Viewing Issue:  Volume 1, Issue 1 (2010)

Topics in Integrative Health Care: an International Journal (TIHC) is a peer-reviewed, open-access online journal. It is dedicated to advancing the integration of multiple disciplines, both complementary and mainstream, into diverse health care settings in order to provide optimal patient care. It presents themed issues on topics of current relevance to health care providers interested in integrative, conservative care, health promotion and disease prevention. It includes international, interdisciplinary Grand Rounds in order to facilitate communication and patient comanagement among various health professions, for the good of patients everywhere.

Topics in Integrative Health Care (TIHC) is published by Healthindex, Inc. (ChiroACCESS).

Editorial

Welcome to Topics in Integrative Health Care: an International Journal


Cheryl Hawk, DC, PhD, CHES    

Topics in Integrative Health Care 2010, Vol. 1(1)     ID: 1.1001   

This is the inaugural issue of Topics in Integrative Health Care (TIHC), a peer-reviewed, open-access quarterly online journal dedicated to advancing the integration of complementary and mainstream approaches to health into diverse settings. We expect our readers to be health care providers who are open to any effective methods to help patients regain and optimize their health, and lead more fulfilling and productive lives. We believe that those methods may be found in all health professions, and in all sorts of settings. TIHC takes an evidence-informed approach, and we intend to stay grounded in its three “legs”: patient values and preferences; clinician experience and expertise; and the best available scientific evidence.

Commentary

Walking Our Talk: Putting the Integrity into Integration


Daniel Redwood, DC    

Topics in Integrative Health Care 2010, Vol. 1(1)     ID: 1.1002   

With passage of the Patient Protection and Affordable Care Act of 2010, federal law for the first time mentions “integrative health care,” endorsing it as a key component of America’s future health care system, while also recognizing a new designation of provider, the “integrative health care practitioner.” However, the law defines neither of these terms. Their ultimate definitions, and the extent to which these may foreshadow a revitalized system of health care delivery, remain very much in play. Discussions exploring the nature of integrative health care have matured in recent years. But no matter how brilliantly conceived, integrative delivery systems cannot be sufficiently functional and sustainable unless the people working within them substantially embody the core values and skills of integrative practice. Integrative structures require integrated individuals, and to the extent that these values and skills are absent or deemphasized in health professions training programs and in the personal beliefs and behaviors of practitioners, the broader reform mission is in jeopardy. A sustainable integrative health care system must identify and nurture beliefs and behaviors that model health-affirming ideals, including patient-centeredness, openness, pluralism, holism, preventive self-care, harmony of action and belief, and minimalism.

Grand Rounds

A Multidisciplinary Approach to Counseling a 65-Year Old Woman on Smoking Cessation


Marion Willard Evans, Jr., DC, PhD, MCHES, CWP

Robert A. Leach, DC, MS, FICC, CHES

Irving A. Cohen, MD, MPH, FACPM, FASAM

Christena Nicholson, DC, DABCI

Shelly Bobbins, RN, LAc, Dipl. CH

Topics in Integrative Health Care 2010, Vol. 1(1)     ID: 1.1003   

Smoking is a leading cause of premature death worldwide and a common co-morbidity with patients with chronic spine-related complaints. This case report presents a multidisciplinary approach to smoking cessation with a patient suffering from the consequences of tobacco use. Methods for promoting patient behavior change, typical drug therapies, hypnosis and acupuncture are among the approaches discussed. Resources that may assist the clinician in helping move their patients toward successful tobacco cessation are also provided.

Research

CAM Services Provided at Select Integrative Medicine Centers: What Do Their Websites Tell Us?


Michael J. Carucci, DC

Anthony J. Lisi, DC

Topics in Integrative Health Care 2010, Vol. 1(1)     ID: 1.1004   

Background: The utilization of complementary and alternative medicine (CAM) services in the United States has been well described. Recently there has been a growth of “integrative medicine” (IM) centers located at or affiliated with academic medical centers. Various structures and facilities exist for the delivery of such services; and within some of these settings, various CAM providers are reported to be providing care. CAM is subject to multiple interpretations and there may be variation among such centers. The inclusion or exclusion of given CAM services in academic medical centers may have policy consequences.
Purpose: To document and describe the CAM services and CAM provider types that are specified on the public websites of a group of IM clinics affiliated with academic medical centers.
Methods: The websites of the IM centers of the 44 member institutions of the Consortium of Academic Health Centers for Integrative Medicine (CAHCIM) were searched. Targeted data from the website review were entered in a spreadsheet (Microsoft Excel) for analysis. Descriptive statistics are reported.
Results: The public websites of 29 of the 44 CAHCIM member institutions specify any clinical services provided. Data on provider types were scarce. The most common CAM therapies specified were stress reduction, acupuncture, and biologically-based practices, each included in 72% or more of websites.
Conclusion: There is variation in breadth and depth of content provided on public websites of CAHCIM member institutions. These preliminary results can inform further research to understand the variation in services provided, as well as the determinants and consequences of such variation.

Integration of Chiropractic Services into a Multidisciplinary Safety-Net Clinic


Mark T. Pfefer, RN, MS, DC

Richard Strunk DC, MS

Cheryl Hawk, DC, PhD, CHES

Michael Ramcharan, DC, MPH, MUA-C

Elizabeth Pa Xiong

Diane Hill, BSN, MSN, EdD, ARNP

Lauren Davis

Topics in Integrative Health Care 2010, Vol. 1(1)     ID: 1.1005   

Nearly 46 million Americans are uninsured. Health care safety-net providers are those that have a mission to offer health care to all patients, regardless of their ability to pay, and typically have a substantial number of patients who are uninsured. This paper describes the establishment of a chiropractic clinic within a free, safety-net health clinic operating in a “medical pluralism” model. In this particular collaborative arrangement, chiropractic was categorized as a specialty service, so patients were referred by the clinic’s primary care physician or nurse practitioner. Ninety one new patients were examined and treated during the first 9 months of integrating chiropractic services into the clinic. Musculoskeletal complaints, particularly low back pain (53%), extremity pain (17%) and neck pain (13%) represented the majority of the type of problems that patients presented for care. Fifty percent of the chiropractic patients were unemployed, and 77% presented with an unhealthy body mass index; 33% were current tobacco users. The first 9 months of integrating chiropractic services was viewed as successful due to consistently full patient appointment times and frequent referrals from other health care providers within the free clinic. Our challenges were almost exclusively logistical in nature.  Staffing the chiropractic service was perhaps the primary challenge.

Health Promotion Needs Assessment at a Faith-Based Substance Abuse Recovery Facility in Alabama


Ronald Ivie, DC, DABCO, MA

Marion Willard Evans, Jr., DC, PhD, MCHES, CWP

Harrison Ndetan, MSc, MPH, DrPH

John Fischer, MD, MBA

Topics in Integrative Health Care 2010, Vol. 1(1)     ID: 1.1006   

Objective: To examine the health promotion and health education needs of an inpatient population at one faith-based addiction treatment center. A secondary aim was to assess the awareness and use of chiropractic care recently made available at the center.
Data Sources: A self-survey previously conducted at the treatment center provided background data. The research team developed and conducted a survey to assess the inpatients’ knowledge and attitudes about specific health behaviors, including physical activity, dietary habits, and tobacco use status, as well as their attitudes toward and use of the clinic’s chiropractic services. Descriptive statistics are reported from both survey samples.
Results: This inpatient population has significant health promotion needs. A majority of patients (74%) use tobacco and none report getting the recommended intake of 5 servings of fruits and vegetables daily. Six percent reported utilizing the free chiropractic services available at the clinic. Over 60% expressed interest in programs on smoking cessation, healthy weight and diet.
Conclusion: Little is being done to address the physical health needs of this population outside of addiction recovery. This program could benefit from and patients would likely support, health education programs on smoking cessation, healthy diet and food preparation along with physical activity programs.

Tobacco Use and Other Predictors of Successful Length of Stay in a Faith-Based Substance Abuse Recovery Center: Results of an Initial Assessment at One Facility


Ronald Ivie, DC, DABCO, MA

Marion Willard Evans, Jr., DC, PhD, MCHES, CWP

Harrison Ndetan, MSc, MPH, DrPH

Michael A. Perko, PhD, CHES, FAAHE

John Fischer, MD, MBA

Topics in Integrative Health Care 2010, Vol. 1(1)     ID: 1.1007   

There has been debate as to whether smoking should be allowed in addiction treatment centers as part of recovery programming. A prior study at one facility assessed health promotion needs and found 80% of inpatients were smokers or tobacco users. This is four times the national average. This study assessed predictors of length of stay at a faith-based, inpatient facility in Alabama and included tobacco use as a possible predictor of success. Other potential predictors such as basic demographics, drugs of choice, intravenous drug use, parental marital status, and education levels were also tested.

Among the 290 participants completing the survey (100%), 83% were males, most were white, mean age was 33 years, and ages ranged from 18-61. Eighty percent used tobacco, and cocaine use was the most common drug for which patients were under treatment. Although approximately one third of patients completed the entire 52 week program, older patients tended to stay longer in the program and those court-ordered were more likely to complete the program as well. Marijuana use predicted longer stays compared to other drugs of choice, and tobacco use was a borderline significant predictor of length of stay (p=0.05), with users less likely to stay as long.

Continued tobacco use did not enhance participants’ length of stay. Modifying program delivery by taking into consideration such factors as age of patients and drugs of choice, and considering a tobacco-free policy are issues that the facility may wish to address. Further studies could include assessment of mandated tobacco cessation and its effects on successful length of stay.

Fast Facts

Fast Facts


Mark T. Pfefer, RN, MS, DC    

Topics in Integrative Health Care 2010, Vol. 1(1)     ID: 1.1008   

Readers are welcome to contribute to Fast Facts. Please include the original abstract (with citation) that is the source of your contribution. Contributors’ names will be included along with the item.

The following is an excerpt:

In a survey of college students, 38% reported back pain within the past school year. The factors most strongly associated with back pain were presence of chronic fatigue and being in an emotionally abusive relationship.

Gilkey DP, Keefe TJ, Peel JL, Kassib OM, Kennedy CA. Risk factors associated with back pain: a cross sectional study of 963 college students. J Manipulative Physiol Ther 2010;33(2):88-95.