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Integrative Healthcare: Arriving at a Working Definition

Authors:
  • University of St. Michael's College
  • Assocation of Registered Nurses of B.C. (ARNBC)

Abstract

A variety of integrative healthcare programs and clinics have been initiated both in Canada and the United States. Many different terms (eg, integrative medicine, integrated medicine, multidisciplinary care, integrative health care) are used to describe these initiatives. The diversity of terminology and absence of a shared conceptual framework makes it difficult to assess when integration is actually happening. The objective of this paper was to explore current efforts to conceptualize integrative healthcare and to identify its components. A qualitative content analysis of articles identified in an extensive literature review resulted in the identification of four key components of integrative care: philosophy/values, structure, process and outcomes. These were used to guide the development of a definition of integrative healthcare that should be seen as an "ideal type" or goal toward which practitioners and health systems could strive.
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INTEGRATIVE HEALTHCARE: ARRIVING AT A WORKING DEFINITION
Heather Boon; Marja Verhoef; Dennis O'Hara; Barb Findlay; Nadine Majid
Alternative Therapies in Health and Medicine; Sep/Oct 2004; 10, 5; Research Library
pg. 48
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
... In recent decades, innovative treatments have focused on addressing depression through a more holistic approach (e.g., increased attention to interactions of physical, mental, spiritual, and social health), [23][24][25] rather than using traditional therapies that more narrowly focus on symptom reduction (e.g., Cognitive Behavioral Therapy, Interpersonal Therapy) [26]. Mindbody practices constitute a form of integrative medicine that has grown in popularity [27]. ...
Article
Full-text available
Background Mind-Body Skills Groups (MBSGs) have shown promise in reducing adolescent depression symptoms; however, little is known about adolescents’ perspectives on this treatment. The objective of this study was to understand the acceptability of a new treatment for depressed adolescents in primary care settings. Methods Adolescents participating in a 10-week MBSG treatment were interviewed to understand their perspectives on the acceptability and effectiveness of the treatment. Interviews were collected at post-intervention and at a 3-month follow-up visit. Results A total of 39 adolescents completed both the post-intervention and 3-month follow-up interview. At post-intervention and follow-up, 84% of adolescents stated the MBSGs helped them. When asked how the MBSGs helped them, 3 areas were identified: learning new MBSG activities and skills, social connection with others within the group, and outcomes related to the group. Many adolescents reported no concerns with the MBSGs (49% at post- intervention; 62% at follow-up). Those with concerns identified certain activities as not being useful, wanting the group to be longer, and the time of group (after school) being inconvenient. Most adolescents reported that their life had changed because of the group (72% at post-intervention; 61% at follow-up), and when asked how, common responses included feeling less isolated and more hopeful. Conclusions Adolescents found the MBSGs to be helpful and acceptable as a treatment option for depression in primary care. Given the strong emphasis on treatment preference autonomy and the social activities within the group, MBSGs appear well-suited for this age group. Trial registration NCT03363750 ; December 6th, 2017.
... This history helps to explain the recent surge in scientific growth [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] and the improved access to chiropractic care after the barriers that were erected by the AMA were finally removed. [25][26][27][28][29][30][31][32][33][34][35][36][37][38] These events clarify chiropractic's previous struggles and how past experiences influence current social constructs. The obstacles and challenges that chiropractic overcame help explain some of the current culture and identify issues that the chiropractic profession may need to address in the future. ...
Article
Objective This paper is the second in a series that explores the historical events surrounding the Wilk v American Medical Association (AMA) lawsuit in which the plaintiffs argued that the AMA, the American Hospital Association, and other medical specialty societies violated anti-trust law by restraining chiropractors' business practices. The purpose of this paper is to provide a brief review of the history of how the AMA rose to dominate health care in the United States, and within this social context, how the chiropractic profession fought to survive in the first half of the 20th century. Methods This historical research study used a phenomenological approach to qualitative inquiry into the conflict between regular medicine and chiropractic and the events before, during, and after a legal dispute at the time of modernization of the chiropractic profession. Our methods included obtaining primary and secondary data sources. The final narrative recount was developed into 8 papers following a successive timeline. This paper is the second of the series that explores the growth of medicine and the chiropractic profession. Results The AMA's code of ethics established in 1847 continued to direct organized medicine's actions to exclude other health professions. During the early 1900s, the AMA established itself as “regular medicine.” They labeled other types of medicine and health care professions, such as chiropractic, as “irregulars” claiming that they were cultists and quacks. In addition to the rise in power of the AMA, a report written by Abraham Flexner helped to solidify the AMA's control over health care. Chiropractic as a profession was emerging and developing in practice, education, and science. The few resources available to chiropractors were used to defend their profession against attacks from organized medicine and to secure legislation to legalize the practice of chiropractic. After years of struggle, the last state in the US legalized chiropractic 79 years after the birth of the profession. Conclusion In the first part of the 20th century, the AMA was amassing power as chiropractic was just emerging as a profession. Events such as publication of Flexner's report and development of the medical basic science laws helped to entrench the AMA's monopoly on health care. The health care environment shaped how chiropractic grew as a profession. Chiropractic practice, education, and science were challenged by trying to develop outside of the medical establishment. These events added to the tensions between the professions that ultimately resulted in the Wilk v AMA lawsuit.
... With the increasing pressure from chiropractic associations to either expand the scope of practice or have parity with medical doctors, medical associations' leadership reacted to these activities as perceived threats into medical territory and took aggressive action against chiropractors. 1 These historical events surrounding this lawsuit are important for chiropractors today, because they help explain the surge in scientific growth [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] and the improvement in access to chiropractic care for patients once barriers implemented by the AMA were removed. [22][23][24][25][26][27][28][29][30][31][32][33][34][35] These events clarify chiropractic's previous struggles and how past experiences may be influencing current events. The obstacles and challenges that chiropractic overcame may help explain the current culture and help to identify issues that the chiropractic profession may need to address into the future. ...
Article
Objective This is the fourth article in a series that explores the historical events surrounding the Wilk v American Medical Association (AMA) lawsuit, in which the plaintiffs argued that the AMA, the American Hospital Association, and other medical specialty societies violated antitrust law by restraining chiropractors' business practices. The purpose of this article is to provide a brief review of the history of the origins of AMA's increased efforts to contain and eliminate the chiropractic profession and the development of the Chiropractic Committee, which would later become the AMA Committee on Quackery. Methods This historical research study used a phenomenological approach to qualitative inquiry into the conflict between regular medicine and chiropractic and the events before, during, and after a legal dispute at the time of modernization of the chiropractic profession. Our methods included obtaining primary and secondary data sources. The final narrative recount was developed into 8 articles following a successive timeline. This article is the fourth of the series that explores the origins of AMA's increased efforts to contain and eliminate the chiropractic profession. Results In the 1950s, the number of chiropractors grew in Iowa, and chiropractors were seeking equity with other health professions through legislation. In response, the Iowa State Medical Society created a Chiropractic Committee to contain chiropractic and prompted the creation of the “Iowa Plan” to contain and eliminate the chiropractic profession. The AMA leadership was enticed by the plan and hired the Iowa State Medical Society's legislative counsel, who structured the operation. The AMA adopted the Iowa Plan for nationwide implementation to eradicate chiropractic. The formation of the AMA's Committee on Chiropractic, which was later renamed the Committee on Quackery (CoQ), led overt and covert campaigns against chiropractic. Both national chiropractic associations were fully aware of many, but not all, of organized medicine's plans to restrain chiropractic. Conclusion By the 1960s, organized medicine heightened its efforts to contain and eliminate the chiropractic profession. The intensified campaign began in Iowa and was adopted by the AMA as a national campaign. Although the meetings of the AMA committees were not public, the war against chiropractic was distributed widely in lay publications, medical sources, and even chiropractic journals. Details about events would eventually be more fully revealed during the Wilk v AMA trials.
... [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] An additional outcome of the lawsuit was the eventual removal of barriers that were previously implemented by the AMA, which resulted in patients being allowed access to chiropractic care and that allowed chiropractors to work with other health care professionals in integrated care settings. [28][29][30][31][32][33][34][35][36][37][38][39][40][41] These events likely would not have happened, and the chiropractic profession would not be as it is today without the 2 trials and the successful conclusion of the Wilk v AMA lawsuit. 42 And yet, the remnants from the past are still with us today. ...
Article
Objective This paper is the first in a series that explores the historical events surrounding the Wilk v American Medical Association (AMA) lawsuit in which the plaintiffs argued that the AMA, the American Hospital Association, and other medical specialty societies violated antitrust law by restraining chiropractors' business practices. The purpose of this paper is to provide a brief review of the history of the AMA and the origins of chiropractic and to explore how the AMA began its monopoly of health care in the United States, possible reasons that organized medicine acted against chiropractic, and how these events influenced the chiropractic profession. Methods This historical research study used a phenomenological approach to qualitative inquiry into the conflict between regular medicine and chiropractic and the events before, during, and after a legal dispute at the time of modernization of the chiropractic profession. We used primary and secondary data sources. The final narrative recount was developed into 8 papers that follow a successive time line. This paper is the first of the series and explores the origins of the aversion of organized American medicine to other health professions and the origins of the chiropractic profession. Results The AMA began in the mid-1800s to unify like-minded “regular” medical physicians who developed a code of ethics and promoted higher educational standards. Their efforts to unify had excluded other types of health care providers, which they called “irregular” practitioners. However, Americans were seeking more natural alternatives to the harsh methods that regular medical physicians offered at that time. Nearly 50 years after the AMA began, the chiropractic profession attempted to emerge during a time when many patients valued vitalism and their freedom to choose what health care provider they would access. Conclusion During the years that chiropractic developed as a healing profession, organized medicine was already well established and developing a monopoly in American health care. These events created the foundation on which the tensions between these professions were built and ultimately resulted in the Wilk v AMA lawsuit.
... The historical events surrounding the Wilk v American Medical Association (AMA) lawsuit 4 are important for chiropractors today, because they help explain the surge in scientific growth [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] and the improvement in access to chiropractic care for patients once barriers were re-moved. [25][26][27][28][29][30][31][32][33][34][35][36][37][38] These events clarify chiropractic's previous struggles and how past experiences may be influencing current events. The obstacles and challenges that chiropractic overcame help to explain the current culture and to identify issues that the chiropractic profession may need to address into the future. ...
Article
Objective This is the sixth article in a series that explores the historical events surrounding the Wilk v American Medical Association (AMA) lawsuit in which the plaintiffs argued that the AMA, the American Hospital Association, and other medical specialty societies violated antitrust law by restraining chiropractors' business practices. The purpose of this article is to provide a brief review of the plaintiffs, lead lawyer, and the events immediately before the lawsuit was filed. Methods This historical research study used a phenomenological approach to qualitative inquiry into the conflict between regular medicine and chiropractic and the events before, during, and after a legal dispute at the time of modernization of the chiropractic profession. Our methods included obtaining primary and secondary data sources. The final narrative recount was developed into 8 articles following a successive timeline. This article, the sixth of the series, explores the plaintiffs' stories. Results Because of the AMA's boycott on chiropractic, chiropractors were not able to collaborate with medical physicians or refer patients to medical facilities, which resulted in restricted trade and potential harm to patients' well-being. The plaintiffs, Patricia Arthur, James Bryden, Michael Pedigo, and Chester Wilk, came from different regions of the United States. Each had unique experiences and were compelled to seek justice. The lead lawyer, Mr George McAndrews, was the son of a chiropractor and had witnessed the effect that the AMA's attacks on chiropractic had on his father. It took several years to gather enough resources to file the suit, which was submitted in 1976. Conclusion The conflicts that the plaintiffs experienced stimulated them to pursue a lawsuit against the AMA and other organized political medicine groups.
... 5 The historical events surrounding this lawsuit are important for chiropractors today, because they help explain the surge in scientific growth [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] and the improvement in access to chiropractic care for patients once barriers were removed. [26][27][28][29][30][31][32][33][34][35][36][37][38][39] These events clarify chiropractic's previous struggles and how past experiences can influence current events. The obstacles and challenges that chiropractic overcame may help explain the current culture and help to identify issues that the chiropractic profession may need to address into the future. ...
Article
Objective This is the fifth article in a series that explores the historical events surrounding the Wilk v American Medical Association (AMA) lawsuit in which the plaintiffs argued that the AMA, the American Hospital Association, and other medical specialty societies violated antitrust law by restraining chiropractors' business practices. The purpose of this article is to provide a brief review of events surrounding the eventual end of the AMA's Committee on Quackery and the exposure of evidence of the AMA's efforts to boycott the chiropractic profession. Methods This historical research study used a phenomenological approach to qualitative inquiry into the conflict between regular medicine and chiropractic and the events before, during, and after a legal dispute at the time of modernization of the chiropractic profession. Our methods included obtaining primary and secondary data sources. The final narrative recount was developed into 8 articles following a successive timeline. This article, the fifth of the series, explores the exposure of what the AMA had been doing, which provided evidence that was eventually used in the Wilk v AMA antitrust lawsuit. Results The prime mission of the AMA's Committee on Quackery was “first, the containment of chiropractic and, ultimately, the elimination of chiropractic.” However, the committee did not complete its mission and quietly disbanded in 1974. This was the same year that the chiropractic profession finally gained licensure in all 50 of the United States; received recognition from the US Commissioner of Education, Department of Health, Education and Welfare; and was successfully included in Medicare. In 1975, documents reportedly obtained by the Church of Scientology covert operatives under Operation AMA Doom revealed the extent to which the AMA and its Committee on Quackery had been working to contain and eliminate the chiropractic profession. The AMA actions included influencing mainstream media, decisions made by the Joint Commission on Accreditation of Hospitals, and the Department of Health, Education, and Welfare. Other actions included publishing propaganda against chiropractic and implementing an anti-chiropractic program aimed at medical students, medical societies, and the American public. Conclusion After more than a decade of overt and covert actions, the AMA chose to end its Committee on Quackery. The following year, documents exposed the extent of AMA's efforts to enact its boycott of chiropractic.
... The historical events surrounding this lawsuit are important for chiropractors today because they help explain the surge in scientific growth [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] and the improvement in access to chiropractic care for patients once barriers were removed. [27][28][29][30][31][32][33][34][35][36][37][38][39][40] These events clarify chiropractic's previous struggles and how past experiences may influence current events. The obstacles and challenges that chiropractic overcame may help explain the current culture and to identify issues that the chiropractic profession may need to address into the future. ...
Article
Objective This is the seventh paper in a series that explores the historical events surrounding the Wilk v American Medical Association (AMA) lawsuit in which the plaintiffs argued that the AMA, the American Hospital Association, and other medical specialty societies violated antitrust law by restraining chiropractors' business practices. The purpose of this paper is to provide a summary of the lawsuit that was first filed in 1976 and concluded with the final denial of appeal in 1990. Methods This historical research study used a phenomenological approach to qualitative inquiry into the conflict between regular medicine and chiropractic and the events before, during, and after a legal dispute at the time of modernization of the chiropractic profession. Our methods included obtaining primary and secondary data sources. The final narrative recount was developed into 8 papers following a successive time line. This paper, the seventh of the series, considers the information of the 2 trials and the judge's decision. Results By the time the first trial began in 1980, the AMA had already changed its anti-chiropractic stance to allow medical doctors to associate with chiropractors if they wished. In the first trial, the chiropractors were not able to overcome the very stigma that organized medicine worked so hard to create over many decades, which resulted in the jury voting in favor of the AMA and other defendants. The plaintiffs, Drs Patricia Arthur, James Bryden, Michael Pedigo, and Chester Wilk, continued with their pursuit of justice. Their lawyer, Mr George McAndrews, fought for an appeal and was allowed a second trial. The second trial was a bench trial in which Judge Susan Getzendanner declared her final judgment that “the American Medical Association (AMA) and its members participated in a conspiracy against chiropractors in violation of the nation's antitrust laws.” After the AMA's appeal was denied by the Court of Appeals for the Seventh Circuit in 1990, the decision was declared permanent. The injunction that was ordered by the judge was published in the January 1, 1988, issue of the Journal of the American Medical Association. Conclusion The efforts by Mr McAndrews and his legal team and the persistence of the plaintiffs and countless others in the chiropractic profession concluded in Judge Getzendanner's decision, which prevented the AMA from rebuilding barriers or developing another boycott. The chiropractic profession was ready to move into its next century.
... The language from the injunction also pertained to hospitals and medical clinics that may have opened new opportunities for chiropractors on interprofessional care teams in integrated care settings. [22][23][24][25][26][27][28][29][30][31][32][33][34][35] Before the final decision on the lawsuit, there had been various internal and external forces that had shaped the chiropractic profession for 95 years. It should not be expected that 1 decision would be able to erase decades of persecution and discrimination. ...
Article
Objective This paper is the eighth in a series that explores the historical events surrounding the Wilk v American Medical Association (AMA) lawsuit in which the plaintiffs argued that the AMA, the American Hospital Association, and other medical specialty societies violated antitrust law by restraining chiropractors' business practices. The purpose of this paper is to discuss the possible impact that the final decision in favor of the plaintiffs may have had on the chiropractic profession. Methods This historical research study used a phenomenological approach to qualitative inquiry into the conflict between regular medicine and chiropractic and the events before, during, and after a legal dispute at the time of modernization of the chiropractic profession. Our methods included obtaining primary and secondary data sources. The final narrative recount was developed into 8 papers following a successive timeline. This paper is the eighth of the series that discusses how the trial decision may have influenced the chiropractic that we know today in the United States. Results Chiropractic practice, education, and research have changed since before the lawsuit was filed. There are several areas in which we propose that the trial decision may have had an impact on the chiropractic profession. Conclusion The lawsuit removed the barriers that were implemented by organized medicine against the chiropractic profession. The quality of chiropractic practice, education, and research continues to improve and the profession continues to meet its most fundamental mission: to improve the lives of patients. Chiropractors practicing in the United States today are allowed to collaborate freely with other health professionals. Today, patients have the option to access chiropractic care because of the dedicated efforts of many people to reduce the previous barriers. It is up to the present-day members of the medical and chiropractic professions to look back and to remember what happened. By recalling the events surrounding the lawsuit, we may have a better understanding about our professions today. This information may help to facilitate interactions between medicine and chiropractic and to develop more respectful partnerships focused on creating a better future for the health of the public. The future of the chiropractic profession rests in the heads, hearts, and hands of its current members to do what is right.
... As a result, the AMA leaders strengthened their efforts and developed increasingly aggressive attacks, which ultimately led chiropractors to file the Wilk v AMA lawsuit. 1 The historical events surrounding this lawsuit are important for chiropractors today because they help explain the surge in scientific growth [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] and the improve-ment in access to chiropractic care for patients once barriers were removed. [22][23][24][25][26][27][28][29][30][31][32][33][34][35] These events clarify chiropractic's previous struggles and how past experiences may influence current events. The obstacles and challenges that chiropractic overcame may help explain the current culture and help to identify issues that the chiropractic profession may need to address in the future. ...
Article
Objective This is the third paper in a series that explores the historical events surrounding the Wilk v American Medical Association (AMA) lawsuit in which the plaintiffs argued that the AMA, the American Hospital Association, and other medical specialty societies violated antitrust law by restraining chiropractors' business practices. The purpose of this paper is to provide a brief review of the history of the growth of chiropractic, its public relations campaigns, and infighting that contributed to the events surrounding the Wilk v AMA lawsuit. Methods This historical research study used a phenomenological approach to qualitative inquiry into the conflict between regular medicine and chiropractic and the events before, during, and after a legal dispute at the time of modernization of the chiropractic profession. Our methods included obtaining primary and secondary data sources. The final narrative recount was developed into 8 papers following a successive timeline. This paper is the third of the series that explores the growth the chiropractic profession. Results By the 1930s, the AMA was already under investigation for violation of antitrust laws and the National Chiropractic Association was suggesting that the AMA was establishing a health care monopoly. Chiropractic schools grew and the number of graduates rose quickly. Public relations campaigns and publications in the popular press attempted to educate the public about chiropractic. Factions within the profession polarized around differing views of how they thought that chiropractic should be practiced and portrayed to the public. The AMA leaders noted the infighting and used it to their advantage to subvert chiropractic. Conclusion Chiropractic grew rapidly and established its presence with the American public through public relations campaigns and popular press. However, infighting would give the AMA material to further its efforts to contain and eliminate the chiropractic profession.
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Background: Ayurveda is widely practiced in South Asia in the treatment of osteoarthritis (OA). The aim of these secondary data analyses were to identify the most relevant variables for treatment response and group differences between Ayurvedic therapy compared to conventional therapy in knee OA patients. Methods: A total of 151 patients (Ayurveda n = 77, conventional care n = 74) were analyzed according to the intention-to-treat principle in a randomized controlled trial. Different statistical approaches including generalized linear models, a radial basis function (RBF) network, exhausted CHAID, classification and regression trees (CART), and C5.0 with adaptive boosting were applied. Results: The RBF network implicated that the therapy arm and the baseline values of the WOMAC Index subscales might be the most important variables for the significant between-group differences of the WOMAC Index from baseline to 12 weeks in favor of Ayurveda. The intake of nutritional supplements in the Ayurveda group did not seem to be a significant factor in changes in the WOMAC Index. Ayurveda patients with functional limitations > 60 points and pain > 25 points at baseline showed the greatest improvements in the WOMAC Index from baseline to 12 weeks (mean value 107.8 ± 27.4). A C5.0 model with nine predictors had a predictive accuracy of 89.4% for a change in the WOMAC Index after 12 weeks > 10. With adaptive boosting, the accuracy rose to 98%. Conclusions: These secondary analyses suggested that therapeutic effects cannot be explained by the therapies themselves alone, although they were the most important factors in the applied models.
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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 $21.2 billion in 1997, with at least $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.
Article
PART ONE: BACKGROUND. 1. Complementary Medicine in Practice. Introduction. What is CAM? The present situation. Provision of CAM in mainstream medical care. Key issue to be addressed. How can CTs be integrated into primary care? Summary. 2. Models and research in CTs. Introduction. Models and theories of healing. Research. Research into specific conditions. Models and research in individual therapies. Research evidence. PART TWO: CT SERVICE IMPLEMENTATION. 3. Designing an integrated service. Introduction. Key issues and questions for practice development and clinical governance. Models of integration and delivery. People issues. Funding and resource issues. Legal considerations. Issues of learning and communication. Information for doctors on specific CT techniques, training & organization. Practitioner development. Practice professional development planning. Patient involvement. Design of material. An examples of service design: the Marylebone Health Centre (MHC) project. Key information sources. 4. Delivering and evaluating the service. Introduction. The service delivery process. Examples of integrated delivery in practice. Can complementary medicine be cost effective? New developments in the Marylebone PCG: disseminating the approach. Summary. 5. Reflecting on and adapting the service. Introduction. Feedback on the service. Reflections. Looking forward. Summary: some final pointers. PART THREE: SERVICE DOCUMENTATION AND INFORMATION SHEETS. 6. Information sheets on management of common disorders. Allergies and intolerance. Anxiety and panic attacks. Asthma. Cardiovascular disease. Headache and migraine. Infections. Irritable bowel syndrome. Mechanical back, neck and head pain. Osteoarthritis. Painful periods. Persistently aching joints and muscles. Premenstrual syndrome. Problems around the menopause. Rheumatoid arthritis. Tiredness and fatigue. 7. Patient Advice and self-help sheets. Therapies. Conditions. Exercises. Diets. 8. Blank forms and evaluation documentation. Introduction. GP to in-house CT referral form. Therapy choice questionnaire. Analysing your results. MYMOP guides and forms. The Smith Project - CP guide to clinical data entry (filemaker Pro 4.1). Staff appraisal and development form. Appendices. Appendix I: Summary and recommendations of a report by the House of Lords Select Committee on complementary and alternative medicine, November 2000. Appendix II: Useful addresses. Appendix III: Information sources. Index.
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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.
Article
EDITOR—Vickers's review is another example of how complementary and alternative medicine (CAM) is being brought into the mainstream rather than integrated.1 Times are indeed changing, but what to? The dictionary defines integration as “the incorporation of equals into society.”2 Let's be honest: there is no equality in medicine; there never was and probably never will be. The recent approval of acupuncture by the BMA is by no means an overarching endorsement of Chinese medicine as a legitimate alternative system.3 It is simply an acknowledgement of the accumulation over time of good enough evidence that shows the effectiveness of acupuncture in some conditions. This is, to borrow a metaphor from the word processing world, a cut and paste approach. It results in the assimilation, and not creation, of a new emergent property. Combination medicine is not integrated medicine. Two other important aspects related to the future of CAM deserve discussion. Health services research—Currently, much of the research effort in CAM is in the form of treatment x for disease y. Almost no systematic research is taking place on the delivery, organisation, and financing of different integrative healthcare models or on the appropriateness, quality, availability, and cost of CAM modalities in the current healthcare system. At a time when there is much interest …