1. So, What’s Integrative Medicine? Jeffrey P Schaefer MSc MD FRCPC March 28, 2008

2. Objectives  Introduce Integrative Medicine,  Describe CHR directions,  Encourage you to think broadly about health and illness.

3. What’s in a label?

4. Complementary & Alternative Medicine A broad domain of healing resources that encompass all health systems, modalities, and practices, and their accompanying theories and beliefs, other than those intrinsic to the politically dominant health system of a particular society or culture in a given historic period.  Complementary  modalities used with, but different from, mainstream medicine  Alternative  modalities not generally recognized by the medical community and used instead of standard treatments  not taught in schools of western medicine

5. Frequency of Use - CAM  n = 1,584 adults in South Carolina

6. CAM TherapyLife< 1 yr Any use complementary alternative medicine 52%44% Personal therapies (home remedies, herbal medicine, homeopathy, or vitamin therapy) 28%25% Relaxation techniques (including massage therapy, imagery, or visualization) 26%23% Chiropractors 21%9% Healing (including healers, spiritual healing, Native American healers, energy healing) 5%4% Commercial weight loss programs 5%3% Life-style diets 4% Self-help groups 3%2% Hypnosis or biofeedback 2%1%

7. Reasons for CAM No. CAM Us er s n= 15 48 To Stay Healty Why CAM Therapy Was Used To Treat a Specific Health Problem MSK or Neuro Psycho social Cardio- vascular & Endo Uro- genital GI Allergy & Resp Other Personal therapies62248%11%1%4%6%3%18%10% Relaxation47856%22%13%1% 5% Chiropractors33212%83%1%0% 1%2%0% Healing8760%8%6%3% 2%14% Weight loss programs8276%1% 21%0% 1% Life-style diet6785%3%0%10%0%2%0% Self-help4441%9%2% 0% 2%34% Hypnosis or biofeedback4142%5%12% 0%5%0%15% All other therapies CAM7823%27%1%9%10%14%9%6%  Stay Healthy, MSK & Neuro, CV & Endo, Urogenital, GI, Allergy & Resp

8. Demographic CharacteristicsLifetime Education Less than high school49% High school diploma47% Some college59% College graduate55% Family income Less than $15,00052% $15,000-$29,99953% $30,000-$49,99951% $50,000 and over60%  Age, Marital Status, Race, Gender (F>M – slight)

9. Satisfaction with CAM % Reporting CAM as Extremely or Very Effective % Having "Bad Experience" With CAM Therapy % Who Would Recommend CAM to Friends/Family Personal therapies (including home remedies, herbal medicine, homeopathy, or vitamin therapy) 62%4%88% Relaxation techniques (including massage therapy, imagery, or visualization) 64%2%92% Chiropractors 63%8%86% Healing (including healers, spiritual, healing, Native American healers, or energy healing) 79%3%89% Commercial weight loss programs 45%11%69% Life-style diets 72%7%82% Self-help groups 74%8%88% Any CAM use 63%5%88%

10. Physicians and CAM % Physicians Who Recommend ed CAM Use % Patients Who Told Provider of CAM Use % Physicians Unaware of Patient's CAM Use Personal therapies (including home remedies, herbal medicine, homeopathy, or vitamin therapy) 15%26%63% Relaxation techniques (including massage therapy, imagery, or visualization) 31%18%56% Chiropractors 25%34%50% Healing (including healers, spiritual, healing, Native American healers, or energy healing) 7%21%73% Commercial weight loss programs 17%33%56% Life-style diets 33%35%43% Self-help groups 33%43%38% Hypnosis or biofeedback 39%12%53% Any CAM use 24%26%57%

11. CAM - Canada Complementary and alternative medicine use among colorectal cancer patients in Alberta, Canada.  Tough SC, Johnston DW, Verhoef MJ, Arthur K, Bryant H.  n= 871 with colorectal cancer  d = Population-based questionnaire completed by 70% (pt or family of deceased)  49% used CAM since diagnosis  psychological and spiritual therapies (65%)  vitamins and minerals (46%)  herbs (42%)  68% informed their medical doctors  Altern Ther Health Med. 2002 Mar-Apr;8(2):54-6

12. So, What’s Integrative Medicine?  I.M. uses the combination of both conventional and alternative approaches to address the biological, psychological, social and spiritual aspects of health and illness.  It emphasizes respect for the human capacity for healing, the importance of the relationship between the practitioner and the patient, a collaborative approach to patient care among practitioners, and the practice of conventional, complementary, and alternative health care that is evidence-based.  UC-SF School of Medicine  Osher Centre for Integrative Medicine

13. Integrative Medicine  Holistic physical, mental, spiritual, social determinants of health  Evidence-based held to the same standard  No distinction traditional, alternative, complementary, folk…  Target focus on unique characteristics of the patient

15.  Alternative Medical Systems:  Complete systems of theory and practice e.g. Homeopathy, Ayurveda and TCM  Mind-Body Interventions:  Support groups (now considered conventional), cognitive therapy, meditation, visualization, art, music, dance therapy  Biologically Based Therapies:  Herbs, vitamins, foods and other dietary products.  Manipulative and Body-Based Methods:  Chiropractic, osteopathy and massage.  Energy Therapies:  Qi Gong, Therapeutic Touch, Reiki

17. Integrative Medicine – other attributes  emphasis on relationship-centered care  patient is active partner  prevention and maintenance of health  nutrition, exercise, stress-management, emotional wellness  provider as educator & mentor  use least invasive (& cost) method  remove barriers to healing  compassion is always helpful  collaboration with others in the health care team  cure sometimes, heal often, support always

18. Integrative Medicine  ‘Good’ Medicine  Dr. Andrew Weil  Harvard Medical School  Program Director of the Program in Integrative Medicine (PIM) at University of Arizona; started in 1994  patients do best utilizing both mainstream and alternative medicine  mainstream medicine well- suited to crisis intervention  alternative medicine is best utilized for prevention and health maintenance  IM is an intelligent combination of both

20. Regional History and Initiatives  Programs and Initiatives  Clinic for Mind-Body Medicine  Guided Imagery Program  Spirituality  Heart Math  Exploring Health and Healing Conference  Traditional Chinese Medicine

23. Spirituality quest for ultimate meaning, purpose, relationship, hope, and transcendence. Religion convictions & practices of a community of faith. Sacred concepts of God, the Devine, the Transcendent or Ultimate Reality. Health a balance of the physical, emotional, social, spiritual, and intellectual well-being. Dr. Chris Carruthers - Manager of Spirituality in Chronic Disease Management

27. Regional History and Initiatives  Institutional and Community Partnerships  University of Calgary  Mount Royal College  Canadian Institute of Natural & Integrative Medicine  Community and CHR Providers  Scripps Clinic

28. Elaine Danelesko

29.  9 – 10 am  Oct 19  Nov 30  Apr 4  May 9  Foothills Auditorium  Telehealth to RGH & PLC & Rural

31. Network or Distributed Model