A monthly round-up of the latest news, events and topics in integrative healthcare policy from John Weeks.

 

Integrative practice organizations finds holes in draft National Prevention Strategy, urge more community input 

In the short, holiday-filled December 23-January 13 (then 18) time-frame for public input to the National Prevention, Health Promotion and Public Health Council’s draft National Prevention (and Health Promotion) Strategy, some in the integrative practice community found time to respond. Among those submitting: Samueli Institute, Integrated Healthcare Policy Consortium, American Chiropractic Association, American Association of Naturopathic Physicians, National Center for Homeopathy and various individuals. These perspectives, published as a group here, yield the following key themes.

  • Appoint the Advisory Group of community experts, including those with expertise in “integrative health care” specifically noted in the law.
  • Change the title: National Prevention Strategy says more of the same. 
  • The present definitions and approaches are too limited if you want the transformational outcome asserted.
  • Explore the value in primary prevention and health promotion of integrative practices and practitioners.
  • Use emerging community and self-care resources.
  • Engage in integrative practice research that has health and wellness outcomes.
  • Bear in mind that the ultimate national strategy that will be transformational will rely on research we need to first engage.

Comment: By sharing their perspectives publicly, these integrative practice organizations allow us to begin to see where common themes emerge and lines of continuity exist. Thanks to each of these organizations and individuals for sharing. My own conclusion, more harsh than these, is that the Council must dramatically slow its time-table. Otherwise it will not successfully engage what the draft declares in the first sentence as “the unprecedented opportunity to shift the nation from a focus on sickness and disease to one based on wellness and prevention.” The focus of the draft strategy, as Samueli Institute CEO Wayne Jonas, MD summarized in a note to the Integrator, “still seems to on preventing death rather than improving health.” The document needs significant work or the outcomes will fall far short of the goal.

Related Integrator articles:

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Charlotte Kerr, RN, MPH, LAc appointed to Advisory Group on Prevention, Health Promotion and Integrative and Public Health

On January 26, 2011, President Barack Obama announced 14 members of the Advisory Group to the Council on Prevention, Health Promotion, and Integrative and Public Health. Congress mandated that this group include at least one integrative practitioner. Filling that bill for the Council is Charlotte Rose Kerr, RSM, RN, BSN, MPH, MAc (UK), LAc, DiplAc (NCCAOM), a former member of the faculty at Tai Sophia Institute. This is Kerr’s second presidential appointment. In 1999, Bill Clinton appointed her to the White House Commission on Complementary and Alternative Medicine Policy. Kerr also served a term on the advisory committee of the NIH Office of Alternative Medicine and was among the group of integrative health leaders who testified before Congress on February 23, 2009 in the days leading up to the Institute of Medicine Summit on Integrative Medicine. (Kerr’s testimony is here.) 

Comment: Never mind, for a moment, that this Advisory Group was appointed after the National Prevention Strategy was drafted and the public comment period closed. Comments on the draft National Prevention Strategy by organizations associated with integrative practice, as noted above, called for more input from the integrative practice community and specifically for appointment of the Advisory Group before the Strategy is finalized.

Kerr is a familiar face representing CAM/IM in the Beltway. I can’t think of anyone else with such a scope of appointments. Yet, to my knowledge, Kerr hasn’t thus far viewed those positions as a responsibility to network deeply with the expertise that surrounds her in the integrative health world to best inform her work as a public servant. I may have missed something. Here’s hoping that Kerr will do all she can to connect with and gather ideas from these community experts for whom she will be the one-and-only obvious point of access. Congratulations, Charlotte, and good luck with this “unprecedented opportunity to shift the nation from a focus on sickness and disease to one based on wellness and prevention.”

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Integrative health community researchers shut out from appointments to the PCORI Methodology Committee 

The January 21, 2011 announcement of appointees to the critically important Methodology Committee of the Patient Centered Outcomes Research Institute (PCORI) did not include any individuals whose published biographies referenced significant experience in integrative health. The language of the enabling statute requires that PCORI’s “Expert Advisory Council(s) shall … include experts in integrative health and primary prevention strategies.” Among organizations that submitted nominations were the Integrated Healthcare Policy Consortium and the Academic Consortium for Complementary and Alternative Health Care, with which I am involved.

Comment: Following a note I sent to colleagues regarding the missing appointment of anyone deeply experience in integrative health research methods, one colleague wrote back that Brian Mittman, PhD, Director, VA Center for Implementation Practice and Research Support, Department of Veterans Affairs in Los Angeles “is a good guy” has some prior involvement in chiropractic research. At present, however, it would appear that the distinct experience that whole person, health-focused integrative practices might have brought into the Committee, as apparently required by Congress, were left on the appointment room floor. My auditor brother-in-law, formerly with the US General Accounting Office, once taught me about the meaning of “compliance audit.” An auditor would find non compliance here.

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Integrated Healthcare Policy Consortium (IHPC) offers statement on meaning of “integrative practitioners” for federal policy-makers, sort of …  

On January 13, 2011, the multidisciplinary Integrated Healthcare Policy Consortium published a press release entitled “Policy Statement on the National Healthcare Workforce in an Era of Integration.” The release responds to an opportunity and some confusion created when Congress, in multiple places in the Patient Protection and Affordable Health Care Act, included phrases such as “integrative health care” and “integrative practitioner” without defining what they mean. The IHPC’s approach is to broadly define who should be included in workforce planning, rather than to specifically define an integrative practitioner. 

Comment: The significant short-coming in the IHPC statement is that it does not note any specific traits that distinguish an “integrative practitioner” from one who is not an integrative practitioner. This is a significant problem. How can IHPC or anyone else argue for the need for inclusion of “integrative practitioners” if Congress does not have a handle on what the term means. The American Association of Naturopathic Physicians, a recent member of the IHPC’s Partners in Health program, offers such a definition in their response to the National Prevention Strategy. IHPC is the ideal body to do this. I hope they still plan to tackle it.  

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Veterans Administration names Tracy Gaudet, MD to head new Office of Patient Centered Care and Cultural Transformation

On January 19, 2011, the Department of Veterans Affairs (VA) announced that it is creating a new office to develop personal, patient-centered models of care for Veterans. The release notes that Tracy Williams Gaudet, MD will direct the new Office of Patient Centered Care and Cultural Transformation. Gaudet formerly served in two key academic medicine capacities in integrative medicine: as executive director of Duke Integrative Medicine and prior to that as the first director of the then “Program in Integrative Medicine” established by Andrew Weil, MD at the University of Arizona. The VA model that Gaudet is developing is expected to influence care in the over 1,000 “points of care across” the Nation that are operated by the VA. States Gaudet: “The Office of Patient Centered Care and Cultural Transformation will be a living, learning organization in which we will discover and demonstrate new models of care, analyze the results, and then create strategies that allow for their translation and implementation across the VA.  VA will continue to be a national leader in innovation, and, in this way, we will provide the future of high-quality health care to our Veterans.” An integrative leader familiar with military practices stated about Gaudet’s appointment: “An unusual pick, but a good one.”

Comment: This is a huge sign of the uptake of integrative approaches in the nation’s largest healthcare system. I couldn’t help but notice that the release stated that Gaudet worked at “Duke Integrated Medicine” rather than its correct title of “Duke Integrative Medicine.”  May have been a slip up. Then again, the VA media managers may have chosen a term more comfortable to the mainstream and less revealing that would allow Gaudet to begin her work without being beset by integrative medicine’s antagonists. My guess: The integrative practice community will soon have a FOT group paralleling the informal FOB that surrounded another influential Beltway person a decade ago.

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Mitchell Stargrove, ND, LAc appointed to HRSA pharmacy program leadership; participation in community teams invited 

Mitchell Stargrove, ND, LAc, author of the highly regarded Herb, Nutrient and Drug Interactions and chief medical officer of MedicineWorks, publishers of InteractionsGuide.com  recently sent information regarding the Patient Safety and Clinical Pharmacy Services Collaborative (PSPC), sponsored by the Health Resources and Services Administration (HRSA). Stargrove has been appointed as a member of the national Leadership Coordinating Council for the initiative. HRSA is inviting other practitioners organizations of various stripes to participate in PSPC community networks. HRSA describes PSPC as:

 ” … a breakthrough effort to improve the quality of health care across America by integrating evidence-based clinical pharmacy services into the care and management of high-risk, high-cost, complex patients … PSPC uses a fast-paced, iterative improvement method designed to support teams in testing and spreading leading practices found to significantly improve health outcomes and patient safety through the integration of clinical pharmacy services. Key to the method’s effectiveness is that the leading practices are drawn from real practice in organizations that have achieved outstanding results.

The PSPC works through 128 teams in 43 states representing “community-based health care providers, including health centers, Ryan White HIV/AIDS providers, poison control centers and rural health clinics.” According to Stargrove, PSPC welcomes participation from diverse community organizations. He adds that recently the “Patient Safety and Clinical Pharmacy Services Alliance” was incorporated as a non-profit organization “to serve as the vehicle for a public-private partnership supporting the ongoing work of the PSPC collaborative.”

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