Integrative Medicine and the Health of the Public A Summary of the February 2009 Summit (2009) / Chapter Skim
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Appendix E: Issue Background Material
Appendix E: Issue Background Material
Pages 207-222
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From page 207... ...
As with each commissioned activity, the responsibility for the content rests solely with the authors and does not necessarily represent the views or endorsement of the Institute of Medicine or its committees and convening bodies. BOX E-1 Commissioned Background Material for the Summit IOM Summit on Integrative Medicine and the Health of the Public: Issue Background and Overview Vicki Weisfeld Integrative Medicine Research: Context and Priorities Gary Deng, M.D., Ph.D.
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Catherine Niemiec, J.D., L.Ac. Health Professions Education and Integrative Health Care Mary Jo Kreitzer, Ph.D., R.N., FAAN Benjamin Kligler, M.D., M.P.H.
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From page 209... ...
Such comprehensive models as these may be replicable for other chronic conditions. The medical home concept currently is being advanced by four specialty societies for primary care physicians, which have issued joint principles intended to operationalize the patient-centered medical home.
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Teams also may include patient navigators to help patients access different health system components. Similarly, some model medical home projects that provide comprehensive services hire LPNs with deep community knowledge and good communications skills to conduct home visits and patient education.
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PREVENTION AND HEALTH OF THE PUBLIC Preventive medicine and public health share the objectives of promoting general health, preventing diseases, and applying the techniques of epidemiology to achieving these ends. Preventive medicine focuses on individual patients, while public health uses organized community efforts
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Clearly, the consequences of unhealthy behavior are costly, not only to individuals and families, but also for the entire health system. Disease prevention and wellness efforts cannot prevent every case of these diseases and injuries, but, even when disease occurs, they usually can help slow disease progress and avoid many serious sequelae.
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From page 213... ...
Since integrative medicine begins from the perspective of maintaining and promoting individual health, it is necessarily closely attuned to the array of behavioral and environmental factors that put health at risk. Inevitably, the health system must look beyond the individual patient to broader social and environmental influences.
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Indeed, prevention and the holistic approach at the core of integrative medicine are substantially marginalized in typical health professions training programs. Academic medicine must play a major part in training clinicians for the new roles of providers called for by integrative approaches, including the need to promote research to test the effectiveness of new practice models.
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From page 215... ...
Clinical education should include practice in conducting comprehensive medical evaluations, health planning, establishing good two-way patient communication and motivation, and disease management. These improvements depend on fundamentally altering health professions training to focus on interdisciplinary education and practical experience in working in effective care teams that can reduce medical errors, improve health care quality, and put at clinicians' disposal the full array of skills needed for effective patient care and wellness promotion.
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From page 216... ...
A long-term goal of many such groups is to influence health policy to remove regulatory and reimbursement barriers to preventive care and to support personalized medicine research. These groups sponsor educational sessions to acquaint the public and policy makers with integrative medicine concepts.
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A recent Kaiser Permanente study of enrollees found that they judged the quality of care provided by the system almost solely on these relationships. Providers and payers alike have a greater responsibility than previously acknowledged to nurture those relationships, for several reasons: growing awareness that satisfaction with the health system improves health care outcomes; from an economic standpoint, it also may reduce patient churn; and, knowing enrollees are likely to stay in a health system or insurance plan for a longer period greatly increases insurers' incentives to work on disease prevention and wellness.
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From page 218... ...
When patients have multiple chronic conditions, the ability to manage, monitor, slow disease progress, and avoid complications becomes increasingly complex, and research is needed on ways to optimize and balance treatment choices for individual patients. Many chronic conditions -- even normal aging -- are frequently accompanied by psychological symptoms that affect patients' ability to recover from illness and motivation to maintain health.
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From page 219... ...
However, such advances will never substitute for clinicians' and patients' judgments, and the data derived from these tools should be seen as an opportunity to build a long-term relationship focused on health maintenance. The data provide a more accurate long-range forecast of outcomes, which enables clinicians and patients to set in motion long-term strategies to minimize identified risks through close monitoring and the management of related behavioral and environmental factors.
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With U.S. health care costs, already so much higher than elsewhere and still rising, making our industries less profitable and less internationally competitive, and with the health system underperforming at such a significant level, it is already a substantial part of our nation's near-term economic problem.
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From page 221... ...
They put more emphasis on teamwork, better meld physical and mental health services, rely more heavily on nonphysician practitioners for patient education and counseling, involve complementary and alternative medicine practices and practitioners as needed, implement electronic health records, and organize their practices in other ways to make care more wellness oriented. Some of these physician practices have been found to not only increase and maintain patients' health more effectively than traditional approaches, but also to reduce health care costs.
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From page 222... ...
2008. Academic Medicine 83:707-714.
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