As integrative medicine purports to combine the best of both conventional medicine and CAM ( Baer & Coulter, 2008) there is still the matter of  the definition of what constitutes Integrative health care remaining elusive making it difficult to determine who are / are not practicing it. Integration can occur at different levels such as from patients combining various therapies to practitioners practicing different modalities, clinics offering a range of therapies and health care systems that facilitate the use of multiple treatment options (Hsio et al, 2006). This in itself throwing up a barrier to integration.

Some other barriers that have become evident are lack of understanding of each others disciplines, lack of communication, lack of confidence in knowing if or when to refer on  (and even who they should be referring on to), lack of focused research & evidence base and lack of funding.

Lack of understanding / lack of confidence.

A lack of understanding on both sides can pose as a barrier. If there was a general understanding of each others disciplines abilities and place within the health care of patients this would make such a difference. If resources were implemented to supply each other with information via leaflets, websites or even access to evidence gained through trials and published literature giving them a bank of information to refer to. I have included lack of confidence alongside, based on  thinking  where there is a lack of understanding of the other’s disciplines  there may be a lack of confidence in the respect of knowing if, when and who to refer patients / clients on to. Even to an extent when GP’s are open and have an understanding of CAM they may vary in terms of which CAM therapies they personally accept or reject and to which degree (Cohen et al, 2005).

Lack of communication.

The issue of communication can be seen not only between GP’s and CAM practitioners but also through patient / client and practitioner which brings further barriers to integration. Rachel Thorpe examines in ‘Integrating biomedical and CAM approaches: The experiences of people living with HIV / AIDS ‘ the perceptions of 18 individuals living with HIV / AIDS who are receiving Integrative medical care. The findings of this research showed that although the use of complementary therapies to be empowering in coping with the chronic condition the process of communicating with conventional physicians and complementary therapists cumbersome and at times exhausting (Baer & Coulter, 2008).

A way forward for the lack of communication between GP’S and CAM practitioners may be education. If training were to be implemented on both sides for the others disciplines. Hollenberg (2006) conducted research on two integrative health settings in Canada interviewing 13 conventional physicians and 8 CAM practitioners with findings including conventional physicians exerted their professional dominance in areas and relegating CAM practitioners to specific therapeutic tasks and using conventional jargon as the principle vehicle of  communication.  Conversely, Hollenberg’s (2006) research showed the adoption of  CAM therapists becoming more fluent in conventional medical jargon enhancing their professional status by working within the corridors of conventional medicine ( which personally I do not feel comfortable with as a CAM practitoner though another issue for another time.)

Lack of focus based research & evidence base.

Although CAM research and evidence base is increasing there is still a long way to go in the minds of the conventional medicine world. The state of evidence based practice in Complementary healthcare was recently discussed in the paper ‘Complementary and alternative medicine : between evidence and absurdity’ by Ernst (2009) suggesting that little research is carried out in this field due to lack of understanding as well as financial constraints. There is however a large amount of evidence within the CAM field & just because it has not been found by a RCT  (which may not always the best form of research) does not mean it is not worthy evidence.

Coulter and Willis (2007) note that most theories to date, even regarding the growth of CAM is highly speculative. It is also noted that the growth of CAM and integration into conventional medicine needs  not only  to explain why greater numbers of patients are choosing it but why both the state and private insurance companies are covering the costs. This exaggerates the need for a great deal of work to be carried out before having a coherent account of integration here.

Regulation within CAM may be a major key to providing a smoother integration of CAM within conventional health care ensuring a high standard of care delivered from practitioners with a good level of training / knowledge following codes of ethics and CPD.

Baer, A.H. & Coulter, I. (2008) ‘Introduction – Taking stock of integrative medicine : Broadening biomedicine or co – option of complementary and alternative medicine?’. Health Sociology Review Vol 17 (Issue 4) pp 331 – 340

Cohen, M.M, Penman, S., Pirotta, M., and Da Costa, C. (2005) ‘The integration of complementary therapies in Australian general practice : Results of a national survey’. Journal of Alternative and Complementary medicine. Vol 11, pp 995 – 1004

Coulter I.D and Willis, E., (2007) ‘Explaining the growth of complementary and alternative medicine’. Health Sociology Review Vol 16, pp214 – 225

Ersnt, E. (2009) ‘Complementary and alternative medicine : between evidence and absurdity’. Perspectives in Biology and Medicine Vol 52 , pp289 – 332

Hollenberg, D., (2006) ‘Uncharted ground : Patterns of professional interaction among complementary / alternative and biomedical practitioners in integrative health care settings’. Social Science and Medicine. Vol 62, pp 731 – 744

Hsaio, A, F., Ryan, G., Hays, R., Anderson, R., Wenger, N. (2006) ‘Variations in provider conceptions of integrative medicine’. Social science & Medicine Vol 62, pp 2973 – 2987

With the definition of what constitutes Integrative health care remaining elusive it makes determining who is / isn’t practicing it difficult. Integration can occur at different levels such as from patients combining various therapies to practitioners practicing different modalities, clinics offering a range of therapies and health care systems that facilitate the use of multiple treatment options (Hsio et al, 2006).

Integrated healthcare to me is having the availability and access to different modalities for all who need it. The most important factor being ‘the patient / client’  who should have an understanding  of what is available to them and have the opportunity to make an informed choice for their healthcare needs to allow a treatment plan to successfully address those needs.

I am unsure at the moment if I really want my therapy to be integrated into mainstream health care. I realise this would be no easy task and a complicated process where not every one is going to agree on or have  the same definition of Integrated health care which may raise some practical problems with for instance some GP’s becoming advocates whilst others being opposed (Russo, 2000).

Even though bearing in mind that homeopathy has resided within the NHS since establishment in 1948 with four homeopathic hospitals with figures from the British Homeopathic Association showing these hospitals were treating 55,000 NHS patients a year at an annual cost of 6 million.

I personally believe that it may be a good move forward in some respects yet a bad move in others. For example in a good way the provision of  therapies within one setting would benefit clients / patients preventing them from having to ‘to &  fro’ between clinics yet on the other hand it may come down to only the people that have money being able to use the services (Thomas et al, 2001) (also with insurance companies for example refusing to cover the cost of CAM), which is a bug bear of mine as unfortunately many people who really need / could benefit greatly from this will lose out simply because of financial status.

Returning the Soul to medicine – a vision of Integrated General practice in the 21st Century prepared by Dr Michael Dixon (2008) promotes a culture of health and wellbeing with people and communities taking more responsibility for their own health and in which health professionals collaborate and share learning in the best interests of the patient.

Audits have been carried out  in the past to see how integration of Conventional medicine & CAM may work. For example the Somerset Trust for Integrated Health ran a three year experiment in the use of Complementary medicine in general practice which showed that it is widely welcomed by patients, appeared to have effectiveness in a wide range of health problems and led to less demand on other health care providers. However, even though funding of such a service did appear difficult in this study evidence proved that it was at least cost neutral on account of savings made elsewhere and at best cost effective. It was also found to be demanding on administrative time with demand for the service out stripping supply leading to a build up in waiting lists.

The Complementary health service in this study was continued but with the funding from patient donations and outside grants. Although evidence base is beginning to evolve this study showed that the evidence of clinical trials undertaken was limited and GP’s relied heavily on the experience of their colleagues and patients (Reilly & Taylor, 1993) or on audit type trials such as this one (Lewith & Davies, 1996).

So possibly the answer is not a marriage between Conventional and CAM in the sense of integration of both in primary health care but the need for working in separate practices yet  all to be educated in understanding the others disiplines and communicate well with each other to enable them to successfully inform patients / clients during referrals. I am sure however as I carry on through this module my points of view will change, change back then change again…

Boon, H., Verhoef, M., O’Hara, D., Findlay, B., Majid, N. (2004) ‘Integrative healthcare : Arriving at a working definition’. Alternative Ther Health Med \vol 10, pp 48 – 56

British Homeopathic Association. NHS referrals to homeopathy, 2009. http://www.trusthomeopathy.org/media_centre/facts_about_homeopathy/nhs_referrals_html

Dixon, M. (2008) Returning the Soul to Medicine – a vision of integrated General Practice in the 21st Century. The Prince’s Foundation for Integrated Health.

Hsaio, A, F., Ryan, G., Hays, R., Anderson, R., Wenger, N. (2006) ‘Variations in provider conceptions of integrative medicine’. Social science & Medicine Vol 62, pp 2973 – 2987

Lewith, G. and Davies, P. (1996) ‘Complementary Medicine: The Need for Audit’. Complementary Therapies In Medicine Vol 4, pp. 223-236

Reilly, D. and Taylor, M. (1993) Developing Integrated Medicine, Report of The RCCM Research Fellowship in Complementary Medicine: Churchill Livingstone

Russo, H., (2000) Integrated Healthcare : A Guide to good Practice. The Foundation for Integrated Medicine, London.

Thomas, K. (2001)  ‘Use & expenditure on complementary medicine in England : a population based survey’.  Complementary Therapies in Medicine. Vol 9, pp 2 -11