Mainstreaming Complementary Therapies: New Directions In Health Care

[Alternative medicine, from North America to East Asia: between persistent exclusion and embodied pluralism]

At a time of growing interest in integrative approaches to health and care, this article examines, from a historical perspective, the factors underlying the global popularity of so-called complementary and alternative medicines (CAM). Focusing on the multiple and changing meanings of the concepts used with reference to CAM since the nineteenth century, it emphasizes the agency of CAM practitioners' and calls into question a linear progression from outright exclusion to gradual inclusion into mainstream health care systems. This analysis concludes that biomedicine and "other" medical systems have mutually defined each other in a process of co-production that has had a significant impact on the medicalization of contemporary societies from North America to East Asia.

Nurse practitioner and physician assistant students' knowledge, attitudes, and perspectives of chiropractic

OBJECTIVE

The purpose of this study was to assess nurse practitioner (NP) and physician assistant (PA) students' views of chiropractic. As the role of these providers progresses in primary care settings, providers' views and knowledge of chiropractic will impact interprofessional collaboration and patient outcomes. Understanding how NP and PA students perceive chiropractic may be beneficial in building integrative health care systems.

METHODS

This descriptive quantitative pilot study utilized a 56-item survey to examine attitudes, knowledge, and perspectives of NP and PA students in their 2nd year of graduate studies. Frequencies and binomial and multinomial logistic regression models were used to examine responses to survey totals.

RESULTS

Ninety-two (97%) students completed the survey. There were conflicting results as to whether participants viewed chiropractic as mainstream or alternative. The majority of participants indicated lack of awareness regarding current scientific evidence for chiropractic and indicated a positive interest in learning more about the profession. Students who reported prior experience with chiropractic had higher attitude-positive responses compared to those without experience. Participants were found to have substantial knowledge deficits in relation to chiropractic treatments and scope of practice.

CONCLUSION

The results of this study emphasize the need for increased integrative initiatives and chiropractic exposure in NP and PA education to enhance future interprofessional collaboration in health care.

Using the framework of corporate culture in "mergers" to support the development of a cultural basis for integrative medicine - guidance for building an integrative medicine department or service

BACKGROUND

An increasing number of clinics offer complementary or integrative medicine services; however, clear guidance about how complementary medicine could be successfully and efficiently integrated into conventional health care settings is still lacking. Combining conventional and complementary medicine into integrative medicine can be regarded as a kind of merger. In a merger, two or more organizations - usually companies - are combined into one in order to strengthen the companies financially and strategically. The corporate culture of both merger partners has an important influence on the integration.

PURPOSE

The aim of this project was to transfer the concept of corporate culture in mergers to the merging of two medical systems.

METHODS

A two-step approach (literature analyses and expert consensus procedure) was used to develop practical guidance for the development of a cultural basis for integrative medicine, based on the framework of corporate culture in "mergers," which could be used to build an integrative medicine department or integrative medicine service.

RESULTS

Results include recommendations for general strategic dimensions (definition of the medical model, motivation for integration, clarification of the available resources, development of the integration team, and development of a communication strategy), and recommendations to overcome cultural differences (the clinic environment, the professional language, the professional image, and the implementation of evidence-based medicine).

CONCLUSION

The framework of mergers in corporate culture provides an understanding of the difficulties involved in integrative medicine projects. The specific recommendations provide a good basis for more efficient implementation.

Experts' opinions on terminology for complementary and integrative medicine - a qualitative study with leading experts

BACKGROUND

Integrative medicine (IM) is currently the most commonly used term to describe the integration of complementary and alternative medicine (CAM) into conventional medicine. In the definitions of IM the most important feature is the focus on evidence as crucial factor for therapeutic decision-making. However, there are discussions on the term "integrative medicine" with the most notable critique from within CAM that it describes the integration of complementary methods into conventional institutions and into a "conventional framework of thinking". The aim of this qualitative study was to understand the thoughts of leading experts on IM and on the scientific debate in the field as well as their personal opinions about terminology in general.

METHODS

We have conducted semi-standardized interviews with ten leading experts in the field of CAM and integrative medicine in the USA, England, and Germany, who have had leading positions at medical schools or the NIH in 2010 and 2011. Interviews were recorded, transcribed and analyzed using content analysis with the qualitative analysis software maxqda.

RESULTS

Overall the current terminology was seen as a problem, although most experts agreed that the term "integrative medicine" (IM) described well what they do or they think is useful for medical care. The terminology debate was discussed from four perspectives: 1) from the perspective of medical practice, 2) from the perspective of research, 3) from the perspective of public relations, and 4) from the perspective of health care delivery. These perspectives may be used to evaluate the appropriateness of different terms in use in the field. When interviewees discussed the terminology question, they also discussed the type of health care system they envisioned. Such reflections led the interviewees to caution about too narrow a focus on the terminology question. The question of naming was one about influencing and changing medicine.

CONCLUSION

The discussion of the experts demonstrated that the discussion about terminology is an important debate about the shaping of medicine. The experts discussed terminology in the light of "how health care systems" should look like in the future.

Use of Creative Arts as a Complementary Therapy by Rural Women Coping With Chronic Illness

Purpose: To investigate the spontaneous use of creative arts as a complementary therapy by rural women in the Western United States who are coping with chronic illness. Design: Women to Women Project was an 11-week research-based computer intervention that provided health education and support to rural women with chronic illnesses in an effort to help them better adapt to living with chronic conditions. Method: Through the use of text queries, messages posted to an unprompted, online support and health education forum were examined for references to the spontaneous use of creative arts and their influence as a complementary therapy for dealing with chronic illness. Findings: In three identified themes—coping with pain, relaxation/quality of life, and giving back to others—participants strongly suggested that creative activity was an important strategy for coping with chronic illness and that it contributed to reduced pain and increased overall well-being, regardless of whether it was the expression of a previously learned skill or a practice established after the onset of chronic illness. Conclusion: The use of creative arts and developing art-making interventions could significantly benefit rural individuals coping with chronic illness. Discovering methods of implementing creative arts interventions in rural populations warrants further study.

Attitudes and interests toward research among students at two colleges of acupuncture and Oriental medicine

BACKGROUND

Collaborative input from clinicians of acupuncture and Oriental medicine (AOM) is required for sound AOM research, and AOM training institutions have begun to include research education into their curriculum. However, few attempts have been made to systematically evaluate AOM practitioners' perspectives on the value of research to their profession.

METHODS

We conducted surveys of AOM students at two institutions that have begun to integrate research training into their curriculum, the New England School of Acupuncture and the Oregon College of Oriental Medicine. Surveys were conducted to assess current attitudes regarding the value of research and to serve as a reference point for documenting the impact of ongoing research training programs on these attitudes. Surveys at both institutions were independently developed and administered but shared seven questions that were phrased very similarly. This paper summarizes responses to these questions.

RESULTS

Surveys at both institutions suggest interest in research among AOM students is high in first-year students; students in later years showed a lower level of interest, but the cross-sectional design of this survey does not allow any temporal effects to be inferred. Results also indicate that AOM students believe research is highly relevant to how both the public and the health insurance industry view their system of healthcare but not highly relevant to their own clinical practice of AOM. The belief that research is of limited relevance to clinical practice was associated with widespread belief that scientific methods may not be consistent with the principles of AOM.

CONCLUSIONS

Results of these surveys provide important preliminary information about attitudes of AOM students toward research, and thus the value and future specific needs of research training programs targeting this population. Repeated implementation of validated versions of our surveys are needed to confirm the trends we report and to evaluate the impact of research training programs already in place on AOM students' attitudes toward research.

Complementary and alternative medicine: attitudes and patterns of use by German physicians in a national survey

OBJECTIVE

To generate valid data on attitudes about complementary and alternative medicine (CAM) as well as patterns of use in a large stochastic sample of general practitioner physicians and specialists.

DESIGN

Cross-sectional survey in a large random sample of 516 German outpatient care physicians with qualifications in 13 medical fields representative of a basic population of 118,085 statutory health insurance physicians.

MATERIALS AND METHODS

Telephone interviews with 36 wide-ranging questions about CAM attitudes and preferred techniques were conducted in November and December 2005 as part of a national healthcare survey.

RESULTS

In our sample, 51% were in favor of CAM use (26% were very much in favor, 25% were in favor). The methods most frequently prescribed (combining answers for "very often" and "at times") were physical therapy (71%), phytomedicine (67%), exercise (63%), nutrition and dieting (62%), massage (61%), relaxation techniques (55%), followed by more typical CAM interventions such as homeopathy (38%), acupuncture (37%), and traditional Chinese medicine (18%). Primary care physicians were significantly more inclined to use CAM than were specialists. No striking differences were observed with respect to gender or age.

CONCLUSIONS

This survey demonstrates a broader acceptance and practice of CAM by physicians than hitherto believed. Methods traditionally known as "natural medicine" were more frequently used than more typical CAM procedures. Further research should focus on physicians' differing motivations and observed results.

Toward a sociological understanding of complementary and alternative medicine use

BACKGROUND AND OBJECTIVES

The wide array of treatments and modalities comprising complementary and alternative medicine (CAM) represent a growing option for many individuals. Seeking to better understand this, much research has centered on identifying sociodemographic (e.g., age, gender, race) or social-psychologic (e.g., absorption, depression, coping) correlates of using CAM therapies. In contrast, sociological perspectives recognize the influence of larger-scale, external forces on individuals' motivations to seek alternative or complementary care.

AIM

This paper, then, illustrates current and potential sociological approaches to understanding CAM use, and the importance of social forces that influence persons' decisions to utilize (or not) "unconventional" medical care.

Patient Disclosure about Herb and Supplement Use among Adults in the US

Analyses of 2002 National Health Interview supplement on complementary and alternative medicine (NHI%AM) indicate that approximately 38 million adults in the US (18.9% of the population) used natural herbs or supplements in the preceding 12 months, but only one-third told their physician about this use. The objectives of this study are: (i) to determine subpopulation rates of patient-physician communication about herbal product and natural supplement use and (ii) to identify the relative influence of patient factors and interaction factors associated with patient-physician communication about herb and supplement use. Logistic secondary analysis was done by using the complementary and alternative medicine supplement of the 2002 National Health Interview Survey. Subjects were a random stratified sample of US adults who used herbs in the past 12 months (n = 5 196) and self-reported rates of disclosure to physicians about herb and supplement use. Results show that disclosure rates were significantly lower for males, younger adults, racial and ethnic minorities and less intensive users of medical care. Across subpopulations, disclosure was the exception rather than the norm. Given the potential risks of delayed or inappropriate treatment and adverse drug reactions and interactions, physicians should be aware of herb and supplement use and counsel patients on the potential risks and benefits of these treatments.

The Advanced Practice Nurse and Integration of Complementary and Alternative Medicine

This article highlights the emerging discipline and evolving policy issues surrounding integration of Complementary and Alternative Medicine into mainstream healthcare, focusing on the potentially influential role of the advanced practice nurse. Current aspects of education, credentialing, scope of practice, risk management, the healthcare marketplace, and innovative research designs are presented.

The status of complementary and alternative medicine education in U.S. physician assistant programs

BACKGROUND

Many Americans use complementary and alternative medicine (CAM). Medical educators have responded by incorporating CAM education into their curricula. Research has reported on the number and types of CAM therapies included in physician assistant (PA) curricula, but information on the purposes, methods, and practice of CAM education is lacking.

PURPOSE

This study was designed to identify the content, methods, purpose, and orientation to CAM education in PA curricula.

METHODS

An online survey of all accredited physician assistant programs in the United States addressing content, teaching methods, instructor qualifications, and core competencies was administered.

RESULTS

Response rate was 68%: 77% of PA programs included CAM education in their curriculum; 93% stated it was required. The median number of CAM therapies included in the curriculum was 10. Reasons for including CAM were increased use by patients (79%), complementary medicine in the medical literature (66%), and faculty interest or request (62%). For most PA programs, CAM is taught as a component of other courses through lectures and written exams. Core competencies are consistent with recommendations of the PA profession, as well as other professional medical associations.

CONCLUSIONS

Most PA programs have incorporated CAM instruction into their curricula. Content is typically limited to those CAM therapies most commonly encountered in medical practice. The means and methods of teaching CAM are largely the same as for traditional medical content. The most common objectives of CAM education are learning to assess for CAM use, educating patients, and recognizing indications and contraindications while respecting patients' health beliefs and choices.

Are consumers reshaping hospitals? Complementary and alternative medicine in U.S. Hospitals, 1999-2003

All types of acute care hospitals across the U.S. are becoming increasingly involved in offering CAM services. Hospitals appear to be responding to consumer demand, CAM specific market forces, and their organizational missions but not to regulatory mandates.

Developing a complementary therapy policy

Increasingly, healthcare professionals from a variety of settings are looking to integrate complementary therapies into mainstream healthcare. Robust policy development is a prerequisite for effective integration and the building of sustainable services. Unfortunately many of those wanting to drive forward the complementary therapy agenda have little knowledge of policy development. For those individuals planning to integrate complementary therapies into care, this article will address some of the issues around developing a complementary therapy policy: the need for a robust policy, how to begin developing a policy and suggested inclusions for such a policy.

Racing Toward The Integration Of Complementary And Alternative Medicine: A Marathon Or A Sprint?

Health care opinion leaders concur that integration of complementary and alternative medicine (CAM) into the U.S. health care system must be based on strong supporting evidence of safety and efficacy. As others have pointed out, integration is under way, despite the lack of reliable, rigorous science supporting the use of most CAM treatments. We contend that optimal integration of CAM is a long-term endeavor--a marathon rather than a sprint. The evidence base does not now support its wholesale assimilation; market forces, although compelling, should not be the primary consideration in integration.