Conventional Health Care System Research Articles

Way Out Yonder, An Experiment Worth Watching

Way Out Yonder, An Experiment Worth Watching

Delays in Seeking Conventional Medical Care and Complementary and Alternative Medicine Utilization

To test the association between delays in utilization of conventional medical care and complementary and alternative medicine (CAM) utilization. The 2007 National Health Interview Survey, a cross-sectional nationally representative study of adults aged 18 years and older. Using zero-inflated regression models, delays in utilizing conventional care due to organizational inaccessibility are examined to determine whether delays are associated with both the decision to try CAM and the number of CAM types used. Individuals have significantly higher odds using provider-based CAM types if they delayed seeking conventional care due to organizational inaccessibility (OR = 1.63). Individuals use significantly more types of both provider-based (IRR = 1.35) and non-provider-based (IRR = 1.49) CAM if they delayed seeking conventional care due to organizational inaccessibility. Individuals who delay seeking conventional medical care are more likely to use CAM and use more types of CAM. The current structure of the conventional health care system may have created barriers that can make conventional health care inaccessible. Individuals who face these barriers appear to be pushed not only into trying CAM but using a greater number of CAM types, a finding not in previous research.

An integrated health care standard for the management and prevention of obesity in The Netherlands

The Partnership Overweight Netherlands (PON) is a collaboration between 18 partners, which are national organizations of health care providers, health insurance companies and patient organizations. The PON published an integrated health care standard for obesity in November 2010. The integrated health care standard for obesity involves strategies for diagnosis and early detection of high-risk individuals as well as appropriate combined lifestyle interventions for those who are overweight and obese and, when appropriate, additional medical therapies. The PON works towards a standard that transcends traditional boundaries of conventional health care systems and health care professions but, instead, focuses on competences of groups of health professionals who organize care from a patient-oriented perspective.

Complementary and alternative health care in Israel.

The paper explores the patterns of coexistence of alternative/complementary health care (CAM) and conventional medicine in Israel in the cultural, political, and social contexts of the society. The data are drawn from over ten years of sociological research on CAM in Israel, which included observation, survey research, and over one hundred in-depth interviews with a variety of CAM practitioners - many with bio-medical credentials - and with policy makers in the major medical institutions. The analysis considers the reasons for CAM use, number of practitioners, the frequency of CAM use and some of its correlates, and how CAM is regulated. The structure of the relationship between the conventional health care system and CAM is discussed in the public sector, which provides two-thirds of CAM services, and in the private sector, which provides about one-third. The history of the development of these structures and some of the dilemmas of their operation are discussed. A number of policy issues are considered against this background: regulation and licensing, CAM in primary care, reimbursement for CAM treatment, and the inclusion of CAM in education and training for the health professions.

Bogus arguments for unproven treatments

Bogus arguments for unproven treatments

Folk medicine should be integrated into the conventional medical healthcare system in the Caribbean

To argue for the integration of folk medicine into theconventional medical healthcare system in the Carib-bean is an interesting debate; interesting because‘folk’ medicine used to be the ‘mainstream’ medicineso, if anything, it should be an argument for reinte-gration. So first, what do these two terms mean, howdid the different medical paradigms get separated andhow, if at all, can they be reintegrated to make a morewholesome, affordable and integrated healthcaresystem in the Caribbean?Before Europeans arrived in the Caribbean, itsplants were being used for healing and maintaininghealth. Historical research has shown that the Taino,a West Indian Arawak tribe who inhabited theCaribbean from ~900 AD, used many plants forhealing purposes.

Use of complementary and alternative medicine at Norwegian and Danish hospitals

BackgroundSeveral studies have found that a high proportion of the population in western countries use complementary and alternative medicine (CAM). However, little is known about whether CAM is offered in hospitals. The aim of this study was to describe to what extent CAM is offered in Norwegian and Danish hospitals and investigate possible changes in Norway since 2001.MethodsA one-page questionnaire was sent to all included hospitals in both countries. The questionnaire was sent to the person responsible for the clinical activity, typically the medical director. 99 hospitals in the authority (85%) in Norway and 126 in Denmark (97%) responded. Given contact persons were interviewed.ResultsCAM is presently offered in about 50% of Norwegian hospitals and one-third of Danish hospitals. In Norway CAM was offered in 50 hospitals, 40 of which involved acupuncture. 19 hospitals gave other alternative therapies like biofeedback, hypnosis, cupping, ear-acupuncture, herbal medicine, art therapy, homeopathy, reflexology, thought field therapy, gestalt therapy, aromatherapy, tai chi, acupressure, yoga, pilates and other. 9 hospitals offered more than one therapy form. In Denmark 38 hospitals offered acupuncture and one Eye Movement Desensitization and Reprocessing Light Therapy. The most commonly reported reason for offering CAM was scientific evidence in Denmark. In Norway it was the interest of a hospital employee, except for acupuncture where the introduction is more often initiated by the leadership and is more based on scientific evidence of effect. All persons (except one) responsible for the alternative treatment had a medical or allied health professional background and their education/training in CAM treatment varied substantially.ConclusionsThe extent of CAM being offered has increased substantially in Norway during the first decade of the 21st century. This might indicate a shift in attitude regarding CAM within the conventional health care system.

Coaching a Healthy Lifestyle

This article is a case study of practitioners of Ayurvedic health counselling in Stockholm, Sweden. The focus is on the practitioners’ ways of presenting their practice. It is found that the practice is construed as a form of coaching, where life style advice is primary in relation to different remedies and medicaments. The majority of the clients suffer from vague, stress-related complaints, problems that “fall through” the conventional health care system. The primary cause of these problems are attributed to imbalances that are created by the fast pace in the Western society of today. Discourse analysis is used to interpret how this implies a positioning of the practitioners as a part of a holistic health milieu.

Detecting Vital Signs with Wearable Wireless Sensors

The emergence of wireless technologies and advancements in on-body sensor design can enable change in the conventional health-care system, replacing it with wearable health-care systems, centred on the individual. Wearable monitoring systems can provide continuous physiological data, as well as better information regarding the general health of individuals. Thus, such vital-sign monitoring systems will reduce health-care costs by disease prevention and enhance the quality of life with disease management. In this paper, recent progress in non-invasive monitoring technologies for chronic disease management is reviewed. In particular, devices and techniques for monitoring blood pressure, blood glucose levels, cardiac activity and respiratory activity are discussed; in addition, on-body propagation issues for multiple sensors are presented.

Seeking Help for Mental Health Problems outside the Conventional Health Care System: Results from the European Study of the Epidemiology of Mental Disorders (ESEMeD)

In certain countries, it is not uncommon to turn to professionals outside the conventional health care system for psychological problems. As this situation is not well documented in Europe, we assessed use of nonconventional care for mental health in 6 European countries. A cross-sectional survey was conducted in representative samples of noninstitutionalized adults in 6 European countries. Participants (n = 8796) completed a survey, which included, among other items, the Composite International Diagnostic Interview 3.0 and in-depth questions about lifetime consultations for mental health problems. Among the respondents (n = 2928) who reported having already sought help in their lifetime for psychological problems (20.0%), 8.6% turned to complementary and alternative medicine (CAM) providers, such as chiropractors and herbalists, and a similar proportion (8.4%) to religious advisers such as ministers, priests, or rabbis. Only a small proportion (2.9%) consulted only these professionals for their problems. CAM providers were more frequently used in the Netherlands (13.5%) and Germany (9.4%), while religious advisers were more often consulted in Italy (12.6%) and Germany (11.6%). Multivariate analyses confirmed differences between countries and revealed that people turning to religious advisers tended to be older, foreign born, and with alcohol problems, whereas those consulting CAM providers were younger, wealthier, and more frequently depressed. In Europe, patients who turn to CAM therapists and those who seek help from religious advisers for psychological problems are not exactly the same. In addition, these professionals are not consulted frequently in most countries, and are almost always associated with more traditional follow-up when used.

Understanding unexpected courses of multiple sclerosis among patients using complementary and alternative medicine: A travel from recipient to explorer

Complementary and alternative medicine (CAM) is frequently used by patients with multiple sclerosis (MS). Some MS patients experience unexpected improvements of symptoms, which they relate to their use of CAM. The aim of this study was to obtain knowledge and develop understandings of such self-defined unexpected improvement of MS symptoms. Two cases were constructed based on documents and 12 qualitative interviews. Our aim was not to make generalisations from the cases, but to transfer knowledge as working hypotheses. We identified four health-related change processes: the process of losing bodily competence; the process of developing responsibility; the process of taking control; and the process of choosing CAM. The patients explained unexpected improvements in their MS symptoms as results of their own efforts including their choice and use of CAM. In our theoretical interpretations, we found the patients’ redefinition of history, the concept of treatment and the importance of conventional health care to be essential, and leading to a change of patients’ position towards conventional health care from recipients to explorers. The explorers can be perceived as boundary walkers reflecting limitations within the conventional health care system and as initiators regarding what MS patients find useful in CAM.

Integrating Complementary and Alternative Medicine Into Conventional Primary Care: The Patient Perspective

The aim of this study was to explore perspectives on integrating complementary and alternative medicine (CAM) into the conventional primary care setting among patients treated at a large academic family medicine clinic in Texas. We developed and administered a multiple choice questionnaire to evaluate perspectives of 502 patients on integrating CAM into the conventional primary healthcare system. All collected data were statistically analyzed to evaluate responses. Among study participants, 66% indicated that they had used CAM treatments during the past year, 77% responded that they would be interested in using CAM during the next year, and 55.4% replied that they would like CAM therapies to be provided in their primary care clinic. The use of CAM in primary care settings in southern Texas is widespread. However, in this primary care setting, patients would like their family physician to provide and supervise these therapies. Patients believe that there is an increased need for family physician involvement in providing and supervising CAM treatments. Our findings are preliminary but can provide a basis for multicenter, cross-cultural studies to further evaluate the patient perspective on the process of integrating CAM into the conventional primary healthcare system so that healthcare policy makers can better address public need.

Facteurs liés au retard du diagnostic de la tuberculose à Conakry (Guinée)

Untreated smear-positive pulmonary tuberculosis constitutes a reservoir of infection which is highly contagious. The present study was conducted in Conakry, Guinea, to determine the different options which are available when seeking treatment or care, and to ascertain the average delay in diagnosis of pulmonary tuberculosis and the main factors linked to the delay in diagnosis after the initial onset of symptoms. Through a cross-sectional study, 113 consecutive patients with smear-positive pulmonary tuberculosis were interviewed through the use of a questionnaire. The median total delay from the onset of symptoms of pulmonary tuberculosis until the diagnosis was 11 weeks. This delay period exceeded 4 weeks for 90 of the patients (80%). The average delay linked to the conventional health care system was double that of the one at the fault of the patient (6 weeks versus 3 weeks, respectively). 54% of the patients had initially resorted to non-conventional care. To shorten this mean delay period, it is necessary to both strengthen the professional abilities and skills which train for one to better to detect tuberculosis and to sensitize the population to the subject matter and information on the illness and its symptoms.

International Conference on Natural Health Products: “Promotion and Development of Botanicals with International Coordination: Exploring Quality, Safety, Efficacy, and Regulations”

The International Conference "Promotion and Development of Botanicals With International Coordination: Exploring Quality, Safety, Efficacy, and Regulations" was organized by the School of Natural Product Studies, JadavpurUniversity, Kolkata, India. This article presents the background, objectives, and highlights of the presentations of different plenary, oral, and poster sessions. The conference was supported by the Drug Information Association of the United States. Different organizations of the government of India such as the National Medicinal Plants Board (NMPB); Department of Ayurveda, Yoga, Unani, Siddha, and Homeopathy (AYUSH); Indian Council of Medical Research (ICMR); Council for Scientific and Industrial Research (CSIR); and Defence Research Development Organization (DRDO) also supported this international event. The key topics were as follows: Developing Botanicals Through International Coordination; Exploring Traditional Medicine for Development of Herbal Drugs; Regulatory Perspective for Development of Herbals; Health Care Resources-Impact of Natural (Traditional) Medicines; Ethnobotany and Ethnopharmacology in Natural Product Development: Global Perspectives; Pharmacovigilance of Natural Health Products-Evaluating Safety and Toxicity; and Industrial Perspectives and Development of Phytomedicines. Conference attendees included a variety of stakeholders: manufacturers of raw materials, phytomedicines, pharmaceuticals, and dietary and food supplements; representatives of conventional and traditional health care systems; sellers and distributors; regulatory authorities; standard-setting organizations; contract laboratories and research organizations, non governmental organizations, academicians, scientists, and health care practitioners. The conference also provided educational opportunities for pharmacists, pharmacognosists, physicians, phytochemists, botanists, ethnobotanists, ethnopharmacologists, pharmacologists, toxicologists, and others involved in the research, evaluation, development, and marketing of botanicals and natural products for use in health care. More than 350 delegates from different countries, including scientists/researchers from the United States, Canada, United Kingdom, Brazil, The Netherlands, France, South Africa, Iran, Thailand, Fiji, and India, participated in the conference from different fields of herbal research. As Director of the School of Natural Products Studies, I was the organizing secretary of this international event.

Patients' Choice of Asthma and Allergy Treatments

Only a few studies have focused on a comparison between general practitioner (GP) patients' and classical homeopath (CH) patients' reasons for choosing, continuing or termination of their treatment by GPs or CHs, respectively. The existing studies are mostly based on quantitative methods and dealing with patients' reasons for choosing complementary and alternative medicine (CAM). The objective of this paper is to develop concepts to understand and compare Danish GP patients' and CH patients' initial choice of, continuing choice of, and termination of treatments for asthma and allergy. Data originate from an explorative study based on semistructured interviews with 18 GP patients and CH patients having asthma and allergy. The selection of the patients to the interviews was based on a questionnaire study including 88 respondents (response rate 58 patients). In understanding the patients' initial choice and continuing choice of treatment and termination of treatment, the concepts push-from, pull, press-into, stop, and stay factors are used. These factors are connected to the patients' experiences with conventional treatment, patients' attitudes toward and personal experiences with alternative treatment, and the patients' understanding of their asthma and allergy. The results of the study indicate that patients before seeking CHs had experienced inappropriate health care within the conventional health care system. The results of the study also indicate that if the CH patients experience inappropriate health care within homeopathic treatment, they terminate the treatment. The study indicates the importance of health providers' insight into GP patients' and CH patients' different reflections on adverse events, the patients' different understandings of asthma and allergy, and the different learning processes that GP patients and CH patients might be involved in while living with asthma and allergy. These are important issues for understanding patients' initial and, continuing choice of and termination of GP treatment and CH treatment, respectively.

General practitioners and classical homeopaths treatment models for asthma and allergy

Complementary and alternative treatment (CAT) is increasingly popular with patients and health-care providers. In the western societies an increasing number of patients with asthma and allergy combine conventional and CAT. But health-care providers knowledge about the different treatment models applied within the conventional health care system and alternative treatment is generally poor. ‘Treatment model’ includes understanding of disease, diagnostic approach, treatment methods and expected effects of treatment. Different treatment models represent different social constructions of understanding. We present a conceptualization of general practitioners’ (GPs) and classic homeopaths’ (CHs) perceptions of their treatment models in patients with asthma and allergy. This is a first phase of a research project conducted in Denmark to study prerequisites for bridge building between conventional and alternative therapists. The research questions were: How do the GPs and the CHs describe their treatment models for asthma and allergy? What are the differences and similarities between the treatment models? Is there a logical connection between the components of the GPs and CHs treatment models? Six GPs and 11 CHs participated in semi-structured interviews. The main difference is in the GPs and CHs descriptions of the purpose of treatment. Similarities are found in the perception of a successful treatment. Both the GPs and the CHs experience treatment effects to be dependent on contextual conditions. Differences and similarities between treatment models are discussed in relation to potential bridge building between conventional and alternative health care.

Patient visits to a hospital-based alternative medicine clinic from 1997 through 2002: Experience from an integrated healthcare system

Efforts to integrate complementary and alternative medicine (CAM) into conventional healthcare systems raise questions about expected levels of CAM use and its cost in an integrated system. This paper documents actual patient usage of a hospital-based alternative medicine clinic that has been operating on a conventional healthcare campus since 1993. Hennepin Faculty Associates (HFA) is a multispecialty physician organization serving the Hennepin County Medical Center (HCMC), a public teaching hospital in downtown Minneapolis. In 1993, HFA opened an alternative medicine clinic, primarily providing acupuncture. The clinic has since expanded services to offer chiropractic, massage/bodywork, and herbs. Administrative claims data showing visit dates, treatment received, payment source, charges, and patient complaints are available from 1997 through 2002. Of all HFA patients who received conventional care on the HCMC campus every year (1997-2002), 6.5% also received care at the Alternative Medicine Clinic (AMC). Nearly 80% of AMC patients received third-party reimbursement for AMC services. Averaged over 6 years, self-pay patients had 3.2 visits per year and incurred $173 in charges per year; patients with a mixture of third-party payment sources had 8.0 visits per year and incurred $634 in charges per year. Number of visits per patient per year remained relatively constant over the 6 years, except for patients aged 65 or older, who showed an increase in number of visits, particularly for acupuncture. This report contributes a new perspective on use of CAM in the general population. Results from this perspective differ markedly from those provided by published survey data, showing a lower prevalence of use and lower charges incurred. Concern that insurance coverage for CAM would increase healthcare costs dramatically are not substantiated by these data.

Assessing a Community's Pediatric Asthma Care Needs: Insights Gained from Physicians, School Nurses, and Parents

Today, about 5 million children in the United States - one in every 15 children under the age of 18 - have asthma. The social and economic costs of childhood asthma are high. Asthma management requires a multifaceted approach, including partnerships among physicians, school nurses, and parents to create a continuum of care that is often missing from conventional health-care delivery systems. At a local level, coalitions are an important strategy for promoting partnerships for the management of asthma. Focus groups were conducted in the Hampton Roads region of southeastern Virginia to provide in-depth information about barriers to the management of asthma. The perspectives of physicians, school nurses, and parents who live in areas characterized as having unusually high rates of emergency department visits or hospitalizations for asthma were included. This paper presents an in-depth analysis of the qualitative data obtained from these focus groups.

Alternative, complementary, and conventional medicine: is integration upon us?

In attempts to improve their health and/or combat illness, approximately 4 in 10 Americans will use a complementary and alternative medicine (CAM) therapy this year. CAM therapies vary widely, with acupuncture, chiropractic, herbal medicine, and homeopathy among the more prominent modalities. CAM therapies are used in addition to and/or instead of the more conventional forms of medical care available in U.S. hospitals or licensed physicians' offices. A rapidly increasing interest in CAM has led to a nascent movement aimed at integrating various CAM therapies with the conventional health care system. In Washington State, for example, health insurance coverage for CAM therapies has been mandated, and a number of "integrated" delivery systems have been born. Although the political and economic forces leading to adoption and integration of CAM therapies vary widely by geographic locale, it is likely that some degree of integration will occur throughout much of the United States. Similar processes are occurring in Canada, Europe, and Australia, and indeed within middle and upper level socioeconomic strata worldwide. This paper identifies potential barriers and facilitators to potential integration, of medical disciplines and argues for an accessible, multidisciplinary and evidence-based, yet humanistic and patient-oriented approach.

US military veterans' perceptions of the conventional medical care system and their use of complementary and alternative medicine

Use of complementary and alternative medicine (CAM) is growing quickly in the USA, prompting hypotheses about why people turn to CAM. One reason for increasing use of CAM modalities may be dissatisfaction with the conventional care system. However, recent studies suggest that dissatisfaction is not a major factor. This paper provides another perspective on the possible relationship between dissatisfaction with conventional care and the use of CAM. Qualitative data collection, in the form of 12 focus groups with 100 CAM users, was used to inquire about issues surrounding the use of CAM. Focus group participants were military veterans enrolled in the Southern Arizona VA Health Care System, and their significant others. Qualitative analysis identified key themes emerging from the focus groups. Although participants were satisfied in general terms with their conventional care, there were particular aspects of the conventional care system that they criticized. Dissatisfaction with aspects of conventional care, particularly its reliance on prescription medications, was an important component in their motivation to use CAM. Results also suggest that the conventional medical system's lack of holism (inadequate information regarding diet, nutrition and exercise, and ignorance of social and spiritual dimensions) is also an important motivation for turning to CAM in this particular population. Independent research and a sense of responsibility on the part of focus group participants for their own health seemed to be taking them outside the domain of the conventional health care system.