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Sadowski A, Garofalo L, Welsh A, Bradley R. Naturopathic Doctors: An Underutilized Resource of Whole Health Delivery in Primary Care. Glob Adv Health Med 2022; 11:2164957X221079787. [PMID: 35223196 PMCID: PMC8874159 DOI: 10.1177/2164957x221079787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 01/25/2022] [Indexed: 01/27/2023] Open
Abstract
Naturopathy, recognized by the National Institutes of Health and the World Health Organization as a distinct system of complementary and integrative health care, is an existing model of whole health delivery. Its unifying principles, respect for the interconnectedness of biological systems, and representation globally uniquely positions naturopathy to serve an integral role in addressing the needs of primary health care. In this viewpoint, we aim to 1) highlight key areas and existing literature supporting the use of naturopathy for health promotion and disease prevention of noncommunicable diseases; 2) describe how naturopathy can addresses the mental health needs of today's societies; and 3) discuss the importance of naturopathy in the access and navigation of complementary and integrative health therapies.
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Affiliation(s)
- Adam Sadowski
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
| | | | - Alanna Welsh
- Legacy Cancer Institute, Legacy Health Services, Portland, OR, USA
| | - Ryan Bradley
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
- Herbert Wertheim School of Public Health, University of California, San Diego, CA, USA
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2
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Steel A, Lloyd I. Community education and health promotion activities of naturopathic practitioners: results of an international cross-sectional survey. BMC Complement Med Ther 2021; 21:293. [PMID: 34847899 PMCID: PMC8630897 DOI: 10.1186/s12906-021-03467-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 11/17/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Health promotion and patient education are crucial to improved population health and are also among the core principles that define naturopathy. Yet, the activities of naturopathic practitioners (NPs) with regards to health promotion and community education have not been widely studied. METHODS A cross-sectional online survey of an international convenience sample of NPs was conducted through disseminating a 15-item questionnaire prepared in five languages. Correlates of most frequently mentioned NP activities were studied. RESULTS The survey was completed by 813 NPs representing all world regions. Almost all participants (98%) reported at least one health promotion activity. Most reported were information sheets and handouts (92.7%) or social and professional network communications (91.8%) and information talks presented to community members (84.9%). The majority of NPs (79.5%) indicated that the 'health issues individuals in NPs' community have said they need help with' were a 'very important' consideration when they designed health promotion activities. NP characteristics associated with the likelihood of engaging in specific health promotion activities varied between activities but include gender, time since first qualification, factors considered to identify need when designing an activity, and stakeholder involvement in activity design. CONCLUSIONS Health promotion is a key activity of the global naturopathic profession. There are a wide range of patient education tools utilized by NPs.
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Affiliation(s)
- Amie Steel
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 235-253 Jones St, Ultimo, Sydney, NSW, 2006, Australia.
| | - Iva Lloyd
- World Naturopathic Federation, Toronto, Canada
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Steel A, Rickwood C, Bradley R, Foley H, Harnett JE. Australian Naturopaths' Approach to Caring for People with Cardiovascular Disease and Associated Risk Factors: A Qualitative Study of the Providers' Perspective. J Altern Complement Med 2020; 26:902-910. [PMID: 32721211 DOI: 10.1089/acm.2020.0095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objectives: To date, no formal research has evaluated how naturopathic practitioners approach the care of people living with CVD and associated CVD risk factors. The primary aim of this research was to collect qualitative data from Australian Naturopathic practitioners about their clinical practices for CVD. Design: Semi-structured interviews were conducted, recorded, transcribed, and ultimately coded by three independent researchers using the Framework Approach. Subjects: 10 Australian Naturopathic practitioners. Results: The key emergent themes from the responses of naturopathic practitioners embodied the elements of patient-centered care (PCC). Numerous factors, including regulation, barriers to service access, and interprofessional communication, were cited as hurdles to additional effectiveness as PCC practitioners. Conclusion: Future research should assess whether the principles of PCC are reported directly from the patients who utilize naturopathy for CVD to determine if their experience mirrors the reports by practitioners.
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Affiliation(s)
- Amie Steel
- Australian Research Centre of Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | | | - Ryan Bradley
- Australian Research Centre of Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Sydney, Australia.,Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA.,Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
| | - Hope Foley
- Australian Research Centre of Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Sydney, Australia.,Office of Research, Endeavour College of Natural Health, Brisbane, Australia
| | - Joanna E Harnett
- Australian Research Centre of Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Sydney, Australia.,School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Bradley R, Harnett J, Cooley K, McIntyre E, Goldenberg J, Adams J. Naturopathy as a Model of Prevention-Oriented, Patient-Centered Primary Care: A Disruptive Innovation in Health Care. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E603. [PMID: 31540415 PMCID: PMC6780388 DOI: 10.3390/medicina55090603] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 08/23/2019] [Accepted: 09/10/2019] [Indexed: 01/01/2023]
Abstract
Background and Objective: The concept of a "disruptive innovation," recently extended to health care, refers to an emerging technology that represents a new market force combined with a new value system, that eventually displaces some, or all, of the current leading "stakeholders, products and strategic alliances." Naturopathy is a distinct system of traditional and complementary medicine recognized by the World Health Organization (WHO), emerging as a model of primary care. The objective here is to describe Naturopathy in the context of the criteria for a disruptive innovation. Methods: An evidence synthesis was conducted to evaluate Naturopathy as a potentially disruptive technology according to the defining criteria established by leading economists and health technology experts: (1) The innovation must cure disease; (2) must transform the way medicine is practiced; or (3) have an impact that could be disruptive or sustaining, depending on how it is integrated into the current healthcare marketplace. Results: The fact that Naturopathy de-emphasizes prescription drug and surgical interventions in favor of nonpharmacological health promotion and self-care could disrupt the present economic model that fuels health care costs. The patient-centered orientation of Naturopathy, combined with an emphasis on preventive behaviors and popular complementary and integrative health services like natural products, mind and body therapies, and other therapies not widely represented in current primary care models increase the likelihood for disruption. Conclusions: Because of its patient-centered approach and emphasis on prevention, naturopathy may disrupt or remain a durable presence in healthcare delivery depending on policymaker decisions.
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Affiliation(s)
- Ryan Bradley
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR 97201, USA.
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA 92093, USA.
- University of Technology Sydney, Australian Research Center in Complementary and Integrative Medicine (ARCCIM), Ultimo NSW 2007, Australia.
| | - Joanna Harnett
- University of Technology Sydney, Australian Research Center in Complementary and Integrative Medicine (ARCCIM), Ultimo NSW 2007, Australia.
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney NSW 2006, Australia.
| | - Kieran Cooley
- University of Technology Sydney, Australian Research Center in Complementary and Integrative Medicine (ARCCIM), Ultimo NSW 2007, Australia.
- Department of Research and Clinical Epidemiology, The Canadian College of Naturopathic Medicine, Toronto, ON M2K1E2, Canada.
- Transitional Doctorate Department, Pacific College of Oriental Medicine, San Diego, CA 92108, USA.
| | - Erica McIntyre
- University of Technology Sydney, Australian Research Center in Complementary and Integrative Medicine (ARCCIM), Ultimo NSW 2007, Australia.
| | - Joshua Goldenberg
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR 97201, USA.
- University of Technology Sydney, Australian Research Center in Complementary and Integrative Medicine (ARCCIM), Ultimo NSW 2007, Australia.
| | - Jon Adams
- University of Technology Sydney, Australian Research Center in Complementary and Integrative Medicine (ARCCIM), Ultimo NSW 2007, Australia.
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Finnell JS, Snider P, Myers SP, Zeff J. A Hierarchy of Healing: Origins of the Therapeutic Order and Implications for Research. Integr Med (Encinitas) 2019; 18:54-59. [PMID: 32549816 PMCID: PMC7217399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The philosophy, principles, and theories of naturopathic medicine include the six Principles of Naturopathic Medicine and the Therapeutic Order. Together these constructs, describe the core principles of the practice of naturopathic medicine, as established by thought leaders throughout the formation and development of the profession. The naturopathic medicine research agenda (NMRA) set forth recommendations for the codification of the foundational theories of naturopathic medical practice. The "Therapeutic Order, Whole-systems, Evidence-based Research Standards" (TOWERS) initiative is proposed with the primary objective to conduct the rigorous evaluation of the Principles of Naturopathic Medicine and the Therapeutic Order constructs. It is envisioned that this initiative will result in the development of an evidence-base concerning the clinical theory, philosophy and principles of whole-systems naturopathic medicine. After over one hundred years of professional organization and formal practice, there is a need to translate these empirically derived constructs into an evidence-informed theory of naturopathic medicine.
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Affiliation(s)
- John S Finnell
- Bastyr University Research Institute, Bastyr University, Kenmore, WA
| | - Pamela Snider
- Foundations of Naturopathic Medicine Institute, Snoqualmie, WA; National University of Natural Medicine, Portland, OR; Bastyr University, Kenmore, WA
| | - Stephen P. Myers
- National Centre for Naturopathic Medicine, Southern Cross University, Lismore NSW Australia; NatMed Research, Division of Research, Southern Cross University, Lismore NSW Australia; Foundations of Naturopathic Medicine Institute, Snoqualmie, WA
| | - Jared Zeff
- Naturopathic Medicine Institute, Vancouver, WA; National University of Natural Medicine; Foundations of Naturopathic Medicine Institute, Snoqualmie, WA
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Elder C, Ijaz N, Weeks J, Rioux J, Ritenbaugh C. Convergent Points for Conventional Medicine and Whole Systems Research: A User's Guide. J Altern Complement Med 2019; 25:S12-S16. [PMID: 30870016 DOI: 10.1089/acm.2018.0515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
CONTEXT Value-based health care has emerged as a manifestation of the conventional medicine community's awareness of the overlapping needs to both better incorporate patient centeredness into practice and research paradigms and further develop a systemic approach to cost reduction. BACKGROUND The origins of the whole systems research (WSR) movement date to the late 1990s, when the U.S. Congress legislated appropriation of funds to stimulate the U.S. National Institutes of Health to evaluate popular traditional, complementary, and integrative medicine (TCIM) practices. Questions immediately arose over how well these forms of practice could be measured through standard randomized controlled trials, and the WSR community began to articulate and adapt innovative methodologies for evaluating TCIM interventions. DISCUSSION This column explores the potential impact of WSR methods and exemplars on the clinical practice and research communities seeking to successfully implement and measure the complexities of value-based health care. Four potentially cross-talking themes are specifically discussed: complex behaviorally focused interventions, patient-centered outcomes, team-based care, and resilience and well-being. CONCLUSION The time is ripe for clinicians and investigators to capitalize on methodologies, exemplars, and learnings from the WSR literature toward improving care, developing more robust research strategies, and furthering the dialogue between the TCIM and conventional medicine communities.
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Affiliation(s)
- Charles Elder
- 1 Kaiser Permanente Center for Health Research, Portland, OR
| | - Nadine Ijaz
- 2 Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - John Weeks
- 3 johnweeks-integrator.com, Editor-in-Chief, JACM, Seattle, WA
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Ijaz N, Rioux J, Elder C, Weeks J. Whole Systems Research Methods in Health Care: A Scoping Review. J Altern Complement Med 2019; 25:S21-S51. [PMID: 30870019 PMCID: PMC6447996 DOI: 10.1089/acm.2018.0499] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objectives: This scoping review evaluates two decades of methodological advances made by “whole systems research” (WSR) pioneers in the fields of traditional, complementary, and integrative medicine (TCIM). Rooted in critiques of the classical randomized controlled trial (RCT)'s suitability for evaluating holistic, complex TCIM interventions, WSR centralizes the principle of “model validity,” representing a “fit” between research design and therapeutic paradigm. Design: In consultation with field experts, 41 clinical research exemplars were selected for review from across 13 TCIM disciplines, with the aim of mapping the range and methodological characteristics of WSR studies. Using an analytic charting approach, these studies' primary and secondary features are characterized with reference to three focal areas: research method, intervention design, and outcome assessment. Results: The reviewed WSR exemplars investigate a wide range of multimodal and multicomponent TCIM interventions, typified by wellness-geared, multitarget, and multimorbid therapeutic aims. Most studies include a behavioral focus, at times in multidisciplinary or team-based contexts. Treatments are variously individualized, often with reference to “dual” (biomedical and paradigm-specific) diagnoses. Prospective and retrospective study designs substantially reflect established biomedical research methods. Pragmatic, randomized, open label comparative effectiveness designs with “usual care” comparators are most widely used, at times with factorial treatment arms. Only two studies adopt a double-blind, placebo-controlled RCT format. Some cohort-based controlled trials engage nonrandomized allocation strategies (e.g., matched controls, preference-based assignment, and minimization); other key designs include single-cohort pre–post studies, modified n-of-1 series, case series, case report, and ethnography. Mixed methods designs (i.e., qualitative research and economic evaluations) are evident in about one-third of exemplars. Primary and secondary outcomes are predominantly assessed, at multiple intervals, through patient-reported measures for symptom severity, quality of life/wellness, and/or treatment satisfaction; some studies concurrently evaluate objective outcomes. Conclusions: Aligned with trends emphasizing “fit-for-purpose” research designs to study the “real-world” effectiveness of complex, personalized clinical interventions, WSR has emerged as a maturing scholarly discipline. The field is distinguished by its patient-centered salutogenic focus and engagement with nonbiomedical diagnostic and treatment frameworks. The rigorous pursuit of model validity may be further advanced by emphasizing complex analytic models, paradigm-specific outcome assessment, inter-rater reliability, and ethnographically informed designs. Policy makers and funders seeking to support best practices in TCIM research may refer to this review as a key resource.
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Affiliation(s)
- Nadine Ijaz
- 1 Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | | | - Charles Elder
- 3 Kaiser Permanente Center for Health Research, Portland, OR
| | - John Weeks
- 4 johnweeks-integrator.com, Editor-in-Chief, JACM, Seattle, WA
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Schloss J, McIntyre E, Steel A, Bradley R, Harnett J, Reid R, Hawrelak J, Goldenberg J, Van De Venter C, Cooley K. Lessons from Outside and Within: Exploring Advancements in Methodology for Naturopathic Medicine Clinical Research. J Altern Complement Med 2019; 25:135-140. [PMID: 30785314 PMCID: PMC6424155 DOI: 10.1089/acm.2018.0403] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Introduction: Naturopathy is a mixture of both traditional and complementary medicine. It incorporates a broad set of health care practices that may or may not be traditional to that country or conventional medicine and are not fully integrated into the dominant health care system. Research required to evaluate or substantiate naturopathic medicine may not fall under the testing of randomized clinical trials, which opens up discussions on what is the best practice for research in naturopathic medicine. Discussion: Not only do advances in health research methodology offer important opportunities to progress naturopathic research, there are also areas where the unique characteristics of naturopathic philosophy and practice can impact other areas of health research. Some of the new advances in health research methodology involve whole-system research, pragmatic trials, template for intervention description and replication protocols for complex interventions, patient-centered care models, and the pragmatic-explanatory continuum indicator summary tool for designing pragmatic trials. Discussion and critique of these health-related methodologies shows that these research methods are more suited for the philosophy and treatment options that naturopathy is based on. Conclusions: Successful implementation of naturopathic research methodologies, and translation and dissemination of research will require a substantial paradigm shift in which naturopathic practitioners adopt a greater level of responsibility for developing an evidence base for naturopathic medicine.
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Affiliation(s)
- Janet Schloss
- 1 Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Faculty of Health, Ultimo, Australia.,2 Office of Research, Endeavour College of Natural Health, Fortitude Valley, Australia
| | - Erica McIntyre
- 1 Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Faculty of Health, Ultimo, Australia
| | - Amie Steel
- 1 Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Faculty of Health, Ultimo, Australia.,2 Office of Research, Endeavour College of Natural Health, Fortitude Valley, Australia
| | - Ryan Bradley
- 1 Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Faculty of Health, Ultimo, Australia.,3 Helfgott Research Institute, National University of Natural Medicine, Portland, OR
| | - Joanna Harnett
- 1 Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Faculty of Health, Ultimo, Australia.,4 Faculty of Pharmacy, University of Sydney, Sydney, Australia
| | - Rebecca Reid
- 1 Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Faculty of Health, Ultimo, Australia.,2 Office of Research, Endeavour College of Natural Health, Fortitude Valley, Australia
| | - Jason Hawrelak
- 1 Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Faculty of Health, Ultimo, Australia.,5 College of Health and Medicine, University of Tasmania, Hobart, Australia
| | - Joshua Goldenberg
- 1 Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Faculty of Health, Ultimo, Australia.,6 Department of Naturopathy, Bastyr University, Kenmore, WA USA
| | - Claudine Van De Venter
- 1 Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Faculty of Health, Ultimo, Australia.,7 Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Kieran Cooley
- 1 Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Faculty of Health, Ultimo, Australia.,8 Office of Research, Canadian College of Naturopathic Medicine, North York, Canada
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Mills PJ, Patel S, Barsotti T, Peterson CT, Chopra D. Advancing Research on Traditional Whole Systems Medicine Approaches. J Evid Based Complementary Altern Med 2017; 22:527-530. [PMID: 29250966 PMCID: PMC5871320 DOI: 10.1177/2156587217745408] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
While the intention of Integrative Medicine (IM) is whole person medicine, it has for the most part remained driven by individual modalities. Like the practice of IM itself, IM research too has been driven primarily by studies on individual modalities. There are significant challenges to moving research on whole systems medicine forward, with funding being at the top of the list. Historically, NIH has not been receptive to supporting research on whole systems, preferring instead to support studies that are more individual modality driven so that mechanisms can be identified. Purely mechanistic research, however, assumes unidirectional causality and linear responses yet clinical responses to whole systems approaches are more often multidirectional and dynamically unpredictable. The concept of emergence is applicable here. Whole systems approaches suggest that by incorporating therapies into holistic treatment programs we not only treat symptoms but accomplish more by activating the body's inherent self-organizing healing mechanisms and treat the root cause of illnesses as well as associated symptoms. Given that interest in integrative therapies with the general public and medical community is steadily increasing, there is need for more research that explores intact whole systems approaches to elucidate the relevant system-wide effects and dynamic interactions related to these practices.
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Affiliation(s)
- Paul J Mills
- 1 University of California, San Diego, La Jolla, CA, USA
| | - Sheila Patel
- 1 University of California, San Diego, La Jolla, CA, USA.,2 Mind-Body Medical Group, The Chopra Center for Wellbeing, Carlsbad, CA, USA
| | - Tiffany Barsotti
- 1 University of California, San Diego, La Jolla, CA, USA.,3 Heal and Thrive, California Institute for Human Sciences, Encinitas, CA, USA
| | - Christine Tara Peterson
- 1 University of California, San Diego, La Jolla, CA, USA.,4 Ayurveda and Yoga Research, Chopra Foundation, Carlsbad, CA, USA
| | - Deepak Chopra
- 1 University of California, San Diego, La Jolla, CA, USA.,2 Mind-Body Medical Group, The Chopra Center for Wellbeing, Carlsbad, CA, USA.,4 Ayurveda and Yoga Research, Chopra Foundation, Carlsbad, CA, USA
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Foley H, Steel A. Patient perceptions of clinical care in complementary medicine: A systematic review of the consultation experience. PATIENT EDUCATION AND COUNSELING 2017; 100:212-223. [PMID: 27693375 DOI: 10.1016/j.pec.2016.09.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 09/20/2016] [Accepted: 09/21/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE This review aims to describe the prevalence of empathy, empowerment and patient-centred clinical care experienced by patients in complementary medicine (CM) consultations. METHODS A systematic review was undertaken of original research exploring patient perceptions of CM clinical care. Ten databases were searched: Alt HealthWatch, AMED, CINAHL Plus, MEDLINE Complete, Cochrane Library, PubMed, Proquest Medical Collection, PsycInfo, Social Sciences Citation Index and Psychology Collection. Studies were included which reported patient perceptions of consultation with CM practitioners and were excluded where experimental methods controlled the nature of consultation processes. RESULTS Findings of included studies (n=34) were categorised under the a priori themes of empathy, empowerment and patient-centred care. This produced a substantial pool of qualitative data detailing patient-reported experiences which consistently confirmed occurrence of these themes in CM consultation. Quantitative data was correlative, yet was insufficient to definitively describe prevalence of such experiences. CONCLUSION While it is evident that CM consultations provide a patient experience of empathy, empowerment and patient-centredness, further research is warranted to quantify this experience before it can be defined as characteristic of CM clinical care. PRACTICE IMPLICATIONS This review draws attention to the potential role of CM as a resource for patients' psychosocial health needs.
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Affiliation(s)
- Hope Foley
- Endeavour College of Natural Health, 2/269 Wickham St., Fortitude Valley, QLD, 4006, Australia.
| | - Amie Steel
- Endeavour College of Natural Health, 2/269 Wickham St., Fortitude Valley, QLD, 4006, Australia; Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia
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Edla SR, Kumar AM, Srinivas B, Raju MS, Gupta V. ‘Integrated Naturopathy and Yoga’ reduces blood pressure and the need for medications among a cohort of hypertensive patients in South India: 3-months follow-up study. ADVANCES IN INTEGRATIVE MEDICINE 2016. [DOI: 10.1016/j.aimed.2016.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Bairy S, Kumar AMV, Raju MSN, Achanta S, Naik B, Tripathy JP, Zachariah R. Is adjunctive naturopathy associated with improved glycaemic control and a reduction in need for medications among type 2 Diabetes patients? A prospective cohort study from India. Altern Ther Health Med 2016; 16:290. [PMID: 27534941 PMCID: PMC4989485 DOI: 10.1186/s12906-016-1264-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 08/05/2016] [Indexed: 01/30/2023]
Abstract
BACKGROUND With an estimated 65 million Diabetes Mellitus (DM) patients, India ranks second in the world in terms of DM burden. The emphasis of current medical practice has been on pharmacotherapy but, despite the best combination therapies, acheiving glycaemic control (reduction of blood sugar to desirable levels) is a challenge. 'Integrated Naturopathy and Yoga'(INY) is an alternative system of medicine that lays emphasis on the role of diet and physical exercise. We assessed the short term effect of INY as an adjunct to pharmacotherapy on glycaemic control among type 2 DM patients. METHODS In this prospective cohort study with a 3 month follow-up, DM patients consecutively admitted to a hospital in India from May-October 2014 for either 15 or 30 days were offered INY - a package of vegetarian diet with no added oil, sugar and salt, yoga-based exercise, patient counselling and rest. A 'favourable outcome' was defined as glycaemic control (glycosylated hemoglobin (HbA1c) < 7 % or absolute reduction by 1 %) along with at least 50 % reduction in antidiabetes medication at 3 months relative to baseline. Compliance to diet was scored by self-report on a scale of 0-10 and categorized into poor (0-5), moderate (6-8) and excellent (9-10). RESULTS Of 101 patients with 3-month follow-up data, 65(65 %) achieved a favourable outcome - with 19(19 %) stopping medication while sustaining glycemic control. Factors associated with favourable outcome were baseline HbA1c and compliance to diet, which showed a significant linear relationship with mean HbA1c reductions of 0.4 %, 1.1 % and 1.7 % in relation to poor, moderate and excellent dietary compliance respectively. CONCLUSION INY, adjunctive to pharmacotherapy, was associated with a significant beneficial effect on glycaemic control and reduced the overall need for antidiabetes medications. These early results are promising. Further studies with long-term follow-up and using more rigorous randomized controlled trial designs are needed.
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Grise DE, McAllister HM, Langland J. Improved clinical outcomes of patients with type 2 diabetes mellitus utilizing integrative medicine: a case report. Glob Adv Health Med 2015; 4:57-61. [PMID: 25984419 PMCID: PMC4424942 DOI: 10.7453/gahmj.2014.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
This case report demonstrates a successful approach to managing patients with type 2 diabetes mellitus (DM2). Botanical herbs (including Gymnema sylvestre) and nutrients (including alpha lipoic acid and chromium) were used alongside metformin to help improve insulin sensitization; however, the greatest emphasis of treatment for this patient centered on a low-carbohydrate, whole-foods diet and regular exercise that shifted the focus to the patient's role in controlling their disease. Research on DM2 often focuses on improving drug efficacy while diet and lifestyle are generally overlooked as both a preventive and curative tool. During the 7 months of treatment, the patient's hemoglobin A1c and fasting glucose significantly decreased to within normal ranges and both cholesterol and liver enzyme markers normalized. A significant body of evidence already exists advocating for disease management using various diets, including Mediterranean, low-carb, and low-fat vegan diets; however, no clear dietary standards have been established. This study supports the use of naturopathic medicine as well as dietary and lifestyle changes to develop the most efficacious approach for the treatment of DM2.
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Affiliation(s)
- Diane E Grise
- Southwest College of Naturopathic Medicine, Tempe, Arizona (Dr Grise), United States
| | - Heath M McAllister
- Southwest College of Naturopathic Medicine, Tempe, Arizona (Dr McAllister), United States
| | - Jeffrey Langland
- Southwest College of Naturopathic Medicine, Tempe, Arizona (Dr Langland), United States
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Kennedy DA, Bernhardt B, Snyder T, Bancu V, Cooley K. Complementary medical health services: a cross sectional descriptive analysis of a Canadian naturopathic teaching clinic. Altern Ther Health Med 2015; 15:37. [PMID: 25880763 PMCID: PMC4362820 DOI: 10.1186/s12906-015-0550-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 02/12/2015] [Indexed: 11/10/2022]
Abstract
Background Historically, alongside regulatory and jurisdictional differences in scope of practices, practice patterns of naturopathic doctors (NDs) have varied widely to promote holistic or whole-person treatment using a variety of therapies including: controlled substances, minor surgery, a variety of complementary therapies, as well as both novel and conventional assessments. However, little is known about the observed practice patterns of NDs, the services provided to their patients, or the type of conditions for which patients of NDs are seeking treatment. In order to address this gap, a cross-sectional descriptive analysis of the largest Canadian teaching clinic for NDs was undertaken to better understand the services provided to the community and increase the knowledge regarding the use of naturopathic medicine. Methods Data stemmed from two sources at the Toronto, Ontario clinic: a passive patient satisfaction survey, and the clinic’s point-of-sale (POS) system. Data included patient demographics, postal codes, health services utilization, ICD-10 codes, therapies employed, along with other data relating to the financial transactions associated with the visit. Simple descriptive statistics and the Kruskal-Wallis test were used to compare different age-based groups and examine health services use between years. This study was approved by the Research Ethics Board of the Canadian College of Naturopathic Medicine. Results 13,412 patients were treated in 76,386 patient visits spanning three clinic years. Median age of patients was 37; females outnumbered males (2.6:1) in all age-based groups except the pediatric population. In the patient satisfaction survey, there were 1552 potential survey respondents; with 118 responses received (response rate: 7.6%). Obtaining health education, health prevention and help with chronic health conditions were the primary motivators for patient visits identified in the patient survey. Conclusion The clinic attracts people from a wide area in the metropolitan Toronto and surrounding region with health concerns and diagnoses that are consistent with primary care, providing health education and addressing acute and chronic health conditions. Further explorations into health services delivery from the broader naturopathic or other complementary/alternative medical professions would provide greater context to these findings and expand understanding of the patients and type of care being provided by these health professionals. Electronic supplementary material The online version of this article (doi:10.1186/s12906-015-0550-6) contains supplementary material, which is available to authorized users.
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Chamberlin SR, Oberg E, Hanes DA, Calabrese C. Naturopathic practice at north american academic institutions: description of 300,483 visits and comparison to conventional primary care. INTEGRATIVE MEDICINE INSIGHTS 2014; 9:7-15. [PMID: 24899792 PMCID: PMC4039213 DOI: 10.4137/imi.s14124] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 03/09/2014] [Accepted: 03/09/2014] [Indexed: 12/18/2022]
Abstract
This study collected patient visit data to explore similarities and differences between conventional and naturopathic primary care (PC). Administrative data from practice management software systems from the main teaching clinics of four of the eight accredited North American naturopathic academic institutions were abstracted into an integrated database containing five years (2006-2010) of visit, patient, laboratory, and prescribing data. Descriptive analyses of healthcare services were compared to the National Ambulatory Medical Care Survey (NAMCS). Over the five-year period, 300,483 patient visits to naturopathic doctors occurred at clinics, excluding visits at clinics operated by the schools in community settings. Patients were 69% female; mean age was 39 (SE 0.09). Older adults (>65) comprised 9% of the population and children (<16) comprised 8%. Comparing academic naturopathic clinics to national conventional PC (NAMCS), we found more patients paid out of pocket at naturopathic clinics (50 vs. 4%) and naturopathic clinics more frequently offered discounted care (26 vs. 0.3%). There was a 44% overlap in the most frequent 25 diagnoses for PC at conventional community clinics. Overall, these data suggest substantial similarities in care offered by academic naturopathic clinics, at which most Naturopathic Doctor (ND) students are trained, and by conventional PC practices.
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Affiliation(s)
| | | | - Douglas A Hanes
- National College of Naturopathic Medicine, Portland, OR, USA
| | - Carlo Calabrese
- Naturopathic Physicians Research Institute, Portland, OR, USA
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Oberg EB, Rempe M, Bradley R. Self-directed Mindfulness Training and Improvement in Blood Pressure, Migraine Frequency, and Quality of Life. Glob Adv Health Med 2013; 2:20-5. [PMID: 24278842 PMCID: PMC3833523 DOI: 10.7453/gahmj.2013.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Interest in case studies has undergone a resurgence concurrent with increasing prioritization of illustrations of patient-centered care. However, substantial inclusion of the patient in these reports remains limited. Here, a doctor and patient collaborate to present her case report of self-directed mindfulness training and the subsequent changes in blood pressure, migraine frequency, and quality of life. Methods: After receiving encouragement from her naturopathic doctor, the patient initiated an 8-week program in mindfulness training following the Kabat-Zinn protocol and logged her daily blood pressure and symptoms before and after meditation sessions over an 11-week period. Results: Patient-reported outcomes included decreased perceived stress, increased focus, and a newfound sense of centeredness and calm. Changes in objective outcomes were clinically and statistically significant, including reductions in mean systolic and diastolic blood pressure between week 1 and week 11 (P = .0001 and P = .0004 for systolic and diastolic, respectively, by paired, 2-sided t-tests). Self-reported frequency of chronic migraine was also reduced. Critical to the patient's success was that mindfulness training was first approached in a simple, accessible manner prior to embarking on a deeper, extended experience. Discussion and Conclusion: Self-directed mindfulness training can have a meaningful impact on both subjective and objective health outcomes. It may take years of encouragement from a healthcare provider before a patient is ready to adopt a mind-body practice; it is important to recognize and counsel patients with messages appropriate to their stage of change and self-efficacy. Additionally, case studies that combine the voice of the clinician and the patient can provide useful illustrations of truly patient-centered care.
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Affiliation(s)
- Erica B Oberg
- Bastyr University-California, San Diego, United States
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