In patients with acute LBP, higher expectations for recovery are associated with greater functional improvement. Eliciting patient expectations for improvement may be a simple way to identify patients with the highest (or lowest) likelihood of experiencing functional improvement. Incorporating questions about patient expectations in future trials may clarify the role of this important correlate of clinical outcomes.
A model of care that offered access to a choice of complementary and alternative medicine therapies for acute LBP did not result in clinically significant improvements in symptom relief or functional restoration. This model was associated with greater patient satisfaction but increased total costs. Future evaluations of this choice model should focus on patients with chronic conditions (including chronic back pain) for which conventional medical care is often costly and of limited benefit.
It was feasible for a multidisciplinary, outpatient IC team to deliver coordinated, individualized intervention to patients with subacute LBP. Results showed a promising trend for benefit of treating patients with persistent LBP with this IC model, and warrant evaluation in a full-scale study.
“Integrative medicine” (IM) refers to the combination of conventional and “complementary” medical services (e.g. chiropractic, acupuncture, massage, mindfulness training). More than half of all medical schools in the United States and Canada have programs in IM and more than 30 academic health centers currently deliver multi-disciplinary IM care. What remains unclear, however, is the ideal delivery model (or models) whereby individuals can responsibly access IM care safely, effectively and reproducibly in a coordinated and cost-effective way.
Current models of IM across existing clinical centers vary tremendously in their: 1) Organizational settings, principal clinical focus and services provided; 2) Practitioner team composition and training; 3) Incorporation of research activities and educational programs; and 4) Administrative organization, e.g. reporting structure, use of medical records, scope of clinical practice as well as financial strategies, i.e. specific business plans and models for sustainability.
In this Perspective, the authors address these important strategic issues by sharing lessons learned from the design and implementation of an IM facility within an academic teaching hospital, i.e. the Brigham and Women's Hospital at Harvard Medical School; and, review alternative options considered based on information about IM centers across the United States.
The authors conclude that there is currently no consensus as to how integrative care models should be optimally organized, implemented, replicated, assessed and funded. The time may be right for prospective research in “best practices” across emerging models of IM care nationally in an effort to standardize, refine and replicate them in preparation for rigorous cost-effectiveness evaluations.
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