Research: MAIZES and COLLEAGUES,

Listed in Issue 173

Abstract

MAIZES and COLLEAGUES,  Arizona Center for Integrative Medicine, University of Arizona, Tucson, AZ, USA. vmaizes@email.arizona.edu review [123 References] integrative medicine and its principles, describe the history of complementary and alternative medicine (CAM) in American healthcare, and discusS the current state and desired future of integrative medical practice and suggest a model grounded in team-based care.

Background

Integrative medicine has emerged as a potential solution to the American healthcare crisis. It provides care that is patient centred, healing oriented, emphasizes the therapeutic relationship, and uses therapeutic approaches originating from conventional and alternative medicine. Initially driven by consumer demand, the attention integrative medicine places on understanding whole persons and assisting with lifestyle change is now being recognized as a strategy to address the epidemic of chronic diseases bankrupting our economy.

Methodology

This paper defines integrative medicine and its principles, describes the history of complementary and alternative medicine (CAM) in American healthcare, and discusses the current state and desired future of integrative medical practice. The importance of patient-centred care, patient empowerment, behaviour change, continuity of care, outcomes research, and the challenges to successful integration are discussed.

Results

The authors suggest a model for an integrative healthcare system grounded in team-based care. A primary health partner who knows the patient well, is able to addresses mind, body, and spiritual needs, and coordinates care with the help of a team of practitioners is at the centrepiece. Collectively, the team can meet all the health needs of the particular patient and forms the patient-centred medical home. The paper culminates with 10 recommendations directed to key actors to facilitate the systemic changes needed for a functional healthcare delivery system. Recommendations include creating financial incentives aligned with health promotion and prevention. Insurers are requested to consider the total costs of care, the potential cost effectiveness of lifestyle approaches and CAM modalities, and the value of longer office visits to develop a therapeutic relationship and stimulate behavioural change. Outcomes research to track the effectiveness of integrative models must be funded, as well as feedback and dissemination strategies. Additional competencies for primary health partners, including CAM and conventional medical providers, will need to be developed to foster successful integrative practices. Skills include learning to develop appropriate healthcare teams that function well in a medical home, developing an understanding of the diverse healing traditions, and enhancing communication skills.

Conclusion

For integrative medicine to flourish in the United States, new providers, new provider models, and a realignment of incentives and a commitment to health promotion and disease management will be required. [References: 123]

References

Maizes V, Rakel D and Niemiec C. Integrative medicine and patient-centered care. [Review] [123 refs] Explore: The Journal of Science & Healing. 5(5): 277-89, Sep-Oct 2009.

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