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Advancing integrative medicine through interprofessional education
Kevin D Willison
Institute for Life Course and Aging, University of Toronto; Department of Sociology, Lakehead University, Orillia Campus, Canada
Abstract
Interprofessional Education (IPE) has the potential to create and sustain the type of vibrant environments needed for Integrative Medicine (IM) to thrive. IPE strategies and initiatives are conducive to the goals of integrative medicine in that both seek to bring together diverse professionals. This makes the application of IPE towards advancing integrative medicine timely.
Bringing together varied disciplines which represent biomedicine and complementary and alternative medicine (CAM), while maintaining each of their unique attributes, is what IPE can accomplish. Their synergy has the potential to improve holistic and patient-centered care, as well as bolster chronic disease management.
That biomedical and CAM driven practice domains could work more collaboratively, by implementing IPE, for their own enhanced legitimisation as well as for the benefit of the people they serve, speaks of the importance of this emerging topic.
Keywords
sociology, complementary and alternative medicine, chronic disease management, Interprofessional Education, Interprofessional Care, integrative medicine
Article Text
The incidence of chronic disease is rising due to such factors as increasing longevity and world-wide population ageing. Older people are particularly susceptible to developing one or more chronic health conditions due to natural ageing. Those who have such conditions face particular challenges: both medical and social (DH 2004). Chronic disease often significantly impacts a person's quality of life, including their ability to remain mobile and independent (Kopec & Willison 2003). A long-standing issue however, is that many health care systems tend to place low priority on the concerns of the chronically ill by remaining dominantly cure oriented (Willison 1993). Undoubtedly, such systems will need to become more accountable as ageing populations increasingly use more health care services (Mullen 2008). It is becoming increasingly important, for example, that care be delivered in an integrated, collaborative and coordinated fashion to help ensure efficiency as well as sustainability (OHA 2008). Towards such goals this review considers the potential of advancing Integrative Medicine through an improved emphasis on Interprofessional Education (IPE).
Integrative Medicine (IM), while difficult to define, may be viewed as using the most appropriate complementary and alternative medicine (CAM) and biomedical treatments, (or both), to address patients and their diseases from the most holistic, mind-body-spirit perspective possible (Scherwitz et al 2003; Willison et al 2005). Support for IM acknowledges it is unreasonable to expect that only one approach to health care, such as biomedicine, can be all encompassing. Clearly the management of most health needs relies on the input of a range of professionals, particularly for people with chronic disease, whose care needs are often complex (Ross & Harris 2005). That positive attributes found in regulated CAM practices may help offset the limitations of biomedical/allopathic practices, and the best of biomedicine could help offset the limitations found in CAM, speaks of what IM strives for. Professionals from both domains need to effectively work together to help improve overall population health and the care provided to our most vulnerable members of society, such as the chronically ill. Such objectives may be supported using IPE initiatives and strategies.
D'Amour and Oandasan (2005) define IPE as the process by which two or more health professions learn with, from and about each other across the spectrum of their life-long professional educational journey, to improve collaboration, practice and quality of patient-centred care. IPE seeks to improve interprofessional care, which may be characterised in part by the provision of comprehensive health services to patients and others, through multiple health caregivers who work collaboratively with a focus to deliver quality care within and across settings (ICSC 2007). IPE endorses the thinking that no person acting alone is as effective as a team to drive best practices and outcomes (Montague 2006; Willison 2007).
Among its potential benefits, which can positively impact overall population health, IPE strives to enhance patient-centered care and assist teams of caregivers to work more effectively. It aims to achieve this through helping to manage increasing workloads, reduce waiting times and reduce the likelihood of patients suffering adverse reactions as a result of the care they receive (CHSRF 2007). There is growing evidence, for example, that teams are less prone to making mistakes than individuals, especially when team members are well aware of their own and their team members' role and responsibilities (Salas & Cannon-Bowers 2000).
The development of IPE has been transpiring for years in such locations as the United Kingdom. Its growth in such areas as North America has been prompted by such developments as the push for primary care teams and a growth in recognition of IPE's potential by college, university and hospital administrators (Willison 2007). Why is IPE becoming increasingly important for such vulnerable populations as the chronically ill? In part because of the growing acceptance that good chronic disease management includes the use of multidisciplinary teams (DH 2004). No single model of health care is likely to meet the range of health and social care needs of populations and individuals (Remsburg & Carson 2002), and neither is a single discipline. Certainly, it is common for such groups as the chronically ill to require a range of caregivers, particularly by those whose illness trajectories move in and out of acute and chronic care phases (Kelly et al 2000). As such, it is not uncommon to see an interdisciplinary team of caregivers including physicians, a physiotherapist, social worker, massage therapist, dietician, nurse clinician and so forth helping to address an individual's physical, psychological and social needs (Singh 2008). Indeed the growing recognition of the need for different professionals to work closely together and improve their coordination and teamwork, has meant it has become a global health policy issue (Howarth et al 2006; Leatt et al 2001). Moreover, the ability to work inter-professionally has become an important (new) skill which needs to be developed, and nurtured (Ferlie & Shortell 2001).
There is growing evidence that those who suffer from chronic health conditions stand to benefit from an IPE approach which supports improved patient care and more effective use of health care resources. Research suggests that environments conducive to interprofessional care (IPC) help, for example, to reduce clinical error by improving communication amongst staff. In one study the use of IPE helped lower emergency department clinical error rates from 30.9 to 4.4 percent (Morey et al 2002). Yet another study, reported in IC-BAO (2007) and reviewing the closed claims in a hospital, showed that improved teamwork could have mitigated or prevented events leading to malpractice claims in 43 percent of the events under study (Barrett et al 2001). Moreover, a study by Buist et al (2002), which addressed the impact of a medical team in a 300-bed hospital, found that the incidence of unexpected cardiac arrest declined by 50 percent (with a reported odds ratio of 0.50, and a 95% confidence interval 0.35 to 0.73). This latter group of researchers conclude that in clinically unstable inpatients, early intervention by a medical emergency team shows promise to reduce the incidence of and mortality from unexpected cardiac arrest in hospital.
In a selected case study by Lorig et al (2001), where interprofessional care was further used, after one year of what is called the Standford Chronic Disease Self-Management Program, using a randomised clinical trial, researchers concluded that participants experienced statistically significant improvements in health behaviours (specifically: exercise, cognitive symptom management, and communication with physicians), as well as self-efficacy, and health status (using such indicators as fatigue, shortness of breath, pain, role function, depression, and health distress). Participants also had fewer emergency department visits (0.4 visits in the 6 months prior to baseline, compared with 0.3 in the 6 months prior to follow-up at p=0.05). That IPE related initiatives may help in the long term to reduce health care spending, by curtailing institutional utilisation, requires further investigation.
In general, the use of Interprofessional Education/interprofessional care may lend to:
a) Enhanced access to health care
b) Improved outcomes for people with chronic diseases
c) The provision of less tension and conflict among caregivers
d) Augmented provider satisfaction
e) Improved use of clinical resources
f) Easier recruitment of caregivers, and
g) Help to lower rates of staff turnover (IC-BAO 2007; HSRF 2007; OHA 2008; Lemieux-Charles and McGuire 2006).
Each of these potential benefits could directly or indirectly help improve overall population health, client-centred care and chronic disease management (Berentson-Shaw & Price 2007). Certainly, more research is urged. Additional potential benefits of IPE are denoted in Table 1.
Understanding complementary and alternative medicine (CAM)
The scope of CAM is vast, encompassing more than 1,800 therapies and systems of care (Snyder & Lindquist 2002). Although there are considerable differences amongst CAM practices in terms of theory, practice and status, this article uses the definitions adopted by Shuval and Mizrachi (2004) and treats CAM as a single, general category. CAM is commonly defined as therapeutic practices that fall outside the boundaries of conventional biomedicine (Hill 2003; McCaffrey et al 2007). CAM interventions may be referred to as ‘complementary' when used with biomedical treatments, and ‘alternative' when used without biomedicine. Specific distinctions between the terms ‘complementary' and ‘alternative' is usually blurred and often denoted interchangeably within the literature.
One of the attributes of complementary and alternative medicine is that it is thought to have an emphasis on self-care, wellness promotion and being home or community-based. ...continues...
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