December 2012 John Weeks Integrator Round-up covering the topics of: Policy; Employers & Costs, Integrative Clinics & Services; Education;
Professions and Organizations and People
From Google Alerts: links to integrative medicine in hospitals, health systems and community centers in December 2012
This monthly report from the Integrator includes 35 short segments, with links, on developments in integrative medicine in hospitals, academic health centers and health systems from mid-November through December 9, 2012. This month’s report also includes some links to non-health system community of integrative practices to provide more balance on the range of developments associated with “integrative medicine.” Included are centers in New Jersey, Connecticut, North Carolina, California, Texas, Florida, Colorado and much more.
Principles for limiting opioids use fail to mention complementary and integrative therapies
Group Health Research Institute has published Principles for More Selective and Cautious Opiod Prescribing following a National Summit on Opioid Safety. The principles emphasize the importance of self care for the patient and empathy and listening for the practitioner. Intermittent use of opioids is one recommendation for limiting addiction. The principles cover such ares as considerations for long-term use, and the practice of long-term administration. Complementary or alternative therapies are not mentioned.
Comment: The Group Health posting has a comment field. The one statement these is from this writer: “I am honestly astonished that an organization as progressive as Group Health, in the Pacific Northwest, and with as long of experience in researching and covering various forms on complementary, alternative, mind-body and integrative therapies, can put out such a statement without any reference to these tools for both self-care and professional management of pain conditions. Doesn’t even merit a mention?” I would add now that this is particularly so given a blueprint for pain treatment from the Institute of Medicine that recommends a multidisciplinary, integrative approach. Recommendations for intermittent use of opioids, for instance, would seem a smart place to use integrative therapies. Backing people off harsh drugs is a top propellant of CAM use.
James Gordon, MD’s work with trauma and cancer in Gaza and Israel featured
The work of the Center for Mind-Body Medicine’s (CMBM) founder James Gordon, MD with trauma and cancer in Gaza and Israel was recently featured in Israel’s leading liberal daily, Haaretz. Psychiatrist Gordon told his CMBM list that the “need for our work … has never been greater.” He adds: “The escalation of the conflict has taken a psychological as well as a physical toll that seems to grow deeper every day in spite of the present cease-fire.” The Haaretz writer observed that “it’s not often that a Jewish psychiatrist is spotted in the Gaza strip.” Gordon, the former chair of the White House Commission on Complementary and Alternative Medicine Policy, has been working with integrative approaches on relief in disaster zones since 1995. He notes in the Haaretz piece that “mental health is neglected, even in very good relief efforts.”
Comment: Gordon and his Georgetown colleague, integrative medicine leader Aviad (Adi) Haramati, PhD, are each involved in some ways in healing in the Middle East. Some of Haramati’s work is here.
Case report on successful integrative medicine primary care clinic in Sydney, Australia
The recent issue of the Journal of Complementary and Alternative Medicine reports an examination of supportive factors and challenges in an ultimately financially successful, multidisciplinary, community-based, integrative medicine (IM) clinic. The clinic was established in Sydney, Australia in 2006, with both primary care and consultative services in the model. The results follow:
“Consistent with success factors identified in the literature, the clinic had an open-minded culture, credible supporters, suitable facilities, and clinically competent practitioners. Throughout the 4 years of its existence, the clinic strove to create an economically sustainable environment and to develop the service. As time progressed, it became evident that at least half of the practitioners needed to be biomedical doctors for the practice to remain viable. The challenges encountered were creating an economically sustainable clinic, managing high staff and practitioner turnover, finding the right balance between practitioners and services offered, developing an integrative medicine team, and building research capacity to evaluate the clinic and patient outcomes.
The authors share that “this multidisciplinary primary care clinic succeeded in establishing a viable health care service offering both integrative medicine and conventional, traditional, complementary, and alternative medicine.” They added: “Finding the right mix of staff members and following up with evaluations to track progress are important.”
Boston’s Visions Healthcare, led Edward Levitan, MD, to move to 21,000 square foot integrative clinic facility
Begun three years ago in Wellesley, MA with just three employees, the integrative medicine operation Visions HealthCare now employs 60, including 12 medical doctors. The clinic is about to move into a 21,000 square foot space in Dedham, MA. The founder of the operation, Edward Levitan, MD was profiled in the Boston Business Journal as an Emerging Leader. Visions HealthCare’s website features service-related drop-downs in two categories: medical and wellness. The former features 6 MD specialties, including palliative care, while the latter is topped by acupuncture, bodywork and energy approaches. Levitan says he is also looking for 200 acres near Boston to host an organic farm and school. The 37-year-old Levitan counts Institute for Functional Medicine founder Jeffrey Bland, PhD as a mentor and chief influencer.
“When naturopaths help people with diabetes to change their ways, what’s the ‘secret sauce’?”
This question head-lined a second short newsletter item from Group Health Research Institute (GHRI) reporting research by GHRI members and other collaborators. The study itself had a more mundane title: Patient-reported experience with first time naturopathic care for Type II diabetes. The GHRI article noted that GHRI and Bastyr University researchers had already published research that “adding naturopathic care to standard care improved health behavior and self-care for Group Health patients with diabetes.” This time collaborators from GHRI, Bastyr, Oregon Health Sciences University and the Naturopathic Physicians Research Institute examined how the approach of the naturopathic doctors’ had these positive impacts. The overall conclusion: “Results indicate that the routine clinical approach used by NDs is consistent with behavior change theory and clinical strategies found most effective in promoting self-efficacy and improving clinical outcomes.”
The researchers used a “content analysis approach” in interviews with 22 of the participants in the original study. They found the following nine elements of continuity. The first three were said to “characterize the nature of the ND-patient interaction.” These were that it was patient-centered, holistic health rather than diabetes focused, and collaborative. They then noted five themes “related to the content of the clinical encounter.” These were: individualized and detailed health promotion; counseling that promoted self-efficacy; pragmatic and practical self-care recommendations; novel treatment options that fostered hopefulness; and patient education that addressed both diabetes self-care and general health. Finally, the researchers added a ninth theme that they called “cross-cutting.” This was the contrast, for the patients, between naturopathic care and conventional medical care. The team was led by NPRI’s acting chair Erica Oberg, ND, MPH, and included Ryan Bradley, ND, MPH (the lead on the original diabetes project), Clarissa Hsu, PhD, Karen Sherman, PhD, MPH, Sheryl Catz, PhD and Dan Cherkin, PhD.
Comment: In a world in which soaring costs are linked to poor personal habits, these outcomes should prompt significant research and payer interest. In a research context in which millions are being spent to understand “patient-reported outcomes” and “patient-centered outcomes,” the nine themes particularly merit examination. At a time when the Institute of Medicine Global Forum on Innovation in Health Professional Education is looking for education models that will better practice, the naturopathic medical education strategies, and those integrative medicine programs in conventional medical schools, merit exploration.