For decades, confusion has existed about terms such as integrative medicine and complementary and alternative medicine (CAM). Part of the confusion is that this evolution of medicine has occurred slowly in the Western hemisphere; at one time, complementary therapies were often listed as "Eastern" therapies, whereas traditional medicine was listed as "Western" therapies.
But the integration has come far. Conventional medicine is the kind we (primarily) see in health care today. It is often expensive and invasive, and it is what I would want initially in the event of a major catastrophic incident. The "other" therapies are generally included as "alternative" modalities and are often less invasive and cheaper. As I healed, I may try these therapies in an effort to get to my baseline. Both kinds of medicine have parts that are scientifically validated and others that are not.
Enter "integrative medicine" where both types of medicine are used as a "complementary" approach to health and healing. For example, during chemotherapy, using ginger syrup to prevent nausea may be the best of both worlds for the patient. See Box 1.
The National Institutes of Health founded the office of the National Center for Complementary and Alternative Medicine (NCCAM) in the early 1990s to investigate integrative therapies through scientific research and then to make its findings available through its publications and website. This breakthrough office updated its name and mission in December 2014 to the National Center for Complementary and Integrative Health (NCCIH). Within this updated office is a simple definition of "integrative medicine": NCCIM defines integrative medicine as one that "combines mainstream medical therapies and CAM therapies for which there is some high-quality scientific evidence of safety and effectiveness" (NCCIH, 2015, p. 1).
NCCIH's role is as the Federal Government's lead agency for scientific research on complementary and integrative health approaches. NCCIH's mission is to define, through rigorous scientific investigation, the usefulness and safety of complementary and integrative health interventions and their roles in improving health and health care. Finally, that scientific evidence will inform decision making by the public, by health care professionals, and by health policy makers regarding the use and integration of complementary and integrative health approaches (NCCIH, 2015). The work this office does is worth referencing when you, a loved one, a patient, or a client discusses health care "plans." See Box 1.
Andrew Weil, MD, a well-known physician, will tell you he is not the world leading proponent of alternative medicine but actually the champion of integrative medicine. Dr. Weil's definition of integrative medicine is "healing-oriented medicine that takes account of the whole person (body, mind, and spirit), including all aspects of lifestyle. It emphasizes the therapeutic relationship and makes use of all appropriate therapies, both conventional and alternative"(Lehm, 2015, p. 1).
Common Types of Modalities Used by Our Patients
Most complementary health approaches fall into one of two subgroups: natural products, or mind and body practices.
1. Natural products may include herbs, vitamins and minerals, and probiotics. According to NCCIH, researchers have conducted large, rigorous studies on a few natural products, but the results often showed that the products didn't work. Research on others is in progress. Although there are indications that some may be helpful, more needs to be learned about the effects of these products in the human body and about their safety and potential interactions with medicines and other natural products.
2. Mind and body practices include a large and diverse group of procedures or techniques. The 2012 National Institutes of Health Survey showed that yoga, chiropractic and osteopathic manipulation, meditation, and massage therapy are among the most popular mind and body practices used by adults. Other mind and body practices include acupuncture, mindfulness techniques/relaxation techniques, tai chi qigong, healing touch, hypnotherapy, and movement therapies (such as Feldenkrais method, Alexander technique, Pilates, Rolfing Structural Integration, and Trager psychophysical integration). Biofield therapies fall under the National Center for Complementary and Alternative Medicine's category of energy medicine, and they include reiki, sound therapy, healing touch, qigong, and polarity therapy.
According to NCCIH, the amount of research on mind and body approaches varies widely depending on the practice. For example, researchers have conducted many studies on acupuncture, yoga, spinal manipulation, and meditation, but there have been fewer studies on some other practices.
Considerations of Integrative Health Modalities for Our Patients
Why do patients (or ourselves) use alternative approaches, and what can the case manager keep in mind when examining this aspect of a person's approach to healing? Understanding why people turn to integrative medicine is important for the holistic case manager to understand. Some reasons include (U.S. News and World Report: Health, 2015):
* Studies show that many turn to these approaches because they consider it to be more aligned with their values, beliefs, and philosophies about health than a strictly conventional medical approach.
* Some prefer the customized, personal care that comes with integrative medicine's whole-person perspective.
* Others believe it is only logical to incorporate health strategies into their lives from the widest array of proven approaches possible, thinking that an integrative approach will allow them to achieve or maintain the best possible health outcomes.
* Studies conducted at Duke Integrative Medicine demonstrate that patients who participate in integrative medicine programs realize more profound health benefits than those who do not. Such programs can be one-on-one learning with a single health coach, or they can be an "immersion" program into a healthful lifestyle.
* The integrative medicine model recognizes the critical role the practitioner-patient relationship plays in a patient's overall health care experience. It seeks to care for the whole person by taking into account interrelated physical and nonphysical factors that affect health, wellness, and disease, including the psychosocial and spiritual dimensions of people's lives-and people like that.
Your Patients May Ask You About Choosing a Practitioner
Some recommendations may include (U.S. News and World Report: Health, 2015):
* Speak with your physician(s). They may be able to recommend a qualified practitioner. Because integrative medicine practitioners include nearly every specialty as well as doctors of osteopathic medicine, mental health professionals, mind-body specialists, and practitioners such as massage therapists and acupuncturists, their educational and accreditation requirements vary widely, as does the regulation of their fields.
* Do not hesitate to ask about a practitioner's training, experience, and certifications. They should have nothing to hide and should be happy to refer you to the professional organizations that train, license, or certify their particular field.
* Experts recommend that prospective patients look for practitioners who fundamentally believe in integrative medicine's mind-body-spirit-community philosophy. A useful litmus test for screening alternative practitioners is to ask about their willingness to collaborate with conventional health care professionals.
* Patients should avoid practitioners who automatically advocate all CAM therapies or discount all conventional medicine practices. Likewise, use caution with conventional medicine practitioners who instantly write off integrative medicine or automatically advocate all mainstream medicine therapies.
* Experts also suggest that prospective patients take a cue from what many of us do when choosing a conventional practitioner: Talk with people whose opinions you respect. Ask friends, family members, and coworkers to share their experiences and make recommendations.
* Let your clients/patient know that many health insurance providers do not cover the complementary and alternative therapies that are often used in integrative medicine. Some cover select treatments. Patients should speak with their insurance representatives before pursuing these treatments and be clear about exactly what type of treatment they are considering as part of integrative medicine. Patients whose policies do not cover alternative therapies may wish to discuss self-payment options with prospective caregivers.
* Patients who have health care reimbursement accounts through their employers may find that many integrative medicine therapies are covered by these plans.
Further Important Recommendations
The claims that nonmainstream practitioners make can sound promising and offer hope that may not be validated. Researchers do not know how safe many of these treatments are or how well they work. Studies are underway to determine the safety and usefulness of many of these practices; those in health care have seen significant side effects from over-the-counter and physician-prescribed treatments, alike.
To minimize the health risks of a nonmainstream treatment, NCCIH recommends (NCCIH, 2015):
* Keep your physician(s) informed of your therapies and results. Your choices may have side effects or interact with other medicines. These may need to be monitored closely or discontinued.
* Find out what the research says about the therapies.
* Choose practitioners carefully.
* Tell all of your doctors and practitioners about all of the different types of treatments you use. This may be key to how your particular health care strategy is managed.
Case managers are the coordinators of health care. Coordination of all aspects of a person's life is the integrative cornerstone of case management.
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