Use of complementary medicine is substantial and growing in the US [1-3]. As use has grown, terminology has evolved. The term "unconventional therapies", used in the early 1990's, referred to therapies not used in academic health centers, not taught in medical schools and not reimbursed by major insurers. This term evolved to "complementary and alternative" medical therapies (CAM) which was adopted by the National Institutes of Health (NIH) in 1998 when it created the National Center for Complementary and Alternative Medicine (NCCAM). NIH NCCAM defines CAM as a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine." This definition has become problematic as therapies that were previously not part of conventional medicine are adopted into conventional settings such as teaching hospitals. For example, acupuncture has become routine in many pediatric pain treatment programs, as have biofeedback, hypnosis, guided imagery and music therapy [4]. Massage therapy is routinely used in neonatal settings [5]. Most major insurers reimburse for chiropractic services [6]. Therapies such as nutritional advice and advice about specific exercise may or may not be considered mainstream or complementary, depending on the content of the advice.
The formation of the Consortium of Academic Health Centers for Integrative Medicine (Consortium) in 2000 and the growing number of publications arising from the Cochrane Complementary Medicine Field (200 reviews as of 2006, accessed 8 January, 2007[7]) reflect the growing interest in integrating diverse therapies within the context of evidence-based comprehensive care at major academic medical centers. The Consortium defines integrative medicine as "the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare professionals and disciplines to achieve optimal health and healing." Thus, the issue has been reframed, not CAM versus mainstream, but an integrated approach to comprehensive care that incorporates evidence-based therapies within the context of patient-centered care. Some might argue that this approach has simply renamed the adoption of evidence-based complementary therapies or good medicine as integrative medicine[8]. For this paper, we will refer to therapies as "CAM" in accordance with the tradition of authors of referenced papers and to specific therapies whenever possible.
Interest in specific therapies and integrative medicine varies regionally and in different demographic and clinical populations. CAM usage is reportedly lower in the southeast than other parts of the US, but even here the prevalence of using complementary therapies among users of conventional medicine reportedly exceeds 40% of adults [9]. In North Carolina in 2006, three academic health centers, University of North Carolina at Chapel Hill (UNC), Duke University School of Medicine, and Wake Forest University School of Medicine (WFUSM), were among the 36 members of the Consortium who use the term "integrative medicine" to refer to evidence-based integration of diverse therapies into comprehensive care.
Specifically, at WFUSM the strong interest in integrative medicine has been reflected in its research activities, e.g., nearly $16 million in funded research and 97 peer-reviewed publications on these topics in 2005–2006 (personal communication, WFUSM Program for Holistic and Integrative Medicine, 7/25/06). Integrative medicine is also incorporated into teaching within the medical school and physician assistant (PA) program at WFUSM which include extensive training in patient-centered care, development of a therapeutic relationship and case-based teaching that includes questions about dietary supplements, special diets, massage, meditation, yoga, acupuncture, chiropractic and homeopathy within existing teaching cases.
Many studies have assessed clinician attitudes and referral practices about CAM [10-40], but most have focused on outpatient services and on services distinct from those usually provided in an academic medical center. Fewer have focused on attitudes within academic medical centers [15,25,39,41-43]. Despite strong academic interest and rising consumer demand, little is known about the interest among our medical staff in offering clinical services marketed as comprehensive or integrative medicine.
The purpose of this study was to assess the interest of practicing clinicians at WFUSM in developing or augmenting integrative health services within the medical center. Here integrative services refers to integration of services which may have existed within the medical center for but utilized variably by different clinicians in different specialties (e.g., nutrition); newer services (e.g. massage therapy); services currently available only within research settings (e.g., yoga and mindfulness-based stress reduction); and services that might be considered in the future (e.g., biofeedback, expert consultation on herbs and dietary supplements, acupuncture and chiropractic).
Answers to all your Biology Questions
