This study is the first to describe patient characteristics and HRQoL treatment outcomes at a university-based integrative medicine clinic in the United States. Consistent with national survey data on CAM use, three quarters of the presenting patients were white and two thirds of the patients were female.13–15
Also consistent with national data, patients presenting for integrative medical care tended to report multiple medical conditions and relatively poor HRQoL.13–15
Clinically significant changes on 6 of 8 HRQoL measures were detected at 3-month follow-up in a medically and demographically representative sample of 370 new patients. These data indicate that individualized, integrative medical treatment was associated with meaningful short-term improvement in physical, mental, and social functioning among patients who responded to follow-up assessment. This study extends previous findings by demonstrating that patients who seek to integrate CAM with allopathic medicine at a university-based academic medical center practice are not simply the “worried well”; rather they are individuals with complex health conditions who may benefit significantly from a whole-person model of care.
Interpretation of results is limited by a nonrandomized study design, which precludes causal inferences. Although a direct comparison group was not available in this study, patient-reported outcomes on the SF-36 were consistent with those published by three other integrative medicine practices: one in California, one in Canada, and one in Germany.16–18
A novel finding of this study was that short-term improvements in HRQoL did not differ significantly as a function of age group, gender, ethnic minority status, or medical comorbidity, suggesting that integrative medical treatment effects were consistent across demographic subgroups and different levels of illness severity. Whereas data were not collected on duration of illness for this study, results indicated that responders and nonresponders to the follow-up SF-36 survey did not differ significantly on measures of illness severity, including physical and mental functioning and the number of medical conditions diagnosed at baseline. These findings suggest that individuals who responded to the follow-up survey were neither healthier nor sicker compared to patients who did not respond. Collectively, this investigation and others demonstrate that integrative, whole-person models of care are associated with clinical benefits among a variety of patients who present with diminished quality of life.
Future research on Integrative Medicine can build upon early HRQoL findings. First, observational estimates of treatment effects can be used to statistically power RCTs, which are needed to compare the relative efficacy, safety, and cost-effectiveness of Integrative Medicine versus conventional care for specific medical conditions. Second, given the relationship-centered focus of Integrative Medicine,19
investigation of the role patient–provider relationships play in determining treatment outcomes is essential. Previous research on family medicine and general internal medicine clinics found that patients treated by physicians who spent more time counseling on psychosocial aspects of care, including interpersonal relationships and emotional well-being, reported significantly greater improvement in HRQoL, even though mean HRQoL did not improve significantly following 1 year of treatment in either specialty.20
Those findings suggest that mean HRQoL improvements observed at a university-based Integrative Medicine clinic compare favorably to conventional primary care practices. Although the relative cost-effectiveness of Integrative Medicine remains unknown, a recent systematic review found that several CAM therapies appear to be of good health economic value.21
Future clinical studies on Integrative Medicine will benefit from taking an integrative “systems” approach to outcome assessment.22,23
For instance, concurrent measurement of biologic, psychologic, social, spiritual, and contextual dimensions of whole-person health can help elucidate patterns of change in medical conditions, risk factors, and/or health behaviors that occur during integrative medical treatment. Advanced data analytic methods, such as structural equation modeling, can be applied to test complex systems of variables that may involve multiple predictors, mediators, and outcomes.24
Similarly, mixed-effects models can be applied to understand sources of variability in Integrative Medicine treatment outcome(s) attributable to group-level (e.g., gender or ethnicity) and individual-level factors (e.g., symptom severity or patient–provider relationship quality) in a single model.25
In conclusion, integrative medical treatment at a university-based practice is associated with notable improvement in HRQoL for a variety of patients. Moreover, the degree of improvement in HRQoL does not appear to differ significantly as a function of demographic characteristics, including illness severity at the time of initial treatment. Controlled studies that measure HRQoL and additional outcomes related to whole-person health—physical, mental, social, and spiritual—are needed to determine the full therapeutic potential of Integrative Medicine, including efficacy and cost-effectiveness relative to conventional medical care.