Date of Defense:
April 1, 2016
The use of complementary and alternative medicine (CAM) has become increasingly popular in the United States, and is anticipated to keep growing. A surge in patient interest and use of these modalities has led the research and medical communities to question the possible benefits, safety concerns, and application to current systems of care. It is common to see multiple terms used to reference this field of medicine, including “complementary”, “alternative”, and “integrative” medicine. The first two refer to any non-mainstream practice used together with conventional medicine, or used in place of conventional medicine, respectively (NCCIH, 2015). “Integrative medicine” (IM) refers to the use of evidence-based complementary and prevailing approaches in a coordinated way, and often emphasizes patient satisfaction and the patient-provider relationship (Ventola, 2010; NCCIH, 2015). In 2012, 34% of adults in the US used any complementary health approach; the age group using these approaches the most were 18-44 (Clarke et al, 2015).
For my field experience I worked as a student researcher with the Integrative Health Research Center (IHRC), a branch of the Penny George Institute for Health and Healing (PGIHH), for the months of June through August, 2015. My primary responsibility was to recruit patients from the PGIHH outpatient clinic into the Patients Receiving Integrative Medicine Interventions Effectiveness Registry (PRIMIER) study. My contributions to the study included data entry and monitoring, patient interactions, and some administrative tasks as needed. I took on additional tasks due to the temporary absence of the study coordinator during this time.
The learning objectives for the Field Experience were to: 1) Gain experience in methods of research, specifically those used for complementary and integrative health; 2) Explore different uses of integrative health for specific populations, especially those that are applicable to the Maternal and Child Health (MCH) population; 3) Understand the administrative and organizational framework of a large healthcare organization and the effect on specific populations; 4) Explore and apply methods of working effectively with patients and specific populations within the community; and 5) Understand the qualifications and duties of members of a research team. I successfully met all objectives.
Each day I would pull a list of patients scheduled for appointments in the PGIHH clinic located on the Abbott Northwestern hospital campus. I would check scheduled patients against a list of those already enrolled in the study and a list of those who had refused in the past. These lists were managed in REDcap and Excel. The majority of my time was spent in the PGIHH lobby, where I approached patients while they were waiting for their appointment. During each interaction I would explain the purpose of the PRIMIER study, the potential benefits, the survey process, and then ask them to register. If the patient agreed to enroll in the study I had electronic (iPad) and paper intake surveys on site, and informational fliers with registration instructions. At the end of the day I would update lists of how many patients I had approached with information, and who had refused or asked not to be contacted. If paper surveys were returned I could manually enter these into the REDcap database. All of these tasks were also completed by another student, who came to the office on opposite days than I did. At the end of the summer we met to compare experiences and compile guidelines for future students who would be doing the data collection process. During my time working with the IHRC, we had the highest patient recruitment of the 14 participating PRIMIER clinics that summer!
Because of my interests in MCH and healthy pregnancies my supervisors also assigned me the task of completing a literature search on IM use in the mother-baby population. A current student worker with IHRC, Caleb, had started this search just before leaving for the summer; I used his template as a starting point. I had multiple meetings with a Mother-Baby holistic nurse, Kathy Kerber, to learn about the goals of the literature search and plans for a secondary data analysis stemming from what we found or what was missing in the current research. I focused on the antenatal population and preterm labor/delivery because we do know that for each additional day in utero, newborn survival rates and outcomes improve significantly (Finnstrom, 1997). I maintained a final spreadsheet of articles and summaries resulting from my search of the literature and gave this to Caleb and Kathy at the end of my IHRC field experience.
PGIHH is the largest integrative health center embedded in a health system in the country, and was founded in 2003 (Allina Health, 2016). The IHRC began in 2007, and its mission is to identify clinical conditions in which integrative interventions enhance care, and address the clinical and cost effectiveness of integrative inpatient and outpatient therapies (Allina Health, 2016). The main outcome of the PRIMIER study is to create a robust dataset for researchers to compare the impact of various integrative therapies on patient reported and clinical outcomes; my work of recruiting patients contributed to this outcome, which aligns with the IHRC mission.
Lessons Learned / Recommendations
The field of IM has ancient roots from many of the traditional and holistic modalities used, but it is not yet widely accepted in Western health care settings. There are many potential benefits to individuals, practitioners, the public and our medical care systems from the increased use and understanding of IM, especially in the mother-baby population. Increased focus on research is key, however, to informing best practices and safe utilization in health care systems. Increased demand from patients will also pose a significant challenge to these systems as they shift current operations to handle capacity, meet patient needs, and make IM a more regular part of the care process.
Much of the current research on IM has been limited due to small sample sizes and retroactive and/or observational data. Approaching IM research is complex, and requires a strong, multi-disciplinary team. Having an entire center of researchers embedded in a health care system works very well, and thus studies like PRIMIER are promising and will likely contribute a wealth of much needed evidence to the field. Such studies require an immense amount of resources, time, and coordination.
Recommendations for the IHRC, similar organizations, and MPH programs:
- Continue and/or develop large, prospective, longitudinal studies to examine the relationship between IM and patient health outcomes. Include both quantitative and qualitative methods.
- Examine the potential benefits of IM modalities for the antenatal mother-baby population, specifically for effects on preterm labor and delivery, to fill a gap in the research.
- The University’s MPH/MCH program should strengthen their partnership with Center for Spirituality, and facilitate student’s education on, and experiences in IM.
The use of Integrative Medicine continues to increase in the general public, and has many potential heath-related benefits. Understanding of safety, uses, and benefits are at present limited and should be bolstered by an increased focus on research and patient experiences. An important group that garners particular attention is the mother-baby population where a noticeable gap in literature exists for the antenatal population. Studies such as PRIMIER, and teams such as the IHRC, are making necessary and much needed valuable leaps in the field of Integrative Medicine research.
Allina Health. (2016). Penny George™ Institute for Health and Healing: About Us. Retrieved from: http://www.allinahealth.org/Penny-George-Institute-for-Health-and-Healing/About-us/
Allina Health. (2016). Integrative Health Research Center. Retrieved from: http://www.allinahealth.org/Penny-George-Institute-for-Health-and-Healing/Research/
Clarke, T. C., Black, L. I., Barbara J. Stussman, B. J., Patricia M. Barnes, P. M., and Nahin, R. L. (February 2015). Trends in the Use of Complementary Health Approaches Among Adults: United States, 2002–2012. National Health Statistics Reports, 79. Retrieved from: http://www.cdc.gov/nchs/data/nhsr/nhsr079.pdf
Finnström, O., Olausson, P. O., Sedin, G., Serenius, F., Svenningsen, N., Thiringer, K., et al. (1997). The swedish national prospective study on extremely low birthweight (ELBW) infants. incidence, mortality, morbidity and survival in relation to level of care. Acta Pædiatrica, 86(5), 503-511. doi:10.1111/j.1651-2227.1997.tb08921.x
McCaffrey, A. M., Pugh, G. F., & O’Connor, B. B. (2007). Understanding Patient Preference for Integrative Medical Care: Results from Patient Focus Groups. Journal of General Internal Medicine, 22(11), 1500–1505. http://doi.org/10.1007/s11606-007-0302-5
National Center for Complementary and Integrative Health (NCCIH). (March 2015). Complementary, Alternative, or Integrative Health: What’s In a Name? Retrieved from: https://nccih.nih.gov/health/integrative-health
Ventola, C. L. (2010). Current Issues Regarding Complementary and Alternative Medicine (CAM) in the United States: Part 1: The Widespread Use of CAM and the Need for Better-Informed Health Care Professionals to Provide Patient Counseling. Pharmacy and Therapeutics, 35(8), 461–468.