Complementary And Alternative Medicine Practitioners Research Articles

Integrated medicine in the management of chronic illness: a qualitative study.

Complementary and alternative medicine (CAM) is popular with patients, yet how patients use CAM in relation to orthodox medicine (OM) is poorly understood. To explore how patients integrate CAM and OM when self-managing chronic illness. Qualitative analysis of interviews. Semi-structured interviews were conducted with individuals attending private CAM practices in the UK, who had had a chronic benign condition for 12 months and were using CAM alongside OM for more than 3 months. Patients were selected to create a maximum variation sample. The interviews were analysed using framework analysis. Thirty five patient interviews were conducted and seven categories of use were identified: using CAM to facilitate OM use; using OM to support long-term CAM use; using CAM to reduce OM; using CAM to avoid OM; using CAM to replace OM; maximising relief using both CAM and OM; and returning to OM. Participants described initiating CAM use following a perceived lack of suitable orthodox treatment. Participants rejecting OM for a specific condition never totally rejected OM in favour of CAM. Patients utilise CAM and OM in identifiably different ways, individualising and integrating both approaches to manage their chronic conditions. To support patients and prevent potential adverse interactions, open dialogue between patients, OM practitioners, and CAM practitioners must be improved.

Integrative Pediatric Care: Parents' Attitudes Toward Communication of Physicians and CAM Practitioners

In this study, we explored parents' perspectives toward complementary and alternative medicine (CAM) use by their children and its impact on parent-doctor and doctor-CAM-practitioner communication. We designed a 2-arm study of parents who approached either conventional primary care or CAM clinics with their children to consult physicians or practitioners regarding their child's health. A total of 599 parents responded to our questionnaire (319 in 5 conventional clinics [83.9% response rate] and 280 in 21 CAM clinics [71.2% response rate]). Parents in conventional clinics reported less use of CAM by their children within the previous year (35.3% vs 73.7%; P < .0001) but used more traditional and homemade remedies (46.4% vs 12.7%; P < .0001). Both parent groups largely supported informing their child's physician regarding CAM use and expected the physician to initiate a CAM-related conversation and to refer their child to a CAM practitioner. The 2 groups' respondents largely supported communication between the child's physician and the CAM practitioner by the use of a referral/medical letter. Compared with respondents in CAM clinics, parents in conventional clinics were more supportive of CAM integration in a pediatric primary care setting and envisioned a more dominant role of physicians regarding CAM referral and a significant role of physicians in providing CAM. Parents who are referred to conventional and CAM clinics express distinctive attitudes toward CAM integration in pediatric care. Parents perceive physician-CAM practitioner communication as highly important and instrumental in promoting their children's health and safety.

The Use of Intuition in Homeopathic Clinical Decision Making: An Interpretative Phenomenological Study

While intuition plays a role in clinical decision making within conventional medicine, little is understood about its use in complementary and alternative medicine (CAM). The aim of this qualitative study was to investigate intuition from the perspective of homeopathic practitioners; its' manifestation, how it was recognized, its origins and when it was used within daily clinical practice. Semi-structured interviews were carried out with clinically experienced non-National Health Service (NHS) UK homeopathic practitioners. Interpretative phenomenological analysis was used to analyze the data. Homeopaths reported many similarities with conventional medical practitioner regarding the nature, perceived origin and manifestation of their intuitions in clinical practice. Intuition was used in two key aspects of the consultation: (i) to enhance the practitioner-patient relationship, these were generally trusted; and (ii) intuitions relating to the prescribing decision. Homeopaths were cautious about these latter intuitions, testing any intuitive thoughts through deductive reasoning before accepting them. Their reluctance is not surprising given the consequences for patient care, but we propose this also reflects homeopaths' sensitivity to the academic and medical mistrust of both homeopathy and intuition. This study is the first to explore the use of intuition in decision making in any form of complementary medicine. The similarities with conventional practitioners may provide confidence in validating intuition as a legitimate part of the decision making process for these specific practitioners. Further work is needed to elucidate if these findings reflect intuitive use in clinical practice of other CAM practitioners in both private and NHS (i.e., time limited) settings.

Touching ethics: Assessing the applicability of ethical rules for safe touch in CAM—Outcomes of a CAM (Complementary and Alternative Medicine) practitioner survey in Israel

Recently, ethical guidelines regarding safe touch in CAM were developed in Israel. Publishing ethical codes does not imply that they will actually help practitioners to meet ethical care standards. The effectiveness of ethical rules depends on familiarity with the code and its content. In addition, critical self-examination of the code by individual members of the profession is required to reflect on the moral commitments encompassed in the code. For the purpose of dynamic self-appraisal, we devised a survey to assess how CAM practitioners view the suggested ethical guidelines for safe touch. We surveyed 781 CAM practitioners regarding their perspectives on the safe-touch code. There was a high level of agreement with general statements regarding ethics pertaining to safe touch with a mean rate of agreement of 4.61 out of a maximum of 5. Practitioners concurred substantially with practice guidelines for appropriate touch with a mean rate of agreement of 4.16 out of a maximum of 5. Attitudes toward the necessity to touch intimate areas for treatment purposes varied with 78.6% of respondents strongly disagreeing with any notion of need to touch intimate areas during treatment. 7.9% neither disagreed nor agreed, 7.9% slightly agreed, and 7.6% strongly agreed with the need for touching intimate areas during treatment. There was a direct correlation between disagreement with touching intimate areas for therapeutic purposes and agreement with general statements regarding ethics of safe touch (Spearman r=0.177, p<0.0001), and practice guidelines for appropriate touch (r=0.092, p=0.012). A substantial number of practitioners agreed with the code, although some findings regarding the need to touch intimate area during treatments were disturbing. Our findings can serve as a basis for ethical code development and implementation, as well as for educating CAM practitioners on the ethics of touch.

Interprofessional collaboration within integrative healthcare clinics through the lens of the relationship-centered care model

Teamwork is a contemporary way to try to improve the healthcare system, not only for the patients but also for the practitioners involved. A new type of interprofessional working arrangement, integrative healthcare (IHC) clinics, has emerged in the last two decades. The literature on interprofessional collaboration is steadily increasing, but little is known about the collaborative organization of the biomedical and complementary and alternative medicine (CAM) practitioners that make up the teams in these clinics. The relationship-centered care model was used to guide an exploration of the interprofessional teamwork within a Canadian IHC setting. A sample of 31 IHC clinics and 228 biomedical and CAM practitioners were included. Eighty-nine questionnaires were returned from 25 clinics, representing a 62% practitioner response rate (within clinic responders). This study established that within the analytical model, practitioners behaviors and skills are the main factors associated with job satisfaction and inter-practitioner conflicts in interprofessional IHC practice. The results of the study also suggested the importance of interprofessional exposure for healthcare practitioners who are being expected to serve a clientele that is increasingly interested in being both cured and healed by the integration of biomedical and CAM paradigms and approaches.

Adverse events associated with the use of complementary and alternative medicine in children

ObjectiveTo determine the types of adverse events associated with the use of complementary and alternative medicine (CAM) that come to the attention of Australian paediatricians.DesignMonthly active surveillance study of CAM-associated...

Families’ visits to practitioners of complementary and alternative medicine in a total population (the HUNT studies)

To investigate characteristics of families with adolescent children who have visited practitioners of complementary and alternative medicine (CAM). The Nord-Trøndelag Health Studies (HUNT) invited all inhabitants aged 13 years and older to a population-based study. The data of parents and adolescents were merged through the Norwegian family register. A family CAM visitor was a family where either the adolescent or the mother or father had visited a CAM practitioner in the previous year. The data were analyzed using multivariable logistic regression. A total of 7,888 adolescents with mother and/or fathers were included. The prevalence of families visiting CAM practitioners was 19.8%. The odds of a family visiting a CAM practitioner was significantly associated (p < 0.01) with a father with poor self-reported global health (adjusted odds ratio (adjOR) 3.0, 95% confidence interval (95% CI) 1.7-5.3), who exercised (adjOR 1.3, 1.1-1.5) or smoked daily (adjOR 0.7, 0.6-0.8). Family CAM visits were also associated with the mother having a recent health complaint (adjOR 1.4, 1.1-1.7) or having fair global health (adjOR 1.6, 1.2-2.0), or with the adolescent, mother or father having visited a general practitioner during the past year (adolescent adjOR 1.3, 1.2-1.5; mother 1.7, 1.5-2.0; father 1.4, 1.2-1.6). For family visits to a homeopath, the strongest association was the mother having visited a general practitioner (adjOR 1.9, 1.4-2.5). For visits to chiropractors the strongest association was whether the father was currently working (adjOR 2.1, 1.2-3.8). The factor most strongly associated with families' visits to CAM practitioners was a father who had poor self-reported health.

Interprofessional Collaborations in Integrative Medicine

Little is known about the implementation of integrative medicine (IM) in Australian health care and the nature of interprofessional collaborations that have been established in IM. The aim of this research was to examine the relationships among general medical practitioners (GPs) and complementary and alternative medicine (CAM) practitioners and their respective roles in co-located integrative practices. This research adopted hermeneutic phenomenology as an effective methodology for revealing people's experiences of IM and the meanings they attached to these experiences. Three (3) data collection methods were used: cumulative case studies, focus groups, and key informant interviews. Data analysis consisted of constant comparison of data from multiple sources to identify patterns and meta-themes. The setting for this research was Australian IM clinics where GPs and CAM practitioners were co-located. Three (3) practice styles were identified among IM practitioners in this research: (1) mutually empowering when GPs and CAM practitioners regarded each other as peers, (2) GP-directed with varying levels of autonomy afforded CAM practitioners, and (3) limited collaboration where patients were offered mainstream medicine and CAM, which GPs performed themselves. IM practice styles differed in terms of interprofessional power-sharing and roles assigned to CAM practitioners. Practice styles where CAM practitioners were highly valued and able to exercise high levels of professional autonomy were perceived as making effective use of the available CAM workforce. Both GP-directed and intragrative practice styles (where GPs practiced CAM themselves without referral to CAM practitioners) were perceived by many GPs and CAM practitioners as enhancing patient safety.

Integration of complementary and alternative medicine into family practices in Germany: results of a national survey.

More than two-thirds of patients in Germany use complementary and alternative medicine (CAM) provided either by physicians or non-medical practitioners (“Heilpraktiker”). There is little information about the number of family physicians (FPs) providing CAM. Given the widespread public interest in the use of CAM, this study aimed to ascertain the use of and attitude toward CAM among FPs in Germany. A postal questionnaire developed based on qualitatively derived data was sent to 3000 randomly selected FPs in Germany. A reminder letter including a postcard (containing a single question about CAM use in practice and reasons for non-particpation in the survey) was sent to all FPs who had not returned the questionnaire. Of the 3000 FPs, 1027 (34%) returned the questionnaire and 444 (15%) returned the postcard. Altogether, 886 of the 1471 responding FPs (60%) reported using CAM in their practice. A positive attitude toward CAM was indicated by 503 FPs (55%), a rather negative attitude by 127 FPs (14%). Chirotherapy, relaxation and neural therapy were rated as most beneficial CAM therapies by FPs, whereas neural therapy, phytotherapy and acupuncture were the most commonly used therapies in German family practices. This survey clearly demonstrates that CAM is highly valued by many FPs and is already making a substantial contribution to first-contact primary care in Germany. Therefore, education and research about CAM should be increased. Furthermore, with the provision of CAM by FPs, the role of non-medical CAM practitioners within the German healthcare system is to be questioned.

Use of complementary and alternative medicine by those with a chronic disease and the general population - results of a national population based survey

BackgroundThe use of complementary and alternative medicine (CAM) is becoming more common, but population-based descriptions of its patterns of use are lacking. This study aimed to determine the prevalence of CAM use in the general population and for those with asthma, diabetes, epilepsy and migraine.MethodsData from cycles 1.1, 2.1 and 3.1 of the Canadian Community Health Survey (CCHS) were used for the study. The CCHS is a national cross-sectional survey administered to 400,055 Canadians aged ≥12 between 2001-2005. Self-reported information about professionally diagnosed health conditions was elicited. CCHS surveys use a multistage stratified cluster design to randomly select a representative sample of Canadian household residents. Descriptive data on the utilization of CAM services was calculated and logistic regression was used to determine what sociodemographic factors predict CAM use.ResultsWeighted estimates show that 12.4% (95% Confidence Interval (CI): 12.2-12.5) of Canadians visited a CAM practitioner in the year they were surveyed; this rate was significantly higher for those with asthma 15.1% (95% CI: 14.5-15.7) and migraine 19.0% (95% CI: 18.4-19.6), and significantly lower for those with diabetes 8.0% (95% CI: 7.4-8.6) while the rate in those with epilepsy (10.3%, 95% CI: 8.4-12.2) was not significantly different from the general population.ConclusionA large proportion of Canadians use CAM services. Physicians should be aware that their patients may be accessing other services and should be prepared to ask and answer questions about the risks and benefits of CAM services in conjunction with standard medical care.

Practitioners' validation of framework of team-oriented practice models in integrative health care: a mixed methods study

BackgroundBiomedical and Complementary and Alternative Medicine (CAM) academic and clinical communities have yet to arrive at a common understanding of what Integrative healthcare (IHC) is and how it is practiced. The Models of Team Health Care Practice (MTHP) framework is a conceptual representation of seven possible practice models of health care within which teams of practitioners could elect to practice IHC, from an organizational perspective. The models range from parallel practice at one end to integrative practice at the other end. Models differ theoretically, based on a series of hypotheses. To date, this framework has not been empirically validated. This paper aims to test nine hypotheses in an attempt to validate the MTHP framework.MethodsSecondary analysis of two studies carried out by the same research team was conducted, using a mixed methods approach. Data were collected from both biomedical and CAM practitioners working in Canadian IHC clinics. The secondary analysis is based on 21 participants in the qualitative study and 87 in the quantitative study.ResultsWe identified three groups among the initial seven models in the MTHP framework. Differences between practitioners working in different practice models were found chiefly between those who thought that their clinics represented an integrative model, versus those who perceived their clinics to represent a parallel or consultative model. Of the scales used in the analysis, only the process of information sharing varied significantly across all three groups of models.ConclusionsThe MTHP framework should be used with caution to guide the evaluation of the impact of team-oriented practice models on both subjective and objective outcomes of IHC. Groups of models may be more useful, because clinics may not "fit" under a single model when more than one model of collaboration occurs at a single site. The addition of a hypothesis regarding power relationships between practitioners should be considered. Further validation is required so that integrative practice models are well described with appropriate terminology, thus facilitating the work of health care practitioners, managers, policy makers and researchers.

Use of complementary and alternative therapy by women in the first 2 years after diagnosis and treatment of invasive breast cancer

Our aim was to document patterns of consultation with alternative practitioners, use of complementary and alternative medicine (CAM) commonly used to alleviate menopausal symptoms, and lifestyle changes made by women in the first 2 years after their diagnosis with invasive breast cancer. A total of 1,588 women in the MBF Foundation Health and Wellbeing After Breast Cancer Study completed both the enrollment questionnaire and the first follow-up questionnaire (FQ1), on average, 41 and 92 weeks after diagnosis, respectively. The Menopause Quality of Life Questionnaire and the Psychological General Wellbeing Index were included in the FQ1. Logistic regression analysis was used to examine characteristics associated with consulting a CAM practitioner or using CAMs. At the time of completion of the FQ1, 16.4% of women had consulted a CAM practitioner and 10.6% reported using at least one CAM commonly used to alleviate menopausal symptoms. Women who consulted a CAM practitioner and women who were using at least one CAM at the time of completion of the FQ1 were, on average, younger and more educated and had a higher Menopause Quality of Life Questionnaire score than did women who did not. Of the women, 33.6% reported having made a dietary change, and the most common lifestyle change was an increase in physical activity, which was reported by 29.0% of women. The frequency of use of CAMs in common usage for menopausal symptoms by women with breast cancer was lower than anticipated, increased with time from diagnosis, and is associated with more severe menopausal symptoms.

Complementary and alternative medicine in the management of hypertension in an urban Nigerian community

BackgroundHypertension is a common non communicable condition worldwide. In developing countries (including Nigeria), the use of complementary and alternative medicine (CAM) is common. This study investigated the frequency and factors associated with use of CAM among hypertensive subjects in an urban Nigerian community. Perspectives about the management of hypertension were obtained from CAM practitioners in the community.MethodsFour hundred and forty hypertensive subjects in Idikan community, Ibadan, were interviewed using a semi-structured survey instrument. Association between categorical variables was tested using the chi-square test. Logistic regression analysis was done to identify independent predictor variables of CAM use, with CAM use as the outcome variable and the demographic and belief items as predictor variables. In-depth interviews were conducted with all known CAM practitioners in the community on issues relating to their beliefs, knowledge, practice and experiences in managing patients with hypertension in the community.ResultsIn the study sample, 29% used CAM in the management of their hypertension. Among those using CAM, the most common forms used were herbs (63%) and garlic (21%). Logistic regression analysis revealed that four variables were independent predictors of CAM use: being male (OR 2.58, p < 0.0001), belief in supernatural causes of hypertension (OR 2.11, p = 0.012), lack of belief that hypertension is preventable (OR 0.57, p = 0.014) and having a family history of hypertension (OR1.78, p = 0.042). Other factors such as age, educational level and occupation were not independent predictors of CAM use. Interviews with CAM practitioners revealed that they believed hypertension was caused by evil forces, stress or "too much blood in the body". They also thought they could cure hypertension but that reduced costs (compared to hospitals) was one of the reasons most of their clients consult them.ConclusionsThe use of CAM is common among hypertensive subjects in this urban Nigerian community. Men were more than twice as likely to use CAM and belief in supernatural causes of hypertension was the most notable belief predicting CAM use. Interviews with CAM practitioners yielded useful perspectives about the role they play in hypertension management in the community. This study adds to the small but growing literature about the use of CAM in hypertension in sub Saharan Africa. Further studies in hypertension and other non communicable disease are needed.

My body, my life, my choice: practices and meanings of complementary and alternative medicine among a sample of Australian people living with HIV/AIDS and their practitioners

In this study we examine the sociocultural meaning and use of complementary and alternative medicine (CAM) by nine people living with HIV/AIDS (PLWHA) and four CAM practitioners. Analysis revealed five themes: focus on health not illness; resistance to antiretroviral therapy and adherence; allopathic medicine as narrow; difficulty disclosing to doctors; and a continuum of CAM that sometimes included conventional medicine and sometimes excluded it entirely. Literature on PLWHA in the West commonly describes them as sophisticated health consumers. We explore the concepts of individual responsibility in relation to health, holism, control and well-being in the context of CAM. We also consider the meaning and significance of CAM and western medicine to comment on the contemporary experience of HIV, including the possible impact of stigma and the perceived limits of allopathic medicine among some PLWHA. Understanding this will enable better insight into the treatment choices of PLWHA, particularly those who may be described as sceptical of conventional medical science.

Practice patterns of doctors of chiropractic with a pediatric diplomate: a cross-sectional survey

BackgroundComplementary and alternative medicine (CAM) is growing in popularity, especially within the pediatric population. Research on CAM practitioners and their specialties, such as pediatrics, is lacking. Within the chiropractic profession, pediatrics is one of the most recently established post-graduate specialty programs. This paper describes the demographic and practice characteristics of doctors of chiropractic with a pediatric diplomate.Methods218 chiropractors with a pediatric diplomate were invited to complete our survey using either web-based or mailed paper survey methods. Practitioner demographics, practice characteristics, treatment procedures, referral patterns, and patient characteristics were queried with a survey created with the online survey tool, SurveyMonkey©®.ResultsA total of 135 chiropractors responded (62.2% response rate); they were predominantly female (74%) and white (93%). Techniques most commonly used were Diversified, Activator ®, and Thompson with the addition of cranial and extremity manipulation to their chiropractic treatments. Adjunctive therapies commonly provided to patients included recommendations for activities of daily living, corrective or therapeutic exercise, ice pack\\cryotherapy, and nutritional counseling. Thirty eight percent of respondents' patients were private pay and 23% had private insurance that was not managed care. Pediatrics represented 31% of the survey respondents' patients. Chiropractors also reported 63% of their work time devoted to direct patient care. Health conditions reportedly treated within the pediatric population included back or neck pain, asthma, birth trauma, colic, constipation, ear infection, head or chest cold, and upper respiratory infections. Referrals made to or from these chiropractors were uncommon.ConclusionsThis mixed mode survey identified similarities and differences between doctors of chiropractic with a pediatric diplomate to other surveys of doctors of chiropractic, CAM professionals, and pediatric healthcare providers. The pediatric diplomate certificate was established in 1993 and provides didactic education over a 2 to 3 year span. The results of this study can be used for historical information as this specialty continues to grow.

Barriers to patient referral for Complementary and Alternative Medicines and its implications on interventions

To study the perceptions of Complementary and Alternative Medicine (CAM) among healthcare professionals and identify factors associated with referral for CAM treatment. An anonymous, self-administered survey was conducted in April 2008. All doctors, registered nurses, physiotherapists and occupational therapists in Tan Tock Seng Hospital were invited to participate. Data were analysed using SPSS v15. The overall response rate was 61.9%. Most respondents perceived their knowledge of CAM to be limited and had little personal experiences with CAM. Few had referred a small percentage of their patients for CAM therapies. Nonetheless, 62.2% of respondents believed that CAM would be safe when practiced by trained professionals and only 6.5% agreed that physicians should warn patients against CAM. Respondents who did not refer patients for CAM therapy cited lack of personal knowledge on the subject (53.4%); not knowing a suitable CAM practitioner (29.0%); and not thinking it was necessary (14.6%). The key reasons for referring were patients' preferences (58.0%); efficacy of CAM for specific conditions (39.1%); and when other treatment modalities were unsuccessful (21.9%). Most respondents (82.7%) had favourable attitudes and expressed interest in attending CAM seminars. The majority of western-trained healthcare professionals perceived their knowledge of CAM to be low. Most referrals to CAM were made because their patients believed in CAM. Limited personal knowledge and experiences were associated with lower referrals. However, they were interested to know about the common CAM modalities. This suggests the need for more CAM education interventions for healthcare professionals.

Factors That Influence Practitioners' Interpretations of Evidence From Alternative Medicine Trials

Clinical trial evidence in controversial areas such as complementary and alternative medicine (CAM) must be approached with an open mind. To determine what factors may influence practitioners' interpretation of evidence from CAM trials. In a mailed survey of 2400 US CAM and conventional medicine practitioners we included 2 hypothetical factorial vignettes of positive and negative research results for CAM clinical trials. Vignettes contained randomly varied journal (Annals of Internal Medicine vs. Journal of Complementary and Alternative Medicine) and CAM treatment type (acupuncture, massage, glucosamine, meditation, and reiki). Response items also included randomly varied patient circumstances-chronic refractory symptoms and the patient requesting CAM. All practitioners rated the effectiveness and their willingness to recommend the therapy for a described patient. We used logistic regression to determine the independent influence of the 4 factors on respondents' effectiveness and legitimacy judgments. A total of 1561 practitioners responded (65%). Relative to Reiki, conventional medicine practitioners were most willing to recommend glucosamine (OR = 3.0; 95% CI [1.6-5.4]), than massage (1.9 [1.1-3.3]), acupuncture (1.3 [0.8-2.2]), and meditation (1.2 [0.7-2.0]). CAM practitioners rated acupuncture as effective more than other CAM therapies (OR = 5.8 [2.6-12.8] compared with Reiki), and were more willing to recommend acupuncture (OR = 12.3 [4.8-31.8]). When presented evidence of inefficacy, CAM practitioners were most willing to recommend acupuncture relative to other CAM therapies (OR = 15.5 [9.0-26.9]). Practitioners' judgments about CAM trial evidence depend on the type of treatments reported. Confirmation bias may play a role in the clinical translation of new evidence from clinical trials.

Towards concordance in healthcare: perspectives of general practitioners, complementary and alternative medicine practitioners and pharmacists in Australia

Partnerships and concordance are desirable concepts for optimal healthcare. The concept of concordance is based on negotiation between equals in a therapeutic relationship, forming a therapeutic alliance between all partners. One field of healthcare in which concordant relationships may be particularly desirable is complementary and alternative medicine (CAM). CAM is increasingly used by consumers worldwide, and provider-patient relationships are important across the spectrum of CAM-to-conventional medicine; thus, it was considered useful to research CAM and concordance in parallel. The objective of this problem-detection study (PDS) was to investigate practitioners' (general practitioners', pharmacists' and CAM practitioners') views on their relationships and reaching concordant partnerships with consumers in the areas of both conventional medicine and CAM. Focus groups and semi-structured interviews guided the development of the PDS instrument. The questionnaire consisted of 36 items corresponding to seven thematic units deduced from the preliminary data. The differences in perceptions between the surveyed groups indicated that achieving concordance relies on mutual respect and communication and understanding of roles, responsibilities and limitations, and differences in opinion may be compromising the formation of partnerships. Potentially problematic issues identified by this research could be addressed by educational interventions and enhancement of communication between all parties involved, as information loses value when not shared, and may be prone to contradiction and confusion. Further research is warranted in order to facilitate positive changes in the health system.

Botanical Products: An Integrative Physician's Perspective

Interest in Complementary and Alternative Medicine (CAM) continues to grow throughout the world. A key paradigm amongst CAM practices is that patients are perceived as multi-dimensional individuals and CAM systems of medicine are not one-size fits all. This paradigm can also influence how a CAM practitioner views quality botanical products.

Practitioner–client relationships in integrative medicine clinics in Australia: A contemporary social phenomenon

The increasing use of complementary and alternative medicine (CAM) in developed countries has been attributed more to contemporary cultural trends than to inherent problems in mainstream medicine. The aim of this study was to examine the impact of post-modern values on relationships between practitioners and clients in integrative medicine (IM) clinics in Australia. This research used hermeneutic phenomenology to uncover experiences of practitioner-client relationships in IM and the meanings clients and practitioners attached to these relationships. Data were collected using cumulative case studies, focus groups and key informant interviews. Data analysis consisted of reading and re-reading texts derived from interview transcripts and field notes and constantly comparing texts to identify meanings and patterns. Themes extracted from the data set were continually refined, discarded and elaborated until meta-themes emerged. Australian IM clinics where general medical practitioners and CAM practitioners were co-located. Post-modern values were evident in practitioner-client relationships in Australian IM clinics and were manifested in two ways. (1) Clients did not bring an expectation that they would receive prescriptive treatment regimens. They regarded consultations as opportunities for obtaining information or advice, or for monitoring their health. (2) Practitioners valued clients' knowledge and judgments and respected clients' right to choose and direct their health care. In the IM clinics in this research, the traditional role of the practitioner as sole possessor of expertise had changed. Practitioners had become one among a number of resources that informed clients used when designing personal health care plans or negotiating health care with practitioners.