbaum and collaborators [40] repeated through an experiment of telepathic communication between two shamans' brains correlated through meditation. This type of nonlocal experiments are present in the "spontaneous cures" [41], [42] (which conventional medicine can not explain), but whose cause and explanation might be justified through a model of Integrative Medicine [43], [44]. ...
In conventional medicine (Western medicine) the methods of healing are carried out externally through allopathic medicines (with several side effects), surgery and radiation (in the case of cancer) until the disease disappears - the biological dimension of the human being. However, Ayurveda (Eastern medicine) and mind-body medicine argues that the cause of some diseases, such as those in the psychiatric area (for example, a depression), is due to an imbalance between the mind (our thoughts, feelings) and the body, and so healing should also be done by the mind itself (through meditation, psychotherapy, etc.) in order to change the pattern of behavior that led to the disease (which is not relevant in Western and conventional medicine) – the psychological dimension of the human being . This "communication" is about the theme of conventional medicine (curative medicine) versus Ayurveda (preventive medicine) and mind-body medicine in order to describe the usefulness of integrative and transdisciplinary medicine – the bio-psycho-spiritual dimensions of the human being - that might contribute to goal #3 («To ensure healthy lives and promoting well-being for all, at all ages») of the Sustainable Development Goals (SDG) of the United Nations 2030 Agenda.
... 6,8 Both empirical evidence and experience-based evidence are acknowledged and valued. 9 By synergistically combining therapies and services, holistic outcomes are realized that are more than the collective effect of individual practices. 7 The term ''integrative heath care'' is used throughout this review as being more consistent with Indigenous worldviews, which emphasise spirituality, relationships and connection to the land. ...
Review questions:
This scoping review aims to explore the following questions.
... In this study, the osteopath is practising as part of a coordinated and integrated care team and participants identified this model as a positive characteristic of their care experience. This approach has been reported elsewhere as a successful model for other integration of complementary healthcare approaches into an existing health care team [34]. Moreover, participants in our study did not have to travel or pay for the sessions. ...
Purpose:
This research aimed to explore the perceptions and experiences of cancer patients receiving osteopathic treatment as a complementary therapy when it is used in addition to conventional treatment for cancer pain.
Methods:
This qualitative study employed semi structured interviews of cancer patients in a palliative care unit in Lyon, France, who received treatment from an osteopath alongside their conventional cancer treatment. We analysed data using grounded theory and qualitative methods.
Results:
We interviewed 16 patients. The themes identified through the analysis included a low awareness of osteopathy among the population and an accompanying high level of misconceptions. The benefits of osteopathy were described as more than just the manual treatments with participants valuing osteopathy as a holistic, meditative, and non-pharmaceutical approach. Participants also described the osteopathic treatments as assisting with a range of cancer-related health complaints such as pain, fatigue, and sleep problems. Offering osteopathic treatment at an accessible location at low or no cost were identified by participants as enablers to the continued use of osteopathy.
Conclusions:
The findings of this study provides preliminary data which suggests, when delivered alongside existing medical care, osteopathy may have health benefits for patients with complex conditions such as cancer.
... Complementary Medicine (T&CM) involves a variety of different medical therapies that are mainly used outside conventional healthcare. However, T&CM and modern medicine are now offered together in an integrative healthcare approach in many modern medicine centers [1,2]. Traditional medicine refers to practices based on the indigenous culture. ...
... 6 Templeman et al have differentiated between the selective integration of the most effective complementary and conventional methods (based on respect of the ontological differences between different schools of medicine), and the selective incorporation of evidence-based complementary medicine interventions. 8 As the first pediatric inpatient department in Switzerland, we wanted to provide integrative pediatric services within a public hospital, in response to the interest of families and interest within the nursing and physician team. Our aim was to provide an expanded and more holistic treatment offer and to further improve patient/family experience and outcomes. ...
Background
For the pilot phase of an integrative pediatric program, we defined inpatient treatment algorithms for bronchiolitis, asthma and pneumonia, using medications and nursing techniques from anthroposophic medicine (AM). Parents could choose AM treatment as add-on to conventional care.
Material and methods
To evaluate the 18-month pilot phase, parents of AM users were asked to complete the Client Satisfaction Questionnaire (CSQ-8) and a questionnaire on the AM treatment. Staff feedback was obtained through an open-ended questionnaire. Economic data for project set-up, medications and insurance reimbursements were collected.
Results
A total of 351 children with bronchiolitis, asthma and pneumonia were hospitalized. Of these, 137 children (39%) received AM treatment, with use increasing over time. 52 parents completed the questionnaire. Mean CSQ-8 score was 29.77 (95% CI 29.04–30.5) which is high in literature comparison. 96% of parents were mostly or very satisfied with AM; 96% considered AM as somewhat or very helpful for their child; 94% considered they learnt skills to better care for their child. The staff questionnaire revealed positive points about enlarged care offer, closer contact with the child, more relaxed children and greater role for parents; weak points included insufficient knowledge of AM and additional nursing time needed. Cost for staff training and medications were nearly compensated by AM related insurance reimbursements.
Conclusions
Introduction of anthroposophic treatments were well-accepted and led to high parent satisfaction. Additional insurance reimbursements outweighed costs. The program has now been expanded into a center for integrative pediatrics.
... Nevertheless, implementation of CM in hospitals is often weighed down by lack of policy, low rate of patient referral and medical skepticism [9]. The debate about the implementation of CM in hospitals is mostly based on the lack of both biomedical and clinical evidence for efficacy, lack of knowledge [10], along with concerns about safety [11]. Therefore, the legitimacy of CM in hospital setting is still contested [12]. ...
Background:
Complementary medicine (CM) is utilized in a growing number of academic centers despite the debate concerning its value, risks and benefits. Healthcare professionals often feel uncomfortable discussing CM with patients, and little is known about their sources of knowledge in the field of CM.
Objective:
To assess healthcare professionals' sources of knowledge and attitude toward CM in an academic hospital.
Design and participants:
The cross-sectional web-based survey took place from October to December 2013. A total of 4,925 healthcare professionals working at Lausanne University Hospital, Switzerland, were invited to answer the questionnaire.
Main measures:
Factors influencing healthcare professionals' opinion toward CM, knowledge and communication about CM.
Key results:
The questionnaire was answered by 1,247 healthcare professionals. The three key factors influencing professionals' opinion toward CM were personal experience, clinical experience and evidence demonstrating the physiological mechanism of CM. Personal experience was more associated with nurses' and midwives' opinion compared to physicians' (80.8% vs 57.1%, OR = 3.08, [95% CI: 2.35-4.05], P<0.001 and 85.3% vs 57.1%, OR = 3.83, [95% CI: 1.95-7.53], P<0.001, respectively) as well as with professionals trained in CM compared to non-trained professionals (86.0% vs 73.2%, OR = 2.60, [95% CI: 1.92-3.53], P<0.001). Physicians relied more on randomized controlled clinical trials compared to nurses (81.3% vs 62.9%, OR = 0.43, [95% CI: 0.33-0.57], P<0.001). A majority of the respondents (82.5%) agreed that they lacked knowledge about CM and 65.0% noted that it was the patient who initially started the discussion about CM.
Conclusions:
Different professionals used different strategies to forge opinions regarding CM: physicians relied more on scientific evidence, while nurses and midwives were more influenced by personal experience. Regardless of preferred information source, most respondents did not feel prepared to address patient questions regarding CM. Enhancing interprofessional education opportunities is an important strategy to help providers become empowered to discuss CM with patients. This in turn will help patients making informed decisions in their healthcare.
Collaboration between midwives and traditional birth attendants for maternal and child healthcare is a challenge in rural South African communities due to the absence of a guiding framework. To address this, this study sought to develop and validate an inclusive framework informed by the Donabedian structure–process–outcome (SPO) framework for collaboration between these healthcare professionals. Method: Key stakeholders were invited to participate in a co-creation workshop to develop the framework. Twenty (20) participants were purposively sampled based on their maternal and child healthcare expertise. A consensus design using the nominal group technique was followed. Results: Participants identified the components needed in the framework, encompassing (i) objectives, (ii) structures, (iii) processes, and (iv) outcomes. Conclusion: This paper will contribute to the development of an inclusive healthcare framework, providing insights for stakeholders, policymakers, and practitioners seeking to improve maternal and child healthcare outcomes in resource-constrained, rural settings. Ultimately, the proposed framework will create a sustainable and culturally sensitive model that optimises the strengths of midwives and TBAs and fosters improved healthcare delivery to rural South African communities.
The ‘Lifestyle Medicine’ approach may offer an effective strategy for improving the outcomes of psychiatric care when used alongside conventional biological and psychotherapeutic treatments. Lifestyle interventions may also be useful in inpatient psychiatric settings, as this context provides a unique setting for adopting lifestyle changes that can be translated following discharge. While the data revealed by the small-scale feasibility studies reporting on the design and implementation of these interventions within psychiatric settings are compelling and indicative of improved patient outcomes, the strength and nature of the relationship between lifestyle factors and psychiatric care provision and outcomes remain unclear. It is strongly suggested that future research should focus on identifying any relevant organisational and programmatic challenges in psychiatric care settings, hence provide clear guidelines to enhance health-promoting behaviours and develop relevant public healthcare standards.
As historian of medicine Shigehisa Kuriyama reminds us, we have always lived in a world replete with multiple, independent, and yet effective, medical systems. Not surprisingly, then, there remains even today much to be learned of value to practitioners and their patients from efforts to integrate traditional and modern medical practices and health perspectives. Over the course of centuries, distinct medical systems have come into contact with one another to varying degrees and with different results. The movement of peoples over time and space, such as through trade, have continually shaped and reshaped practices, beliefs, goals, expectations, institutions, and the very roles signified by categories such as “patients” and “practitioners.” Few medical systems are “islands” unto themselves; interaction, change, appropriation, and a host of (positive, negative, or neutral) “symbiotic” relations mark historic and emergent exchanges among the world’s multiple medical systems and traditions, which this chapter discusses.
Abstract
Introduction: Patients prefer primary healthcare to include conventional medical services together with complementary medicine. The process of integration can be a stressful process for providers of both complementary and modern medical services.
Aim: This study aimed to determine the elements of integrating traditional and complementary medicine into primary healthcare.
Methods: This systematic review searched the Web of Science, Scopus, PubMed, Ovid, and EMBASE from January 2000 to February 2017. Data were analyzed by the content analysis method.
Results: The search of databases resulted in 1391 records. The duplicates were removed, titles and abstracts were screened, and irrelevant records were excluded. Finally, 25 studies were included and five elements identified that important for integrating traditional and complementary medicine into primary health care. Eighteen studies addressed Communication and collaboration, twelve studies addressed Patient-centeredness, twelve studies addressed types of practice, eleven studies mentioned Education and training, eight studies mentioned policy and plan, seven studies addressed financial support.
Conclusion: Integrating traditional medicine into primary healthcare requires government support and policy-making. Communication, professional dealings, and training are important and influential in all stages of integration. Integrated services should be culturally acceptable and financially covered by insurance.
Keywords: Traditional medicine, primary healthcare, Integrated health care
Introduction: Patients prefer primary healthcare to include
conventional medical services together with complementary
medicine. The process of integration can be a stressful
process for providers of both complementary and modern
medical services.
Aim: This study aimed to determine the elements of integrating
traditional and complementary medicine into primary healthcare.
Materials and Methods: This systematic review searched the
Web of Science, Scopus, PubMed, Ovid, and EMBASE from
January 2000 to February 2017. Data were analysed by the
content analysis method.
Results: The search of databases resulted in 1391 records. The
duplicates were removed, titles and abstracts were screened,
and irrelevant records were excluded. Finally, 25 studies were
included and five elements identified that are important for
integrating traditional and complementary medicine into primary
health care. Eighteen studies addressed communication and
collaboration, 12 studies addressed patient-centeredness,
12 studies addressed types of practice, 11 studies mentioned
education and training, 8 studies mentioned policy and plan,
7 studies addressed financial support.
Conclusion: Integrating traditional medicine into primary
healthcare requires government support and policy-making.
Communication, professional dealings, and training are
important and influential in all stages of integration. Integrated
services should be culturally acceptable and financially covered
by insurance.
Abstract
Background: Globally, Indigenous peoples are the victims of social inequalities in health. Their state of health is much lower than the health of the general population. Colonialism, living conditions and access to care are the main determinants of observed health conditions. The scientific objective of this systematic literature review is to study the facilitators and barriers to access healthcare for both, traditional and allopathic medicines.
Methods: An inclusive search of electronic databases (e.g ProQuest, Ovid, Medline, CINAHL PLUS, Cochrane Library, ApaPsyNet, PsyINFO and Sociological Abstracts databases) of the past 20 years was performed. We retained studies discussing (1) traditional medicine (TM) or allopathic medicine (AM) or both and occurring (2) within Indigenous population worldwide. We made no distinction between research carried out in rural as opposed to urban areas.
Results: A total of 45 studies published between 1996 and 2016 met our inclusion criteria and this speaks to the high interest and contemporary pertinence of accessing both systems of healthcare for Indigenous populations worldwide. Our thematic analysis enabled us to group barriers and facilitators into five categories, namely related to personal, relational, cultural, structural and policy components. As far as barriers and facilitators are concerned, the category that encompasses the most themes is the structural category.
Conclusions: Mutual respect, trust and understanding of each other’s modalities is essential to offer the best healthcare options from both AM and TM to Indigenous peoples and hence pave the way to reducing health inequities. Wellness and strengthbased approaches must also be favoured.
Résumé
Problématique : Mondialement, les peuples autochtones sont victimes d’inégalités sociales en santé. Leur état de santé est largement inférieur à celui de la population générale. Le colonialisme, les conditions de vie et l’accès aux soins sont les principaux déterminants des états de santé observés. L'objectif scientifique de cette revue systématique de littérature est d’étudier les leviers et obstacles à l'accès aux soins de santé autant pour les médecines traditionnelles qu’allopathiques.
Méthodes : Une recherche approfondie de bases de données électroniques a été effectuée sur une période de 20 ans, notamment les bases de données ProQuest, Ovid, Medline, CINAHL PLUS, Cochrane Library, ApaPsyNet, PsyINFO et Sociological Abstracts. Nous avons retenu des études portant sur (1) la médecine traditionnelle (MT) ou la médecine allopathique (MA), ou les deux, et survenant (2) au sein de la population autochtone du monde entier. Nous n'avons fait aucune distinction entre les recherches effectuées dans les zones rurales ou urbaines.
Résultats : Au total, 45 études publiées entre 1996 et 2016 ont répondu à nos critères d'inclusion, ce qui témoigne de l'intérêt élevé et de la pertinence contemporaine de l'accès aux deux systèmes de soins de santé pour les populations autochtones du monde entier. L'analyse thématique a permis de regrouper les obstacles et les facilitateurs en cinq catégories, à savoir les composantes personnelles, relationnelles, culturelles, structurelles et politiques. En ce qui concerne les obstacles et les facilitateurs, la catégorie qui englobe le plus de thèmes est la catégorie structurelle.
Conclusions : Le respect mutuel, la confiance et la compréhension des modalités des uns et des autres sont essentiels pour offrir les meilleures options de soins de santé à la fois des AM et TM aux peuples autochtones et ainsi ouvrir la voie à la réduction des disparités sur le plan de la santé. Les approches axées sur le bien-être et la force doivent également être privilégiées.
Purpose
This study aims to test a conceptual model using public attitudes toward biomedicine and traditional Chinese medicine (TCM) to predict respondents’ medical treatment choice.
Design/methodology/approach
A quantitative online survey was conducted using quota sampling. Altogether 1,321 questionnaires from Hong Kong residents of age 15 years or above were collected.
Findings
Attitudes toward biomedicine in relation to TCM and perceived cost of TCM consultation were found to be significant variables in predicting respondents’ medical treatment choice of treatment. Perceived efficacy of TCM, however, was not a significant predictor. Older respondents, as well as respondents with higher education, were less likely to consult biomedicine first when ill. They were also less likely to consult biomedicine exclusively.
Research limitations/implications
This study uses a convenience sample recruited through personal networks. The findings cannot be generalized to the rest of the population.
Practical implications
Respondents in the study generally perceived TCM’s efficacy to be high, but not high enough to make it the medical treatment of choice. To promote TCM in Hong Kong, there is a need to enhance trust in it. This can be achieved through strengthening scientific research and development of TCM, enhancing professional standards of TCM practitioners and educating the public about the qualifications of TCM practitioners. Strategic channel planning to reach potential target and reducing the time cost of TCM medication should be examined.
Originality/value
The study is the first to relate attitudes to and perceptions of TCM with medical treatment choices in Hong Kong.
There is a link between integrative medicine (IM) and prospective research on complementary and alternative medicine (CAM). IM is the future direction of CAM and research is needed to support clinical practice. Meaning of IM, proposed models of IM, and existing research on IM will be presented. Prospective research on CAM will cover methodologies presenting randomised controlled trials, harms studies of CAM in kidney disease, and a gap of CAM research. Study design and outcome measures are current challenges in CAM/IM research. Several networks of CAM research worldwide are still working on them and have proposed possible alternative approaches, such as pragmatic clinical trials and cohort multiple randomised controlled trials.
These approaches would solve some limitations of randomised controlled trials in CAM research.
Although the definition of integrative, complementary and alternative medicine (CAM) remains under discussion by members of the clinical community, the medical literature contains few reports on the process of integration of CAM methods into clinical practice. This report describes a study of the clinical approach of holistic clinicians in one clinic over 14 months, based on selection of diagnoses and therapies. Methods included observations of clinical encounters and physician interviews. Findings suggest that physicians initially selected diagnoses and treatments that reflected their biomedical orientation. Subsequent diagnoses incorporated energy healing, homeopathy, and spiritual hypnotherapy. This gradual introduction of CAM modalities into practice allowed physicians to address body—mind—emotional and spiritual causes of disease. Incorporation of CAM modalities into clinical practice by these biomedically trained physicians with additional CAM experience gave them flexibility to offer patients different treatment options and alleviated the need to reconcile conflicting theories of disease etiology.
A prior national survey documented the high prevalence and costs of alternative medicine use in the United States in 1990.
To document trends in alternative medicine use in the United States between 1990 and 1997.
Nationally representative random household telephone surveys using comparable key questions were conducted in 1991 and 1997 measuring utilization in 1990 and 1997, respectively.
A total of 1539 adults in 1991 and 2055 in 1997.
Prevalence, estimated costs, and disclosure of alternative therapies to physicians.
Use of at least 1 of 16 alternative therapies during the previous year increased from 33.8% in 1990 to 42.1% in 1997 (P < or = .001). The therapies increasing the most included herbal medicine, massage, megavitamins, self-help groups, folk remedies, energy healing, and homeopathy. The probability of users visiting an alternative medicine practitioner increased from 36.3% to 46.3% (P = .002). In both surveys alternative therapies were used most frequently for chronic conditions, including back problems, anxiety, depression, and headaches. There was no significant change in disclosure rates between the 2 survey years; 39.8% of alternative therapies were disclosed to physicians in 1990 vs 38.5% in 1997. The percentage of users paying entirely out-of-pocket for services provided by alternative medicine practitioners did not change significantly between 1990 (64.0%) and 1997 (58.3%) (P=.36). Extrapolations to the US population suggest a 47.3% increase in total visits to alternative medicine practitioners, from 427 million in 1990 to 629 million in 1997, thereby exceeding total visits to all US primary care physicians. An estimated 15 million adults in 1997 took prescription medications concurrently with herbal remedies and/or high-dose vitamins (18.4% of all prescription users). Estimated expenditures for alternative medicine professional services increased 45.2% between 1990 and 1997 and were conservatively estimated at 12.2 billion paid out-of-pocket. This exceeds the 1997 out-of-pocket expenditures for all US hospitalizations. Total 1997 out-of-pocket expenditures relating to alternative therapies were conservatively estimated at $27.0 billion, which is comparable with the projected 1997 out-of-pocket expenditures for all US physician services.
Alternative medicine use and expenditures increased substantially between 1990 and 1997, attributable primarily to an increase in the proportion of the population seeking alternative therapies, rather than increased visits per patient.
Background: The Danish Multiple Sclerosis Society has initiated a research project dealing with bridge building and integrative treatment. Little attention has been paid to research on the experience of conventional and alternative practitioners with bridge building and integrative treat-ment through teamwork. Objective: The objective of this article is to describe essential features of the preparatory phase of the research project focusing on the process of initiating and developing a team of conventional and alternative practitioners before treating people with Multiple Sclerosis at a specialized MS hospital in Denmark. The team consists of five conventional and five alterna-tive practitioners. Materials and Methods: The preparatory phase took place from August 2004 to May 2005. In-depth, semi-structured interviews were conducted with the ten team practition-ers. Each practitioner was interviewed before and eight months after joining the team, and after participating in four practitioner-researcher seminars. Written materials and participatory observa-tions of practitioner-researcher seminars have been used in addition. Results: The team-building process involved motivation, emotions, challenges, professional and personal competences, and the development of a professional team identity. The practitioners assessed the preparatory phase based on researcher-practitioner seminars as an essential basis for moving on to provide treatments to people with MS.
The term bracketing has increasingly been employed in qualitative research. Although this term proliferates in scientific studies and professional journals, its application and operationalization remains vague and, often, superficial. The growing disconnection of the practice of bracketing in research from its origins in phenomenology has resulted in its frequent reduction to a formless technique, value stance, or black-box term. Mapping the subtle theoretical and philosophical underpinnings of bracketing will facilitate identification and delineation of core elements that compose bracketing, and distinguish how different research approaches prioritize different bracketing elements. The author outlines a typology of six distinct forms of bracketing that encompasses the methodological rigor and evolution of bracketing within the richness of qualitative research.
Evidence for integrative therapies (IT) in children with hematological malignancies is slowly evolving. The ideal model of integrative pediatric oncology would offer IT modalities that are deemed safe and effective in conjunction with effective conventional medical treatments. Because of potential interactions, herbs and other dietary supplements should be used with caution, especially during active therapy. Health and wellness should be the emphasis, with IT therapies supporting health promotion and key disease prevention strategies for childhood cancer survivors. All uses, responses, and effects of IT therapies should be carefully documented. A desire to use IT therapies may be an effort to become an active participant in the healing process. Health care providers should encourage, not discourage, this partnership.
Six family medicine residency programs in the United States collaborated on the development and implementation of an integrative family medicine (IFM) program, which is a postgraduate training model that combines family medicine residency training with an integrative medicine fellowship. This paper reports on effects of IFM on residency programs and clinical systems in which it was implemented.
We used the Integrative Medicine Attitudes Questionnaire (IMAQ) to assess participants' attitudes toward integrative medicine before and after the program was implemented. We assessed residency program recruitment success before and after the program was implemented. We conducted interviews with key informants at each program to evaluate the effects of the IFM on the six participating residency programs.
IMAQ scores demonstrated a significant increase in the acceptance of integrative medicine after implementation of IFM. Recruiting data showed that participating programs filled at a rate consistently above the national average both before and after implementation. Analysis of interview data showed that programs became more open to an integrative medicine (IM) approach and offered a wider range of clinical services to patients.
Our mixed-methods strategy for evaluation of IFM showed that implementing the program increased acceptance of IM, did not affect residency fill rates, and increased use of IM in clinical practice. The combination of quantitative and qualitative methods was an effective strategy for documenting the "systems level" effects of a new educational program.
The demand for integrative medicine care is increasing rapidly among patient consumers, yet the integrative medicine model is not the norm in clinical practice, nor is this approach a focus in traditional medical schools. Furthermore, patient well-being and satisfaction outcomes within an integrative care model are not common in the literature.
The purpose of this paper is to offer a summary of a model of integrative medicine patient care and its evaluation and outcomes from the University of Michigan Integrative Medicine Clinic.
Using three tools to evaluate patient outcomes and satisfaction, statistically significant outcomes were noted. The SF-12 showed positive change in the physical component score, the Holistic Health Questionnaire showed improvements in all of the subscales of body, mind, and spirit, and a unique Integrative Medicine Patient Satisfaction Tool suggested high satisfaction with an integrative approach to care.
Findings, limitations, and implications are discussed.
Evaluation of the Arthritis Self-Management Course revealed significant positive changes in the practice of behaviors that were taught and in health outcomes. However, utilizing a variety of statistical techniques, we were able to demonstrate only weak associations between changes in behavior and changes in health status. This suggests the need to examine the mechanisms by which health education affects health status.
Nurses must practice state-of-the-art pain management. Organizational endorsement for a dynamic, comprehensive pain management program began in the early 1990s and included assessment, education, interventions, and reassessment. Based on study findings and pain management recommendations from national guidelines and authoritative resources, retooling and updating of the pain management program was shaped to include a multidisciplinary team approach, principles of total quality improvement, and outcomes management. Faced with a merger that is building one organization at two sites, there continues to be strong organizational endorsement for a dynamic, comprehensive pain management program to ensure best practice in pain management. Again, this challenge will be undergirded by The Center for Advanced Nursing Practice Evidence-Based Practice Model and the principles of total quality improvement, processes that are complementary in ensuring best practice.
The general view of descriptive research as a lower level form of inquiry has influenced some researchers conducting qualitative research to claim methods they are really not using and not to claim the method they are using: namely, qualitative description. Qualitative descriptive studies have as their goal a comprehensive summary of events in the everyday terms of those events. Researchers conducting qualitative descriptive studies stay close to their data and to the surface of words and events. Qualitative descriptive designs typically are an eclectic but reasonable combination of sampling, and data collection, analysis, and re-presentation techniques. Qualitative descriptive study is the method of choice when straight descriptions of phenomena are desired. © 2000 John Wiley & Sons, Res Nurs Health 23:334–340, 2000.
Despite the realization that total objectivity is neither achievable nor necessarily desirable in qualitative research, researchers often are required to put aside assumptions so that the true experiences of respondents are reflected in the analysis and reporting of research. In many qualitative publications and conference presentations, researchers report that they have attempted this process, but the means by which this attempt was made often are not explicated. In this article, the author provides guidance to help qualitative researchers use reflexivity to identify areas of potential bias and to “bracket” them so their influence on the research process is minimal.
The general view of descriptive research as a lower level form of inquiry has influenced some researchers conducting qualitative research to claim methods they are really not using and not to claim the method they are using: namely, qualitative description. Qualitative descriptive studies have as their goal a comprehensive summary of events in the everyday terms of those events. Researchers conducting qualitative descriptive studies stay close to their data and to the surface of words and events. Qualitative descriptive designs typically are an eclectic but reasonable combination of sampling, and data collection, analysis, and re-presentation techniques. Qualitative descriptive study is the method of choice when straight descriptions of phenomena are desired.
The profile of complementary and alternative medicine (CAM) has risen dramatically over the last decade and cancer patients represent its most prolific users. As a result, the NHS and UK cancer services are attempting to develop a wider range of therapeutic options for patients. Despite such developments, little is known about why cancer patients use CAM, its perceived benefits and the perspectives of the doctors and nurses involved. Drawing on extensive fieldwork in the UK, Therapeutic Pluralism includes over 120 interviews with cancer patients and professionals, plus innovative 'diary' data which, for the first time, detail the experiences of CAM users. It gives a systematic analysis of issues such as: The development of patient preferences and influences on decision making Expectations of CAM and interpretations of 'success' in cancer treatment The nature and importance of 'evidence' and 'effectiveness' for patients The organisational dynamics involved in integrating CAM into the NHS Pathways to CAM and the role of the Internet The role of oncology clinicians in patients' experiences of cancer and their use of CAMs Therapeutic Pluralism is essential reading for students and researchers of medical sociology, complementary and alternative medicine and cancer. It will also be useful to medical and health professionals, and policy-makers with an interest in complementary and alternative medicine.
This paper employs a Foucauldian perspective on the shifting spacialisation of medical knowledge to explore the manner in which integrative medicine is discursively represented by its biomedical architects so as to ensure good cultural fit with neoliberal strategies of governance amid the development of transnational global cultural flows in which human subjectivity has itself hybridized, provoking this reconfiguration of medical knowledge. It is argued that integrative medicine represents an expansion of medical rationality into all domains of human life: biological, psychological, sociological, and spiritual. This proposed expansion of biomedical influence rests not upon domination but rather, through enabling the autonomous individual of transnational, neoliberal governance.
In response to the emergence of the holistic health movement in the early 1970s and the rising popularity of complementary and alternative therapies, a growing number of biomedical physicians and institutions have embraced complementary and alternative medicine (CAM), often under the guise of integrative medicine. Whereas alternative medicine is often defined as functioning outside biomedicine and complementary medicine beside it; integrative medicine purports to combine the best of both biomedicine and CAM. Some social scientists have argued biomedicine has become more holistic as a result of this development, whereas others suggest it has embarked upon a subtle process of absorbing or co-opting CAM. This special issue consists of six articles that address changes in the health care sectors of four Anglophone societies, namely the United States, Great Britain, Australia, and New Zealand, associated with the adoption of integrative medicine or CAM. The authors examine some of the causes and consequences of this development. Is this a reframing of biomedicine itself, an erosion of medicine's political, economic, and social authority, a response to managerialism and the demands of consumers or market pressures, an expression of rising legitimacy for CAM, or a new professional strategy for biomedicine? And finally, where might the push for evidence-based medicine fit into this equation?
This paper examines the primarily sociological and anthropological literature that discusses the current challenges posed by the ‘modernisation’ of herbal knowledge through its co-option by biomedicine. Through this examination we identify evidence for a trend which suggests this co-option is a tactical strategy to preserve biomedical dominance through control of the knowledge base of ‘other’ medicines. Having identified such a trend, we examine the invention of the term ‘complementary and alternative medicine’ (CAM), suggesting that the universalising of non-orthodox health care practices under this construct is a problematic symptom of biomedical co-option. We then go on to argue that a possible outcome of biomedical co-option is an epistemological bifurcation between ‘traditionally’ orientated and ‘biomedically’ informed herbal knowledge and practice, a phenomenon whose implications demand serious recognition and analysis, not only in the academic literature, but also in wider public debates.
Complementary therapies should be a supplement to, not a substitute for, orthodox medical care. When a GP's patient makes use of a complementary therapist under the NHS, a ‘treatment triangle’ is created between GP, patient and therapist - together with a number of problems of competence and liability. This paper takes five principles of consumer rights - rights to access, information, choice, safety and redress - and uses them to examine the responsibilities of all three parties within the treatment triangle.
In Denmark people react by exit to unsatisfactory aspects of the officially high-praised 'socialized' health-care system More than 20 per cent of the total adult population in Denmark and Sweden use alternative therapists outside the health-care system In recent years centres for integrated medi one have been established on private initiative in Denmark In these centres authorized health personnel and alternative therapists co-operate The demand for alternative ways of understanding and handling disease could be interpreted as a reaction to developmental trends within the conventional health-care system. In this paper, a theoretical perspective on these trends is outlined and the paradigm of conventional medicine is opposed to a paradigm of integrated medicine
The idea that orthodox and alternative medical systems are converging, postulated by Willis (1989), is tested through a survey of general practitioners and interviews with alternative practitioners in Hobart, Tasmania, Australia, undertaken in 1997. The results suggest that there is convergence between the practices of both therapeutic modalities evidenced by use of medical diagnostic procedures by alternative practitioners, use of alternative therapies by doctors and cross-referral of patients. However, it is argued, such convergence is only weak and the use of the term complementary, rather than alternative by both doctors and alternative practitioners, allows differences in interests between the two groups to be glossed over. Weak convergence is more compatible with a postmodern society than strong convergence.
Current definitions of complementary medicine are based on comparisons with orthodox medicine. Such definitions become problematic with increasing use of complementary therapies and principles within orthodox practice. Therapies now described as complementary need to be located within a new model of medicine which focuses on the degree of intervention. This is conceptualised in terms of the putative effects of an intervention on a healthy individual. Basic self-care may be described as low intervention medicine, with drug therapy and surgery as high intervention medicine. Complementary therapies, as well as certain orthodox practices such as nutrition and physiotherapy, are classed as intermediate medicine. The Degree of Intervention Model is more accurate, more historically and geographically stable and less divisive than the traditional complementary/conventional model.
Integrative medicine, or the varied combination of conventional biomedicine with “complementary/alternative medicine” (CAM), has emerged recently as an important aspect of cancer care. Called “integrative oncology” (IO), health practitioners and certain institutions are exploring how to combine interdisciplinary modalities to ameliorate the suffering of cancer patients, and ultimately to promote wellness. As a reflection of the rising interest in and use of CAM by patients, frontline health care workers in mainstream cancer care are faced daily with patients who tell them they are combining biomedical and CAM modalities. Yet, practitioners may have little understanding or training in the principles of IO or specific CAM modalities. This lack of familiarity with CAM may lead to a number of care-related issues, including potential contraindications between modalities and the concealment by patients of their use of CAM.In this paper, the field of IO as an aspect of integrative medicine will be reviewed, with reference to current developments in the field. Leading controversies in IO will be explored and analyzed. Finally, a summary of the experiences and perspectives of those practitioners in the medical radiation sciences—or those in frontline cancer care—will be shared to highlight issues in the clinical application of IO.
Complementary and alternative medicine (CAM) is becoming increasingly popular in western countries, with estimates of CAM usage as high as 40%. This has prompted a change of attitude of the medical establishment: the initial dismissal of CAM is being replaced by a drive to integrate CAM into the mainstream. Two possible explanations for this integration thrust are considered. Firstly, integration could be motivated largely by cognitive interest in CAM. Secondly, integration could be mainly power-driven, aimed at controlling the alternative movement and exploiting its capacity to make money. The second explanation seems more plausible, and is supported by data showing the paucity of research on CAM. The medical establishment does not sufficiently appreciate the challenge CAM poses, and does not consider its scientific appraisal to be a high priority. Instead, the allopathic community seems preoccupied with the opportunistic desire to protect its authority and social status. Such a discourse can become dogmatic, reluctant to revise critically the ‘accepted’ body of knowledge. Popper's critical rationalism could help to undercut dogmatism and encourage a critical, open-minded orientation of medical science.
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.
Editorial by BermanPatients are increasingly using complementary and alternative medicine, 1 2 and doctors are responding to this in several ways, from being enthusiastic and interested to mystified and critical.3–5 Complementary and alternative medicine incorporates several different approaches and methodologies,6 with techniques ranging from spiritual “healing” in cancer to nutritional interventions for premenstrual tension, acupuncture for pain relief, and manipulation for backache. In this article we encourage you to reflect on your understanding of complementary and alternative medicine in relation to your clinical practice, share some of the current initiatives in undergraduate and postgraduate familiarisation and training in this type of medicine, and explore the implications of education, support, and development.The BMA's attitude to complementary and alternative medicine became much more positive between its first and second reports on the subject in 1986 and 1993.7 Around 39.5% of general practice partnerships in England provide access to some form of complementary therapy for their NHS patients,8 but this raises questions about how the provision of such treatment can be integrated into conventional practice. If the care is provided on a delegated or referred basis, how much does a doctor need to know to make appropriate referrals and supervise delegated treatment? If doctors are to treat patients with complementary and alternative medicine what training do they require?Summary pointsThe growth in patients' use of complementary and alternative medicine has an impact on conventional medical practiceTo advise about complementary and alternative medicine, doctors need to understand its potential benefits and limitationsDoctors are training in complementary and alternative medicine and report benefits both for their patients and themselvesPatients' safety and the effective integration of complementary and alternative medicine and conventional medicine is influenced by the professionalism and ethics of the training availableDoctors need …
The past 10 years has seen a significant increase in the amount of complementary medicine being accessed through the NHS. These services are not evenly distributed, and many different delivery mechanisms are used, some of which (such as homoeopathic hospitals) predate the inception of the NHS. Others depend on more recent NHS reorganisations, like general practice fundholding and health commission contracting, or have been set up as evaluated pilot projects.View larger version:In a new windowDownload as PowerPoint SlideComplementary therapies have been available in the NHS since its inception
Integrating complementary medicine into conventional settings
Successful integration is more likely with
Demand from patientsCommitment from high level staff in the conventional organisationProtected time for education and communicationOngoing evaluation of service (may help to defend service in the face of financial threat)Links with other conventional establishments integrating complementary medicineRealism and good will from all partiesJointly agreed guidelines or protocols between complementary and conventional practitionersSupport from senior management or health authorityCareful selection and supervision of complementary practitionersFunding from charitable or voluntary sector
Problems are likely with
Financial insecurityTime pressureLack of appropriate premisesUnrealistic expectationsOverwhelming demandInappropriate referralsUnresolved differences in perspective between complementary and conventional practitionersReal or perceived lack of evidence of effectivenessLack of resources and time for reflection and evaluation
List adapted from the report of the Delivery Mechanisms Working Party of the Foundation for Integrated Medicine
In general, development of these services has been demand led rather than evidence led. A few have published formal evaluations or audit reports. Some of these show benefits associated with complementary therapy—high patient satisfaction, significant improvements on validated health questionnaires compared with waiting list controls, and suggestions of reduced prescribing and referrals. However, data from other services are less clear, and many have not been formally evaluated These pilot projects have also identified various factors that influence the integration of complementary medicine practitioners within NHS settings.
Causes for concern
While much needed evidence is gathered, the debate about more widespread integration of complementary medicine continues. The idea of providing such care within a framework of evidence based medicine, NHS reorganisations, and healthcare rationing raises various concerns for the different parties involved.
Conventional clinicians and managers want persuasive evidence that complementary medicine can deliver safe, cost effective solutions to problems that are expensive or difficult to manage with conventional treatment. Unfortunately, such evidence is both scarce and equivocal Only a moderate number of randomised trials and very few reliable economic analyses of complementary medicine have been conducted Moreover, no systematic process exists for collecting data on safety and adverse events.
Patients—Public surveys show that most people support increased provision of complementary medicine on the NHS, but this question is often asked in isolation and does not mean that patients would necessarily prefer complementary to conventional care. When planning services, it is essential to try to distinguish between patients' desires and defined patients' needs that can be met by complementary medicine. Patients also want to be protected from unqualified complementary practitioners and inappropriate treatments. NHS provision might go some way to ensuring certain minimum standards such as proper regulation, standardised note keeping, effective channels of communication, and participation in research. It would also facilitate ongoing medical assessment.
Organisations promoting interdisciplinary cooperation in complementary medicine
Foundation for Integrated Medicine
Initiative of Prince of Wales, convenes working parties and events on aspects of integrated medicine
International House, 59 Compton Road, London N1 2YT Tel: 0171 688 1881. Fax: 0171 688 1882
British Holistic Medical Association
Membership organisation for healthcare professionals with associate lay members
59 Lansdowne Place, Hove, East Sussex BN3 1FL. Tel/fax: 01273 725951. URL: www.bhma.org
Complementary practitioners—Some practitioners support NHS provision because it would improve equity of access, protect their right to practise (currently vulnerable to changes in European and national legislation), and guarantee a caseload. It would also provide opportunities for inter-professional learning, career development, and research. Others fear an inevitable loss of autonomy, poorer working conditions, and domination by the medical model.
Current provision in the NHS
In primary care
Most of the complementary medicine provided through the NHS is delivered in primary care.
View larger version:In a new windowDownload as PowerPoint SlideModel of provision of complementary medicine
Direct provision
Over 20% of primary healthcare teams provide some form complementary therapy directly. For example, general practitioners may use homoeopathy, and practice nurses may use hypnosis or reflexology. Advantages of this system are that it requires minimal financial investment and that complementary treatments are usually offered only after conventional assessment and diagnosis. Also, practitioners can monitor patients from a conventional viewpoint, ensure compliance with essential conventional medication, and identify interactions and adverse events.
A disadvantage is that shorter appointments may leave less time for non-specific aspects of the therapeutic consultation. Also, members of primary healthcare teams have often undertaken only a basic training in complementary medicine, and this generally forms only a small part of their work. Doubts about the effectiveness of the complementary treatments they deliver, compared with those given by full time complementary therapists, have been expressed. Although no comparative evidence is available, it is clear that limits of competence need to be recognised.
In many general practices osteopathy is provided indirectly by an independent complementary practitioner
Indirect provision
Complementary practitioners without a background in conventional health care work in at least 20% of UK general practices. Osteopathy is the most commonly encountered profession. Such practitioners usually work privately, but some are employed by the practice and function as ancillary staff. An advantage for patients is that general practices usually check practitioners' references and credentials. Although some guidelines for referral may exist, levels of communication with general practitioners vary widely and true integration is rare.
In specialist provider units
Five NHS homoeopathic hospitals across the United Kingdom accept referrals from primary care under normal NHS conditions: free at the point of care. They offer a variety of complementary therapies provided by conventionally trained health professionals. They provide opportunities for large scale audit and evaluation of complementary medicine, but many services have been cut in recent years.
View larger version:In a new windowDownload as PowerPoint SlideMarylebone Health Centre was one of the first general practices to offer multidisciplinary complementary therapies to NHS patients. It provides osteopathy, massage, naturopathy, and homoeopathy
Some independent complementary medicine centres have contracts with local NHS purchasers. For example, Wessex Health Authority has a specific service contract with a private clinic to provide a multidisciplinary package of complementary medicine for NHS patients with chronic fatigue or hyperactivity. Some fundholding general practices have delegated patients to independent centres such as local chiropractic clinics rather than employ complementary practitioners in house.
A few health authorities have set up pilot projects for multidisciplinary complementary medicine in the community or on hospital premises Advantages have included clear referral guidelines, evaluation, good communication with general practitioners, and supervised and accountable complementary practitioners. However, such centres are particularly vulnerable when health authorities come under financial pressure. Examples are the Liverpool Centre for Health and the former Lewisham Hospital NHS Trust Complementary Therapy Centre, which was closed when the local health authority had to reduce its overspend.
In conventional secondary care
Many NHS hospital trusts offer some form of complementary medicine to patients. This may be provided by practitioners with or without backgrounds in conventional health care. However, the availability of such services varies widely and depends heavily on local interest and high level support.
View this table:View PopupView InlineExamples of complementary medicine in secondary care
Funding for complementary medicine
Complementary medicine can be provided by conventional NHS healthcare professionals as part of everyday clinical care. This requires no special funding arrangements. General practitioners cannot claim item of service payments for complementary treatments they give to their own NHS patients.
Since 1991, health authorities can reimburse general practitioner principals who employ complementary therapists, although the staff budget is limited and a complementary practitioner is therefore employed at the expense of another member of staff. General practitioner fundholders have had additional control over staffing budgets and fundholding savings, which some have used to purchase complementary therapies. Primary care groups have greater power to allocate funds as they choose, but it remains to be seen whether complementary medicine will be identified as a priority by sufficiently large numbers of general practitioners for the creation of any new initiatives. Indeed, the change from general practice fundholding to primary care groups may mean that some established complementary services will be lost.
An increasing number of hospital pain clinics now offer acupuncture as a treatment for chronic pain
Local health commissions and authorities have sometimes used money for research and development, or for waiting list initiatives, to finance complementary medicine. Block service contracts or individual extracontractual referrals can be made with complementary medicine providers, but in practice financial constraints restrict this type of access.
Funds from the voluntary sector or charities may also be sought. The complementary therapy service at the Marylebone Health Centre in London was initially funded by a research grant from a charitable trust. Fundraising and donations by the local patients are now essential to its ongoing financial viability. In addition, some charities, such as the London Lighthouse for people infected with HIV, subsidise complementary medicine for people who could not otherwise afford treatment.
Some occupational health and private medical insurance schemes fund complementary therapies.
Medicolegal considerations
If doctors participate in patients' seeking complementary therapies—by advising, treating, delegating, or referring—they need to be aware of the medicolegal implications. Although each case is judged on its merits, certain guidelines apply.
Some complementary therapies, such as relaxation, can be delivered effectively in group sessions, which improves their cost effectiveness
Doctors who practise complementary therapies
Under the Medical Act of 1858, conventionally trained doctors can legally administer any unconventional medical treatments they choose However, as with most medical practice, the “Bolam test” is used to determine appropriate standards of care. This means that “a doctor is not guilty of negligence if he or she has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art as long as it is subject to logical analysis.” In other words, if a doctor has undergone additional training in a complementary discipline and practises in a way that is reasonable and would be considered acceptable by a number (not necessarily a majority) of other medically qualified complementary practitioners, his or her actions are defensible.
Referral to medically qualified practitioners
A doctor who asks another doctor to provide complementary medicine is in the same legal situation as when referring to a doctor for any other services. As long as the decision to make the referral is appropriate, all further responsibility regarding the complementary treatment is taken over by the doctor providing the specialist service.
Medicolegally acceptable delegation to non-medically qualified complementary practitioners
Initial decision to delegate to a practitioner must pass Bolam test
Evidence based decisions are most persuasiveCommonly accepted but unproved indications are also acceptable
Doctors must take reasonable steps to ascertain that practitioners are appropriately qualified
It is usually sufficient for delegating doctors to ensure that they are a member of the main professional regulatory body responsible for that particular disciplineThe main bodies require members to be fully indemnified
Doctors must retain “overall clinical responsibility”—that is, ensure appropriate follow up, reassessment, etc
Doctors should not issue repeat complementary prescriptions without having or obtaining sufficient information to ensure safe prescribing
Delegation to non-medically qualified practitioners
This situation, more than any other, concerns doctors who wish to make complementary medicine available to their patients. Despite theoretical worries, however, it is considered a very low risk area by medical defence societies. The situation may change if complementary medicine becomes more widely used.
Doctors must ask themselves three main questions:
Is my decision to delegate to this complementary therapy appropriate?Have I taken reasonable steps to ensure that the practitioner concerned is qualified and insured?Has my medical follow up been adequate?
To date, no claims or cases have been sustained against doctors who have delegated to complementary practitioners.
Delegation to state regulated complementary practitioners
Now that osteopaths and chiropractors are state regulated, delegating to these practitioners is medicolegally similar to delegating care to a physiotherapist or other conventional healthcare professional.
Key evaluation reports from NHS complementary medicine services
ReferencesRichardson J. Complementary therapy in the NHS: a service evaluation of the first year of an outpatient service in a local district general hospital. November 1995. Report prepared by Health Services Research and Evaluation Unit, Lewisham Hospital NHS Trust, LondonHotchkiss J. Liverpool Centre for Health: the first year of a service offering complementary therapies on the NHS. Liverpool: Liverpool Public Health Observatory, 1995 (Observatory Report Series No 25)Hills D, Welford R. Complementary therapy in general practice: an evaluation of the Glastonbury Health Centre Complementary Medicine Service. Somerset Trust for Integrated Health Care, 1998Rees R. Evaluating complementary therapy on the NHS: a critique of reports from three pilot projects. Complement Ther Med 1996: 254–7Scheurmier N, Breen AC. A pilot study of the purchase of manipulation services for acute low back pain in the United Kingdom. J Manipulative Physiol Ther 1998; 21: 14–8
Obtaining lists of the main professional registers
Council for Complementary and Alternative Medicine (CCAM)
Deals with registration of acupuncture, herbal medicine, homoeopathy, and osteopathy
63 Jeddo Road, London W12 6HQ. Tel: 0181 735 0632
British Complementary Medicine Association (BCMA)
Deals with registration of wide range of complementary practitioners including reflexologists, aromatherapists, craniosacral therapists, nutritional therapists, and hypnotherapists
249 Fosse Road South, Leicester LE3 1AE. Tel: 0116 282 5511
Further reading
ReferencesSharma U. Complementary medicine today: practitioners and patients. Rev ed. London: Routledge, 1995Fulder S. The handbook of alternative and complementary medicine. 3rd ed. Oxford: Oxford University Press, 1996Stone J, Matthews J. Complementary medicine and the law. Oxford: Oxford University Press, 1996Coates J, Jobst K. Integrated healthcare, a way forward for the next five years? J Alternative Complement Med 1998; 4: 209–47Complementary medicine: new approaches to good practice. Oxford: Oxford University Press, 1993
Acknowledgments
The pictures of Royal London Homoeopathic Hospital and acupuncture are reproduced with permission of the Royal London Homoeopathic Hospital The picture of osteopathy is reproduced with permission of the General Osteopathic Council. The picture of group therapy is reproduced with permission of BMJ/Ulrike Preuss.
Footnotes
The ABC of complementary medicine is edited and written by Catherine Zollman and Andrew Vickers. Catherine Zollman is a general practitioner in Bristol, and Andrew Vickers will shortly take up a post at Memorial Sloan-Kettering Cancer Center, New York. At the time of writing, both worked for the Research Council for Complementary Medicine, London The series will be published as a book in spring 2000.
"Integrative health care" (IHC), combining various aspects of Western biomedicine and complementary/alternative medicine (CAM), is a relatively new development in health care systems. IHC is recognized internationally, yet the occurrence of private CAM therapies and their various effects on IHC settings has not extensively been analyzed. This paper presents findings from a larger study of three IHC settings in Canada conducted between 2002 and 2003. The main research question addressed here is: How have private CAM therapies affected IHC settings combining CAM and biomedicine in a publicly funded health care system? Drawing on ethnography, 38 indepth interviews are drawn upon, including those with 15 biomedical and eight CAM practitioners, 13 patients and two health care managers. Ethnographic observation and document analysis was conducted at each site. Findings illustrated that patients could not consistently afford unfunded CAM treatments, resulting in the premature termination of an integrative care plan. CAM practitioners from the private sector could not uniformly attend group rounds, resulting in disrupted care co-ordination. Certain biomedical institutions viewed CAM as a commodity from which to generate revenue and lower budgetary deficits. This study argues that the unfunded nature of CAM therapies in public health systems, although CAM has therapeutic value, does not contribute to an equitable partnership when attempting to integrate biomedicine and CAM. Future analyses of IHC need to take into account the complexities of health system context that continues to shape IHC.
Partnerships and concordance are desirable concepts for optimal healthcare. The concept of concordance is based on negotiation between equals in a therapeutic relationship, forming a therapeutic alliance between all partners. One field of healthcare in which concordant relationships may be particularly desirable is complementary and alternative medicine (CAM). CAM is increasingly used by consumers worldwide, and provider-patient relationships are important across the spectrum of CAM-to-conventional medicine; thus, it was considered useful to research CAM and concordance in parallel. The objective of this problem-detection study (PDS) was to investigate practitioners' (general practitioners', pharmacists' and CAM practitioners') views on their relationships and reaching concordant partnerships with consumers in the areas of both conventional medicine and CAM. Focus groups and semi-structured interviews guided the development of the PDS instrument. The questionnaire consisted of 36 items corresponding to seven thematic units deduced from the preliminary data. The differences in perceptions between the surveyed groups indicated that achieving concordance relies on mutual respect and communication and understanding of roles, responsibilities and limitations, and differences in opinion may be compromising the formation of partnerships. Potentially problematic issues identified by this research could be addressed by educational interventions and enhancement of communication between all parties involved, as information loses value when not shared, and may be prone to contradiction and confusion. Further research is warranted in order to facilitate positive changes in the health system.
Stepping back from the immediate demands of policy-making, Mainstreaming Complementary and Alternative Medicine allows a complex and informative picture to emerge of the different social forces at play in the integration of CAM with orthodox medicine. Complementing books that focus solely on practice, it will be relevant reading for all students following health studies or healthcare courses, for medical students and medical and healthcare professionals.