Process of care in outpatient Integrative healthcare facilities: a systematic review of clinical trials

Abstract

BackgroundPatients currently integrate complementary medicine (CM) and allopathic, choosing a combination of therapies rather than a single therapy in isolation. Understanding integrative healthcare (IHC) extends beyond evaluation of specific therapies to encompass evaluations of multidisciplinary complex interventions. IHC is defined as a therapeutic strategy integrating conventional and complementary medical practices and practitioners in a shared care setting to administer an individualized treatment plan. We sought to review the outcomes of recent clinical trials, explore the design of the interventions and to discuss the methodological approaches and issues that arise when investigating a complex mix of interventions in order to guide future research.MethodFive databases were searched from inception to 30 March 2013. We included randomized and quasi-experimental clinical trials of IHC. Data elements covering process of care (initial assessment, treatment planning and review, means for integration) were extracted.ResultsSix thousand two hundred fifty six papers were screened, 5772 were excluded and 484 full text articles retrieved. Five studies met the inclusion criteria. There are few experimental studies of IHC. Of the five studies conducted, four were in people with lower back pain. The positive findings of these studies indicate that it is feasible to conduct a rigorous clinical trial of an integrative intervention involving allopathic and CM treatment. Further, such interventions may improve patient outcomes.ConclusionsThe trials in our review provide a small yet critical base from which to refine and develop larger studies. Future studies need to be adequately powered to address efficacy, safety and include data on cost effectiveness.

Care coordination across healthcare systems: development of a research agenda, implications for practice, and recommendations for policy based on a modified Delphi panel

“…We used four key publications selected by project staff to represent different aspects of care coordination research (clinical integration, implementation of technological advances, social network analysis of provider relationships and interpersonal relationships between providers) as seed articles for a forward search 1 2 6 7. We screened studies included in 127 systematic reviews on care coordination to obtain a broad range of care coordination approaches 3–5 8–131. The reviews addressed common chronic conditions managed in primary as well as specialty care, cancer care, palliative care, comorbidity and complexity, personnel specialising in care coordination, frameworks and strategies to promote coordination, technology supporting coordination, settings for temporary care such as emergency departments and care models applied to specific populations.…”

Characterizing Interprofessional Collaboration and Referral to Mindfulness-Based Stress Reduction Programs

“…For instance, due to the increased data demonstrating the effectiveness of complementary practices to help treat chronic illness, and increased conventional practitioners practicing complementary health approaches, the integrative medicine model emerged to combine conventional and complementary methods to deliver holistic, patient-centered care. [15][16][17][18] Integrative models have already shown benefits of mindfulness-based therapies utilized by their patients. For example, a prospective cohort study of Kaiser Permanente Colorado patients with chronic pain, chronic illness, or a stress-related problem and without uncontrolled psychiatric illnesses found that an eight-week MBSR program led to significant improvements in selfreported pain, psychological symptoms, and reduced health services utilization.…”

The effectiveness of integrative healthcare for chronic disease: A systematic review

“…While previous reviews of the effectiveness of IHC have been published, the literature searches are now more than seven years old; as such, these reviews no longer reflect the state of the art. Furthermore, the scope of previous reviews of IHC have been limited to clinical outcomes and processes of care; no known reviews have explored the impact of IHC on service‐related outcomes. A contemporary, comprehensive and systematic review of the best available evidence of the effectiveness of integrative healthcare for the management of chronic disease, which considers both patient‐ and service‐related outcomes, is therefore warranted.…”

“…Furthermore, the scope of previous reviews of IHC have been limited to clinical outcomes 29 and processes of care 30 ; no known reviews have explored the impact of IHC on service-related outcomes.…”