Integrative Medicine, Part I: Incorporating Complementary/Alternative Modalities, An Issue of Primary Care Clinics in Office Practice

J. Adam Rindfleisch

Description

Complementary and alternative medicine encompasses a wide range of modalities, including acupuncture, herbs and supplements, naturopathy, and body and mind therapies. The use of these healing methods is increasing rapidly, and more and more patients are approaching primary care physicians with questions about them. The purpose of this issue is to help doctors understand the evidence supporting and refuting complementary and alternative medicine techniques so they can provide patients with answers. This is the first of a two-part series, and it focuses on the various modalities.

Sujets

• Family Practice
• General Practice
• Medical
• Médecine

Informations

• Publié par: Saunders
• Date de parution: 22 mars 2010
• Nombre de lectures: 0
• EAN13: 9781455700592
• Langue: English
• Poids de l'ouvrage: 2 Mo

Extrait

Primary Care Clinics in Office Practice , Vol. 37, No. 1, March 2010
ISSN: 0095-4543
doi: 10.1016/S0095-4543(10)00006-0

Contributors
Primary Care Clinics in Office Practice
Integrative Medicine, Part I: Incorporating Complementary/Alternative Modalities
J. Adam Rindfleisch, MD, Mphil
Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Odana Atrium Family Medicine Clinic, 5618 Odana Road, Madison, WI 53719, USA
CONSULTING EDITOR Joel J. Heidelbaugh, MD
ISSN  0095-4543
Volume 37 • Number 1 • March 2010

Contents
Cover
Contributors
Forthcoming issues
Foreword
Preface
Introduction to Integrative Primary Care: The Health-Oriented Clinic
Advising Patients About Herbs and Nutraceuticals: Tips for Primary Care Providers
Prescribing Yoga
An Introduction to Clinical Research in Osteopathic Medicine
Prolotherapy in Primary Care Practice
Meditation in Medical Practice: A Review of the Evidence and Practice
Biofeedback and Primary Care
Acupuncture in Primary Care
Naturopathy and the Primary Care Practice
Integrating Sustainability and Health Care
Integrative Care of the Mother-Infant Dyad
Biofield Therapies: Energy Medicine and Primary Care
Integrative Primary Care and the Internet: Opportunities and Challenges
Index
Primary Care Clinics in Office Practice , Vol. 37, No. 1, March 2010
ISSN: 0095-4543
doi: 10.1016/S0095-4543(10)00008-4

Forthcoming issues
Primary Care Clinics in Office Practice , Vol. 37, No. 1, March 2010
ISSN: 0095-4543
doi: 10.1016/j.pop.2009.11.001

Foreword
Traditional Medicine in Primary Care is Not Enough: We Must All Integrate CAM!

Joel J. Heidelbaugh, MD
Departments of Family Medicine and Urology, University of Michigan Medical School, Ann Arbor, MI, USA
Ypsilanti Health Center, 200 Arnet Street, Suite 200, Ypsilanti, MI 48198, USA
E-mail address: [e-mail]


Joel J. Heidelbaugh, MD Consulting Editor
It’s inescapable: Complementary and alternative medicine (CAM) is not only here to stay, but it also continues to permeate our lives in popularity, prevalence, and necessity. Moreover, clinical and translational research in this arena has proven that a myriad of nonconventional therapies provide benefit for many disorders that ail us, and waves of outcomes-based data continue to demonstrate impressive efficacy. From herbs to nutritional supplements, meditation to yoga, biofeedback to acupuncture, these and other modalities have piqued our interest and improved the lives of many of us and of people we know. In our daily routine of conventional medical practice, we must ask ourselves: “Is what we’re doing for our patients adequate enough?” “What other resources can I use to help my patients achieve their goals and minimize their risk of morbidity and mortality?” Ultimately: “Could integrating CAM practices enable us to offer better education to our patients regarding healthier lifestyle choices and disease prevention?”
The “necessity” component of CAM in our society should not go overlooked. Centered on the biopsychosocial approach to patient care, it enables us to create the ideal paradigm on which primary care is centered: namely, taking care of the “whole patient.” The various components of CAM bring great optimism toward the management of chronic diseases, including cardiac, gastrointestinal, endocrinologic, pulmonary, and rheumatologic conditions, as well as the potential for managing many others. We can only hope that the future of health care turns more attention toward offering CAM services as an integral part of primary care, and that these services will become covered benefits by insurance payers.
Clinicians stand to learn a great deal from current and advancing CAM practices. Unfortunately, the great majority of this learning must occur after completion of medical school and residency, as only a few clinicians pursue additional specialized training and even fewer feel comfortable incorporating such knowledge in their practices. According to the American Association of Medical Colleges, 113 of 126 medical schools in 2008 required courses in CAM, while 77 schools offered elective courses in this discipline. However, among schools that required such courses, only 4.4 hours in the preclinical years and 3.1 hours in the clinical clerkships were dedicated to CAM. 1 Despite this exposure, we continue to produce clinicians who have insufficient understanding and skill in integrating CAM modalities in their daily practices. Similarly, most clinicians are not equipped to answer their patients’ questions regarding even the most basic principles of integrative medicine.
As the consulting editor for Primary Care Clinics , the consistent advice I give to guest editors is to work closely with their authors to create a novel publication that contains current and salient evidence-based practice guidelines highlighting what they would need to enhance their everyday practices and enrich their teaching experiences. Dr Adam Rindfleisch has mastered this assignment, coupling his extensive background of clinical practice and research experience in CAM with that of his authors, to deliver a unique and informative issue that serves as the first of two issues dedicated to this topic. Readers will discover and enjoy well-crafted literature reviews featuring principles of osteopathic medicine, naturopathy and nutraceuticals, meditation and biofeedback, yoga, and acupuncture. Quite impressive is a review that discusses integrating sustainability in health care. This source, providing vast amounts of information for clinicians across all fields of medicine, enables readers to easily integrate this new knowledge into their practices and to enrich their own lives.

Reference

   1. Association of American Medical Colleges. US medical schools teaching selected topics 2008 LCME part II annual medical school questionnaire. Retrieved from the World Wide Web on October 25, 2009. Available at: http://services.aamc.org/currdir/section2/2008hottopics.pdf Accessed October 25, 2009
Primary Care Clinics in Office Practice , Vol. 37, No. 1, March 2010
ISSN: 0095-4543
doi: 10.1016/j.pop.2009.09.014

Preface
Integrative Medicine in Primary Care

J. Adam Rindfleisch, MD, MPhil
Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Odana Atrium Family Medicine Clinic, 5618 Odana Road, Madison, WI 53719, USA
E-mail address: [e-mail]


J. Adam Rindfleisch, MD, MPhil Guest Editor
In recent years, we have been hearing about—and directly experiencing—many trends that affect primary care. Primary care providers are in short supply. 1 We do a great deal of uncompensated work. 2 Some say we are the key to “fixing” the broken US health care system. 3 We are encouraged to build medical homes, 4 recruit more students into primary care, 3 and adopt new technologies, such as electronic medical records. 5 Meanwhile, primary care providers continue to confront the never-ending daily challenge of seeing as many patients as possible without compromising the quality of care we provide or the balance between our professional and personal lives. It is no surprise that we are said to be at high risk for burnout, 6 with many of us transitioning to hospitalist medicine, intermediate care, or other pursuits. 7
For all the challenges we face, however, there is reason for optimism. Ample opportunity exists, in the context of all these shifts, to reinvent our profession, exploring new ways to meet patients’ needs, enrich our practices, and reconnect with the reasons we became primary care providers in the first place.
This issue’s main objective is to explore how integrative medicine (IM) might inform primary care. Defined in detail in the first article of this volume, IM draws from complementary and alternative medicine, with an emphasis on evidence-based practice and safety. Beyond that, IM is an overall philosophy of care; it is primary care par excellence, emphasizing provider-patient relationships, the innate human capacity for healing, individualization of care, and use of a holistic (bio-psycho-social-spiritual) approach. IM focuses on prevention, healthy lifestyle choices, and fresh approaches to chronic disease management. It also promotes provider self-care, an all-too-often ignored aspect of our work.
Patients want this approach. In 2007, according to the National Health Interview Survey, 4 out of 10 adults and 1 out of 9 children were reported to use some form of complementary and alternative medicine. 8 Over $38 million was spent on 354.2 million visits, most of which was paid out of pocket. 9 People state they use these services because they are safer, more individualized, less invasive, and more consistent with their beliefs about their health.
As my practice partners and I have worked to create an integrative primary care model over the past few years, we have found the process fulfilling and frustrating at times. Challenges have included resistance from some colleagues (though most of them are quite supportive of IM), outdated reimbursement structures, and simply not having enough time to incorporate new ideas. Positives have included enhanced patient satisfaction, having more to offer patients (in particular those with chronic conditions), and seeing burgeoning interest in IM among the medical stud