Complementary and Alternative Medicine in the United States (2005) / Chapter Skim
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7 Integration of CAM and Conventional Medicine
7 Integration of CAM and Conventional Medicine
Pages 196-225
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From page 196... ...
Hospitals are offering CAM therapies, health maintenance organizations (HMOs) are covering such therapies, a growing number of physicians use CAM therapies in their practices, insurance coverage for CAM therapies is increasing, and integrative medicine centers and clinics are being established, many with close ties to medical schools and teaching hospitals.
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From page 197... ...
An example is coronary bypass surgery which became accepted treatment before undergoing controlled clinical trials. The evident effectiveness of coronary bypass surgery in reducing symptoms of stable angina fostered great enthusiasm for the procedure, with many clinicians assuming that its effectiveness would be similar in reducing the risks of heart attack and death because of coronary disease.
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From page 198... ...
Second, most existing CAM therapies already exist in practice; that is, patients are using these therapies. This means that the cycle must begin at the integration step so that studies can be carried out to evaluate the therapies already in use.
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From page 199... ...
This step requires a careful peer-review process and competent researchers to evaluate the evidence and recommend the findings for publication or presentation. The articles may be published in CAMrelated journals (e.g., Journal of Complementary and Alternative Medicine)
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From page 200... ...
Payers then decide on coverage policy. Coverage policy is important to the adoption of new tests and treatments, although many patients pay out of pocket for CAM services that payers do not cover.
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From page 201... ...
By 2001, the number of hospitals offering CAM therapies had more than doubled to 15 percent "indicating a steadily growing interest by hospitals to enter into this arena" (Ananth, 2002)
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From page 202... ...
It is a bridge between standard medical care and spiritual healing that we call complementary and integrative medicine" (M.D. Anderson Cancer Center, 2004)
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From page 203... ...
For homeopathy and herbal approaches, 26 and 23 percent of physicians, respectively, believed in the efficaces of these therapies. In recognition of the growing use of CAM therapies by individual conventional medical practitioners, the Federation of State Medical Boards of the United States developed Model Guidelines for the Use of Complementary and Alternative Therapies in Medical Practice.
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From page 204... ...
positions on nurses' practice of CAM therapies and found that 47 percent
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From page 205... ...
205 783) and Practice = (n Family General 98.4 96.1 92.5 92.5 72.5 65.1 66.9 73.2 71.2 54.5 45.9 60.7 56.6 46.1 41.2 44.5 27.2 34.9 37.6 Specialty by Internal Medicine 99.1 94.8 91.5 91.5 62.5 59.9 63.8 65.1 65.7 50.6 38.7 68.9 44.6 43.6 29.4 42.8 21.9 33.9 38.1 Practices, CAM Pediatrics 98.9 96.1 92.6 92.1 51.7 57.6 55.1 57.6 62.9 32.9 18.9 47.7 30.1 34.2 26.3 44.6 18.2 26.4 29.4 Use Would Total 98.8 95.7 91.1 92.7 64.6 61.6 63.0 66.8 67.9 48.2 37.5 60.4 46.6 42.5 33.8 44.5 24.4 32.6 35.9 Who or Use Used 6.5 Would 24.5 43.8 47.6 30.9 32.4 39.0 42.8 48.0 29.0 21.3 48.7 36.5 34.3 27.9 39.5 20.6 29.8 33.5 Have Sample Used Who 8.2 5.9 5.0 3.8 2.8 2.4 Total Have 92.3 71.2 47.3 44.1 33.7 29.2 24.0 24.0 19.9 19.2 16.2 11.7 10.1 (1998)
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From page 206... ...
(2003) evaluated nurses' attitudes toward CAM use in critical care and found that nurses are open to the use of CAM therapies, with many already incorporating CAM therapies into their own practices.
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From page 207... ...
(2002) found that the extent of insurance coverage for CAM providers and the use of CAM therapies for wellness are strong correlates of the frequent use of CAM providers.
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From page 208... ...
Although few studies have focused on why health care institutions and practioners are incorporating CAM therapies, this section examines the available evidence about why institutions and practitioners (both conventional medicine and CAM) are moving toward integrated care.
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From page 209... ...
Few would argue against the notion that health care practitioners desire to provide the best care for their patients. Some restrict the definition of "best care" to those therapies found in conventional medicine; however, the growing body of evidence demonstrating that some CAM therapies are safe and effective is likely to be a factor contributing to the increased use of CAM by both health care practitioners and health care institutions.
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From page 210... ...
He writes "integrative medicine refers to a clinical approach that combines the strengths of conventional and alternative medicine with a bias toward options that are considered safe, and which, upon review of the available evidence, offer a reasonable expectation of benefit to the patient." According to Snyderman and Weil (2002) , integrative medicine is a movement, driven by consumers, which is attracting the attention of academic health centers.
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From page 211... ...
As discussed earlier in this chapter, the level of integration of conventional and CAM therapies is growing. That growth generates the need for tools or frameworks to make decisions about which therapies should be provided or recommended, about which CAM providers to whom conventional medical providers might refer patients, and the organizational structure to be used for the delivery of integrated care.
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From page 212... ...
. these tools should be the goal of providing comprehensive care that is safe and effective, that is collaborative and interdisciplinary, and that respects and joins effective interventions from all sources.
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From page 213... ...
propose that practitioners may wish to guide their recommendations for treatment for both conventional and CAM therapies by evaluating whether the medical evidence: · supports both safety and efficacy (option A) ; · supports safety, but evidence regarding efficacy is inconclusive (option B)
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From page 214... ...
From a liability perspective, the more acute and severe the condition is or the more curable the condition is by conventional medical therapies, the more important it is to monitor and, as neces EFFICACY Option B Option A ¥ Tolerate ¥ Recommend and ¥ Provide caution and ¥ Continue to monitor ¥ Closely monitor effectiveness Option D Option C SAFETY ¥ Avoid and ¥ Consider tolerating ¥ Actively discourage ¥ Provide caution and ¥ Closely monitor safety FIGURE 7-3 Clinical risk and the therapeutic posture. SOURCE: Adapted from Cohen and Eisenberg (2002)
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From page 215... ...
The next section explores issues related to the provision of CAM therapies in health care institutions. HEALTH CARE INSTITUTIONS Health care institutions face a number of potential operational barriers to the provision of integrative medicine, including issues of financial sustainability and the development of appropriate clinical models for the provision of medical care by teams comprising various conventional medical and CAM providers.
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From page 216... ...
. In developing approaches that include both CAM and conventional medical therapies, health care institutions may take advantage of existing health care institution policies and guidelines to address liability concerns, implement risk management practices, and otherwise find ways to appropriately include CAM therapies and providers in existing systems of care.
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From page 217... ...
The development of appropriate clinical models to implement care that includes both CAM and conventional medical therapies is an additional challenge for this emerging field of integrative medicine. The next section explores various approaches.
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From page 218... ...
· Ongoing subsidies are needed if only CAM services are offered. A report prepared for the Philanthropic Collaborative for Integrative Medicine (Clohesy Consulting, 2003)
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From page 219... ...
For centers that do accept direct insurance payment, because insurers do not reimburse for the full costs of integrative medicine consultations and therapies, the more patients these centers see, the more money they lose. Centers that bring in research grants are able to use the overhead from these grants to balance income and expenditures.
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From page 220... ...
. CONCLUSIONS AND RECOMMENDATIONS Health care that integrates CAM therapies with conventional medicine has been termed "integrative medicine" by many (Berndtson, 1998; Hess, 2002; Maizes et al., 2002; Snyderman and Weil, 2002)
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From page 221... ...
and policy makers with the information necessary to make decisions about the future of integrative medical practice. There is an urgent need for health systems research efforts that focus on identifying the elements of various models of integrative medicine, the outcomes of care delivered through these models, and whether these models are cost-effective compared with the cost of care obtained in conventional medical practice settings.
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From page 222... ...
This framework should include both conventional medical and CAM approaches to health promotion, disease prevention, and the treatment of illness that have been shown to be safe and effective. To the extent that evidence indicates that models of health care that integrate CAM and conventional therapies (e.g., integrative medicine clinics)
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From page 223... ...
2001. A regional survey of health insurance coverage for complementary and alternative medicine: Current status and future ramifi cations.
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From page 224... ...
1997. Current trends in the integration and reimbursement of complementary and alternative medicine by managed care, insurance carriers, and hospital providers.
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From page 225... ...
2002. Insurance coverage, medical conditions, and visits to alternative medicine providers: Results of a national survey.
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