Primary Care: Clinics in Office Practice
Special Issue Integrative Medicine
Edited by Deborah S. Clements and Melinda Ring
Authored by Osher Collaborative members
Volume 44, Issue 2, Pages 203-398 (June 2017)
“Too Much?”
Joel J. Heidelbaugh
Over the past decades, integrative medicine has exploded as a
mainstream alternative to conventional medicine, marrying a
holistic approach with directed attention toward the mind-body
connection, nutrition, and biophysiologic medicine with a
patient-centered approach. It’s popular; it’s in demand, and the
demand often can’t be adequately met in many areas of the
country. Most US medical schools still eschew any codified
curricula to provide adequate education in integrative medicine,
nutrition, or any other form of alternative medicine.
Fortunately, fellowship and additional training programs now
provide the venue for practitioners across all medical fields to
learn and incorporate such knowledge into their practices.
Insurance companies still view most alternative therapies as
nontraditional and rarely cover any therapeutic provisions or
supplements. The landscape of health care in the coming years has
the opportunity to embrace integrative medicine, but the story is
yet to be told.
Integrative Medicine and Primary Care
Deborah S. Clements, Melinda Ring
In primary care, we have become increasingly aware of our
patients’ interest in seeking alternatives to conventional
approaches to treatment. This interest often arises from a
patient’s desire to have their care aligned with their values,
beliefs, and philosophies about wellness. Patients understand
they are more than the sum of their illnesses. Integrative
medicine, the practice of medicine that focuses on caring for the
whole person, using all available therapeutic choices from a
variety of cultures, is a way to introduce additional healing
tools into primary care practice. The principles we associate
with primary care—comprehensiveness, continuous, coordinated care
in the context of the community—are reflected in the integrative
medicine model as well. In caring for the whole person, we
recognize that both physical and nonphysical factors impact
health, well-being, and disease. This interrelatedness of the
patient and their environment is at the heart of both primary
care and integrative medicine.
Introduction to Integrative Medicine in the Primary Care
Setting
Melinda Ring, Rupa Mahadevan
Integrative Medicine has been described as “healing oriented
medicine that takes account of the whole person (body, mind, and
spirit) including all aspects of lifestyle. It emphasizes
therapeutic relationships and makes use of all appropriate
therapies, both conventional and alternative.” National surveys
consistently report that approximately one-third of adults and
12% of children use complementary and integrative medicine
approaches. Although there are barriers to primary care
professionals engaging in discussions about lifestyle change and
complementary and integrative medicine options, there is also
great potential to impact patient well-being.
Phytotherapy: An Introduction to Herbal
Medicine
Charles C. Falzon, Anna Balabanova
Herbal medications are commonly used in all medical settings,
making it essential for primary care providers to learn about the
products being used and resources they can access for continuing
education. Understanding how herbal medicines are sourced,
processed, and standardized can help providers guide patients who
are trying to choose the most clinically effective and affordable
treatments. Multiple herbs are often combined and sold as
proprietary blends, which can increase the risk of allergies,
adverse reactions, or cross-reactivity with other pharmaceuticals
and supplements. Several textbooks, online point-of-care
resources, and conferences are available for primary care
providers to expand their knowledge of herbal medicines.
Integrative Medicine Strategies for Changing Health
Behaviors: Support for Primary Care
Ruth Q. Wolever, Karen L. Caldwell, Lindsey C. McKernan, Marni G.
Hillinger
Until system reforms allow adequate time and reimbursement for
primary care providers to focus on lifestyle change to prevent
and mitigate chronic disease, primary care providers need a
manageable, defined role to support lifestyle change. The authors
suggest this role is to serve as a catalyst, priming the patient
for change; educating and pointing the patient to appropriate,
evidence-based resources for additional guidance and hands-on
support; and providing ongoing encouragement throughout the long
journey of change while patients work more intensely with health
coaches or allied health providers.
Integrative Medicine for the Treatment of Persistent
Pain
Marni G. Hillinger, Ruth Q. Wolever, Lindsey C. McKernan, Roy
Elam
Integrative health modalities can provide useful tools in the
management of persistent pain in the primary care setting. These
modalities, such as acupuncture, mind-body medicine, diet and
herbs, and movement strategies can be safely used and may provide
patients with hope and empowerment. It is highly recommended that
the patient work alongside trained professionals for a given
modality and/or an interprofessional team.
Integrative Medicine for Gastrointestinal
Disease
Michelle L. Dossett, Ezra M. Cohen, Jonah Cohen
Gastrointestinal conditions are prevalent in the population and
account for significant morbidity and health care costs. Patients
with gastrointestinal conditions use integrative medicine. There
is growing evidence that integrative medicine approaches can
improve symptoms and affect physiology and disease course. This
article reviews data on some common and well-studied approaches,
including mind–body therapies, acupuncture, diet, probiotics, and
dietary supplements and herbs. Although clear recommendations can
be made for some conditions, in others there are challenges in
translating these findings owing to small study size, lack of
standardization, and trial heterogeneity.
Integrative Medicine and Mood, Emotions and Mental
Health
Anuj K. Shah, Roman Becicka, Mary R. Talen, Deborah Edberg,
Sreela Namboodiri
An integrative approach to individuals with mood, emotional or
mental health concerns involves a comprehensive model of care
that is person-centered. Integrative medicine builds on a
patient’s personal meaning and goals (spiritual aspects) and
includes herbal therapies, nutritional support, movement and
physical manipulative therapies, mindfulness, relaxation
strategies, and psychotherapies.
Complementary and Integrative Interventions for Chronic
Neurologic Conditions Encountered in the Primary Care
Office
Danny Bega
Chronic neurologic conditions are frequently managed in the
primary care setting, and patients with these conditions are
increasingly seeking nonconventional treatment options. This
article provides a review and summary of the evidence for some of
the most commonly studied and most frequently used complementary
and integrative interventions for 3 conditions managed every day
in primary care offices – diabetic neuropathy, migraine, and
dementia.
Restoring Balance for People with Cancer Through
Integrative Oncology
Judy A. Fulop, Ania Grimone, David Victorson
Integrative Oncology incorporates conventional and western cancer
treatment approaches with the best of ancient and traditional
medicine including nutrition, supplements, Qigong, herbal
medicine, mind-body practices, and more. This article offers a
guiding conceptual paradigm from an integrative perspective based
on the principles of balance and imbalance. An integrative
approach is used to help improve quality of life, enhance
lifestyle choices and mitigate symptoms and side effects from
conventional treatments. By supporting the patient’s mind, body
and spirit throughout the cancer treatment journey, the primary
care physician is in a key position to work with their patient’s
oncologist to provide supportive care and recommendations during
cancer treatment.
Pediatric Integrative Medicine
David K. Becker
The practice of pediatrics from an integrative framework is based
on physician-patient relationship, informed by evidence, and
approaches the health of children and their families from a broad
perspective. This article reviews the basic principles of
integrative pediatrics and summarizes data and integrative
approaches to common pediatric conditions seen in the primary
care setting.
Integrative Medicine and Cardiovascular
Disorders
Darshan Mehta
Integrative medicine (IM) has developed an increasingly
significant role in health care worldwide, including
cardiovascular diseases (CVD). This review describes the commonly
used IM in CVD, with particular attention placed with dietary
supplements and mind-body therapies. More rigorous research
continues to be needed to determine the mechanisms and efficacy
of IM cardiovascular morbidity and mortality. Health care
providers will need to develop skills in open communication and
nonjudgmental dialogue around IM use in discussing treatment
plans with their patients.
Women’s Health: Pregnancy and ConceptionReview
Article
Judith Cuneo
Preconception is an ideal time to assist women contemplating
pregnancy to modify health behaviors. Dietary needs in pregnancy
are critical and may require supplementation. The use of
mind-body medicine in the antenatal period assists patients in
childbirth preparation. Integrative medicine techniques can be
safely and effectively used for common third-trimester obstetric
complications of pregnancy.
Women’s Health: Polycystic Ovarian Syndrome, Menopause,
and Osteoporosis
Melinda Ring
Surveys consistently show that a significantly higher percentage
of women with chronic medical conditions report use of
complementary and integrative medicine (CIM) approaches compared
with men. A total of 54.5% of women report use of at least one
CIM approach specifically for obstetric or gynecologic problems.
However, primary care providers remain an underutilized resource
by patients for guidance in the safe and appropriate use of
integrative therapies. This article provides a practical overview
of the most appropriate integrative therapies to consider in the
management of commonly seen women’s health conditions: polycystic
ovarian syndrome, menopause, and osteoporosis.