Institute for Functional Medicine begins $1.2 million Florida state backed clinical pilot with Tallahassee family medicine programOn January 21, 2011, the Gig Harbor, Washington based Institute for Functional Medicine (IFM) announced a collaboration between IFM and the Tallahassee Memorial Family

Institute for Functional Medicine begins $1.2-million Florida state-backed clinical pilot with Tallahassee family medicine program  

On January 21, 2011, the Gig Harbor, Washington-based Institute for Functional Medicine (IFM) announced a collaboration between IFM and the Tallahassee Memorial Family Medicine Residency Program (FMRP). The collaboration, funded by a $1.2 million grant from the Florida Agency for Health Care Administration, will be a pilot project to “establish a Medical Symptom Reduction Clinic utilizing the functional medicine model and a chronic-care team approach for patient care.” The project, according to the release, will “integrate functional medicine/nutrition into [the residency’s] curriculum and clinical activities.”

One area of investigation includes “personalized care for individuals with chronic disease, particularly for vulnerable patients recently discharged from the hospital.” Key outcome measures are potential reductions in ER usage and hospitalizations. The project will be headed up by FMRP behavioral medicine faculty member Cathy Snapp, PhD. The team also includes Narayanan Krishnamurthy, MD, Phillip Treadwell, PharmD, Dean Watson, MD and Ruth DeBusk, PhD, RD, IFM’s lead faculty member for its functional nutrition course. In addition, IFM faculty members Rich Panico, MD and Michael Stone, MD, MS will be consultants.

Comment:  This breakthrough project is more thoroughly described here in the release. This appears to be a model to potentially emulate. Take a look. Congratulations to IFM, the leaders of which have been promising a development like this since publication of their exceptional white paper 21st Century Medicine.Fun to see Panico involved. His integrative medicine leadership at Athens (Georgia) Regional Medical Center was featured in this Integrator article

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Holistic Primary Care
finds “convergence of conventional and holistic medicine” in physician survey

An article in the Winter 2010 issue of Holistic Primary Care contains results of a 52 item survey of 2000 primary care doctors (9% response rate) across the United States. Core finding: “The numbers tell us that nearly 80% of all primary care practitioners are incorporating some modalities from holistic or ‘alternative’ medicine into their practices, with nutrition counseling and stress management being most common. Many are getting into functional medicine, botanical medicine, and acupuncture. One-fifth … are using some form of hands-on manual technique with your patients.”

The survey was sent to practitioners who routinely receive HPC. Of the respondents: 78% were MDs, 12% DOs, and the remainder NDs, DCs, nurses and others; 62% were men; and the average age was 50. Over half of the respondents surveyed said they use information from HPC in their practices and one-third have it available in their waiting rooms. The  synopsis on the HPC site notes that while supplement prescription is growing, roughly a third of respondents reported having seen a significant adverse reaction to supplement use. The full survey outcomes, which also includes data on practice patterns, is available for purchase here.

Comment: The sample selected for this survey and the low response rate each urge caution on extrapolations to the broader primary care population. Still, these data, and the spin on them, are interesting.

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Survey of recent graduates of the University of Arizona IM Fellowship finds many struggling to create practices 

Duke Primary Care physician Richard Schneider, MD, a recent graduate of the Fellowship in Integrative Medicine at the University of Arizona Center for Integrative Medicine, found difficulties in developing an integrative medicine practice after he completed his program. He wondered how his fellow graduates were doing. Schneider surveyed 27 of them. In a report entitled Integrative Medicine: The Spirit is Willing, Schneider shares that 23% were in integrative practices, about 50% were “in planning stages”, and those in the other quarter were “thinking about it.” Schneider, a medical director in the Duke system where integrative medicine investment has been relatively high, concludes: “The results are quite encouraging, but not without caveats to the development of an IM practice.” The top obstacle was reimbursement with the second “time constraints.”

Schneider’s report includes information on the barriers and ideas where the Fellows need to focus attention to foster the development of their integrative medicine practices. Schneider is medical director at Duke Primary Care’s Creedmoor Road Clinic and is co-founder and faculty at CoHvation, which he describes as “a think-tank for collaborative healthcare innovations which seeks to assist and promote Integrative Medicine practice in both the in and out patient setting.”

Comment: Schneider’s findings recalled to mind survey data on practices of licensed acupuncturists in which significant under-employment was found. My sense is that many naturopathic medical graduates are similarly under-utilized. Detractors may conclude that the problem is that these services don’t work, otherwise they’d draw patients, wouldn’t they? Advocates will say that time and money (reimbursement and constraints) are significant obstacles; challenges with business models has little to do with the potential health care value of these practices. Meantime, I wonder how long spirits across these fields will remain willing if something doesn’t give. The best hope on the horizon are practical pilots such as that which appears to be modeled by IFM in Tallahassee (see article this Round-up).

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