Mind-Body Seeps Into Primary Care in Many Streams
July 25, 2016
National Center for Complementary and Integrative Medicine. A steady body of research is finding multiple values. Among these: basic science experts are tracking positive gene expression. A real world project found that a multi-week mind-body protocol produced 43 percent less utilization of regular medical services. But only recently has evidence emerged on how well this science and these powerful practices are becoming part of regular medical delivery.A team of researchers from Albert Einstein School of Medicine, led by Chelsea McGuire, MD (pictured right) and including Benjamin Kligler, MD, MPH (pictured below, left) recently took up the challenge via a qualitative study. They published their findings as “Facilitators and Barriers to the Integration of Mind–Body Medicine [MBM] into Primary Care.” The bottom line was not surprising. “The potential of MBM to improve delivery of healthcare remains far from fully realized, especially within primary care.”The researchers described mind-body practices as a big basket that includes “mindfulness-based therapies, relaxation, hypnosis/autogenic training, visual imagery, meditation, yoga, biofeedback, t’ai chi, cognitive-behavioral therapies, group support, and spirituality.”What made the most difference in facilitating the uptake were personal positive experiences of practitioners in using mind-body treatments in their own lives. These practitioners’ personal mission to find a way to integrate MBM – if only breathing exercises – was the driver more than organizational dictum. This was despite compelling system reasons to promote more MBM use. After all, mind-body services, according to the research team, can have an influence on the course of a remarkably diverse set of conditions routinely seen in primary care that are “poorly managed by biomedical solutions alone.” Among these are chronic pain, irritable bowel syndrome, insomnia, and the management of multiple other chronic diseases. The chief barriers are “the lack of reimbursement” on the one hand and, on the other, ‘‘insufﬁcient time.” The study led concluded that the best means to enhance MBM is to add tools to individual primary care practitioners and thus re-frame primary care as “mind-body primary care.” This is in juxtaposition to other strategies found to have additional time and money barriers. For instance: expand the team care concept to include practitioners trained to offer these modalities; or deliver MBM via group services, which can require a group room that a clinic might not have, and facilitation or team-leadership skills that a family doctor may not have.Comment: Learning that the chief obstacles to one’s plans are time and money may suggest that the best next step should be – as my father would have put it – “to punt on first down.” The study recalls early survey work of John Astin, PhD (pictured below, right) published a decade ago, in which his team concluded that “ … the finding that physicians identify lack of time and inadequate reimbursement as significant barriers suggests that the current health care delivery system may, in many respects, be antithetical to the biopsychosocial model.”MBM has ascended in 10 years, in part through NIH prioritization of funding in this area. Astin’s point about the misfit can be refined now as a dosage question. The researchers suggest that the best model is “mind-body primary care.” Primary care practitioners add clinical skills and deliver them. Thus the discover in the study that teaching patients breathing techniques is the form easiest to incorporate. This is suggested as the most workable model in the currently broken system.One wonders, however, if the baby may be tossed out the window and down two flights with the bathwater. Certainly the most robust values to US medicine from MBM come from programs that challenge the time-money issues of regular medicine. For example: the multi-week, group-based, mind-body protocol mentioned at the top of this article that produced 43 percent less utilization of regular medical services. Squeezing MBM practices into the slivers of space that the present broken prioritization of time makes available will demean their value. To create major benefits, the present primary care model is likely to need to be significantly altered.Still, kudos to these inside-the-machine guerrilla warriors for better care who are finding ways, if limited, to provide services they deem valuable. Breathing well is good, and can be significant.