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1.  Identifying the barriers to conducting outcomes research in integrative health care clinic settings - a qualitative study 
Background
Integrative health care (IHC) is an interdisciplinary blending of conventional medicine and complementary and alternative medicine (CAM) with the purpose of enhancing patients' health. In 2006, we designed a study to assess outcomes that are relevant to people using such care. However, we faced major challenges in conducting this study and hypothesized that this might be due to the lack of a research climate in these clinics. To investigate these challenges, we initiated a further study in 2008, to explore the reasons why IHC clinics are not conducting outcomes research and to identify strategies for conducting successful in-house outcomes research programs. The results of the latter study are reported here.
Methods
A total of 25 qualitative interviews were conducted with key participants from 19 IHC clinics across Canada. Basic content analysis was used to identify key themes from the transcribed interviews.
Results
Barriers identified by participants fell into four categories: organizational culture, organizational resources, organizational environment and logistical challenges. Cultural challenges relate to the philosophy of IHC, organizational leadership and practitioner attitudes and beliefs. Participants also identified significant issues relating to their organization's lack of resources such as funding, compensation, infrastructure and partnerships/linkages. Environmental challenges such as the nature of a clinic's patient population and logistical issues such as the actual implementation of a research program and the applicability of research data also posed challenges to the conduct of research. Embedded research leadership, integration of personal and professional values about research, alignment of research activities and clinical workflow processes are some of the factors identified by participants that support IHC clinics' ability to conduct outcomes research.
Conclusions
Assessing and enhancing the broader evaluation culture of IHC clinics prior to implementing outcomes research may be a critical step towards ensuring productive and cost-effective research programs. However, as IHC clinics are often complex systems, a whole systems approach to research should be used taking into account the multidimensional and complex nature of such treatment systems so that the results are useful and reflect real life.
doi:10.1186/1472-6963-10-14
PMCID: PMC2826302  PMID: 20074354
2.  CAM Use in Pediatric Neurology: An Exploration of Concurrent Use with Conventional Medicine 
PLoS ONE  2014;9(4):e94078.
Background
Previous studies have found that up to 60% of children with neurologic conditions have tried complementary and alternative medicine (CAM).
Objective
To assess the use of CAM among patients presenting to neurology clinics at two academic centers in Canada.
Methods
A survey instrument was developed to inquire about use of CAM products and therapies, including reasons for use, perceived helpfulness, and concurrent use with conventional medicine, and administered to patients or their parents/guardians at the Stollery Children's Hospital in Edmonton and the Children's Hospital of Eastern Ontario (CHEO) in Ottawa.
Results
Overall CAM use at the Stollery was 78%, compared to 48% at CHEO. The most common CAM products used were multi-vitamins (84%), vitamin C (37%), homeopathic remedies (24%), and fish oil/omega 3 s (22%). The most common CAM practices used were massage (47%), chiropractic (37%), faith healing (18%), aromatherapy (16%), homeopathy (16%), and relaxation (16%). Many patients used CAM products at the same time as conventional medicine but just over half (57%) discussed this concurrent use with their physician.
Conclusion
CAM use is common in pediatric neurology patients and most respondents felt that it was helpful, with few or no harms associated. However, this use is often undisclosed, increasing possibility of interactions with conventional drugs. We urge clinicians to inquire about CAM use during routine history taking at every patient visit. Parents would clearly like more information about CAM from their specialty clinics; such information would be easier to share if more primary data were available about the safety and effectiveness of commonly used therapies.
doi:10.1371/journal.pone.0094078
PMCID: PMC3988088  PMID: 24736474
3.  Complementary and Alternative Medicine: A Survey of Its Use in Pediatric Oncology 
Background. The use of complementary and alternative medicine (CAM) is high among children and youths with chronic illnesses, including cancer. The objective of this study was to assess prevalence and patterns of CAM use among pediatric oncology outpatients in two academic clinics in Canada. Procedure. A survey was developed to ask patients (or their parents/guardians) presenting to oncology clinics at the Stollery Children's Hospital in Edmonton and the Children's Hospital of Eastern Ontario (CHEO) in Ottawa about current or previous use of CAM products and practices. Results. Of the 137 families approached, 129 completed the survey. Overall CAM use was 60.5% and was not significantly different between the two hospitals. The most commonly reported reason for not using CAM was lack of knowledge about it. The most common CAM products ever used were multivitamins (86.5%), vitamin C (43.2%), cold remedies (28.4%), teething remedies (27.5%), and calcium (23.0%). The most common CAM practices ever used were faith healing (51.0%), massage (46.8%), chiropractic (27.7%), and relaxation (25.5%). Many patients (40.8%) used CAM products at the same time as prescription drugs. Conclusion. CAM use was high among patients at two academic pediatric oncology clinics. Although most respondents felt that their CAM use was helpful, many were not discussing it with their physicians.
doi:10.1155/2013/527163
PMCID: PMC3836302  PMID: 24307910
4.  Potentials and barriers in cooperation between conventional and complementary practitioners at a Danish Multiple Sclerosis Hospital 
Introduction
More than 50% of the People with Multiple Sclerosis (PwMS) in Denmark have used complementary and alternative medicine (CAM). The majority of these combine CAM and conventional treatment, and from 2004 to 2010 the Danish Multiple Sclerosis Society conducted a research project with the purpose of investigating and testing models for cooperation between conventional and complementary practitioners.
Theory
Five health care providers and five CAM practitioners were set up to work together from 2004 to 2010 in developing and offering integrated treatment to 200 PwMS at a Danish MS Hospital. The investigation of the collaborative process between practitioners has been based on theories of epistemic cultures as well as learning theories, focusing on interdisciplinary development.
Methods
Empirical material consists of individual interviews with practitioners, a group interview with practitioners, a group interview with professional staff at the Danish MS Hospital, interviews with patients as well as written responses from the practitioners.
Results and conclusions
The six-year cooperation among the practitioners documented mutual inspiration and learning within the team, as well as numerous basic challenges involved in developing interdisciplinary treatment for PwMS. Cooperation between researchers and the treatment team resulted in the development of four interdisciplinary models, which describe the potentials and barriers in relation to various types of collaboration.
Discussions
In many cases, integrating CAM and conventional treatment providers is seen as an ideal. This paper points out the importance of not overlooking the opportunities, values and the potential inherent in a pluralistic ideal in terms of the patients’ own active efforts and the dynamism that can arise when the patient becomes a co-informant, co-coordinator and/or co-integrator.
PMCID: PMC3225281
multiple sclerosis; integrative treatment; integrative care; teambased treatment; complementary medicine; CAM
5.  Pediatric integrative medicine: pediatrics' newest subspecialty? 
BMC Pediatrics  2012;12:123.
Background
Integrative medicine is defined as relationship-centered care that focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare professionals and disciplines to achieve optimal health and healing, including evidence-based complementary and alternative medicine. Pediatric integrative medicine (PIM) develops and promotes this approach within the field of pediatrics. We conducted a survey to identify and describe PIM programs within academic children’s hospitals across North America. Key barriers and opportunities were identified for the growth and development of academic PIM initiatives in the US and Canada.
Methods
Academic PIM programs were identified by email and eligible for inclusion if they had each of educational, clinical, and research activities. Program directors were interviewed by telephone regarding their clinical, research, educational, and operational aspects.
Results
Sixteen programs were included. Most (75%) programs provided both inpatient and outpatient services. Seven programs operated with less than 1 FTE clinical personnel. Credentialing of complementary and alternative medicine (CAM) providers varied substantially across the programs and between inpatient and outpatient services. Almost all (94%) programs offered educational opportunities for residents in pediatrics and/or family medicine. One fifth (20%) of the educational programs were mandatory for medical students. Research was conducted in a range of topics, but half of the programs reported lack of research funding and/or time. Thirty-one percent of the programs relied on fee-for-service income.
Conclusions
Pediatric integrative medicine is emerging as a new subspecialty to better help address 21st century patient concerns.
doi:10.1186/1471-2431-12-123
PMCID: PMC3470978  PMID: 22894682
6.  A Self-Report Measure of Clinicians' Orientation toward Integrative Medicine 
Health Services Research  2005;40(5 Pt 1):1553-1569.
Objective
Patients in the U.S. often turn to complementary and alternative medicine (CAM) and may use it concurrently with conventional medicine to treat illness and promote wellness. However, clinicians vary in their openness to the merging of treatment paradigms. Because integration of CAM with conventional medicine can have important implications for health care, we developed a survey instrument to assess clinicians' orientation toward integrative medicine.
Study Setting
A convenience sample of 294 acupuncturists, chiropractors, primary care physicians, and physician acupuncturists in academic and community settings in California.
Data Collection Methods
We used a qualitative analysis of structured interviews to develop a conceptual model of integrative medicine at the provider level. Based on this conceptual model, we developed a 30-item survey (IM-30) to assess five domains of clinicians' orientation toward integrative medicine: openness, readiness to refer, learning from alternate paradigms, patient-centered care, and safety of integration.
Principal Findings
Two hundred and two clinicians (69 percent response rate) returned the survey. The internal consistency reliability for the 30-item total scale and the five subscales ranged from 0.71 to 0.90. Item-scale correlations for the five subscales were higher for the hypothesized subscale than other subscales 75 percent or more of the time. Construct validity was supported by the association of the IM-30 total scale score (0–100 possible range, with a higher score indicative of greater orientation toward integrative medicine) with hypothesized constructs: physician acupuncturists scored higher than physicians (71 versus 50, p<.001), dual-trained practitioners scored higher than single-trained practitioners (71 versus 62, p<.001), and practitioners' self-perceived “integrativeness” was significantly correlated (r=0.60, p<.001) with the IM-30 total score.
Conclusion
This study provides support for the reliability and validity of the IM-30 as a measure of clinicians' orientation toward integrative medicine. The IM-30 survey, which we estimate as requiring 5 minutes to complete, can be administered to both conventional and CAM clinicians.
doi:10.1111/j.1475-6773.2005.00425.x
PMCID: PMC1361208  PMID: 16174147
Integrative medicine; complementary and alternative medicine; clinicians' orientation; reliability; validity
7.  Self-Reported Use of Traditional, Complementary and Over-the-Counter Medicines by HIV-Infected Patients on Antiretroviral Therapy in Pretoria, South Africa 
Current management of HIV involves the use of conventional prescription medicines, called ‘antiretroviral drugs’ (ARV), over-the-counter (OTC), complementary and alternative medicines (CAM), as well as African traditional medicine (ATM). The aim of this study was to determine the prevalence of use of traditional, complementary and over-the-counter medicines. A cross-sectional survey of HIV-infected patients who started ART between July 2004 and August 2005 at Dr George Mukhari Hospital (Pretoria), who consented to be interviewed, was conducted. Using a pre-tested structured questionnaire, data were collected by two trained interviewers on sociodemographic characteristics, and on non-prescribed medicines used of three sources: African traditional medicine (ATM), complementary and alternative medicine (CAM), and over-the-counter (OTC) medicines. The 180 patients who consented to be interviewed had a mean age of 36.7 (±8.1) years old; 68.8% were female, 86.7% unemployed, 73.9% with high school level of education, 77.8% single. Some 8.9% of respondents used at least one non-prescribed medicine. In descending order, 4.4% of respondents used ATM, 3.3% CAM, and 1.7% OTC medicines. The ATM products used included unspecified traditional mixtures, and those made of the African potato (Hypoxis hemerocallidea), and coconut (Cocos nucifera); OTC products used were paracetamol and sennosides (Senokot®) tablets as well as a soap containing triclosan 1.5%; CAM products used were “sex booster” capsules of unknown composition, mercury-containing soaps (Mekako®), and the Zion Church of Christ special tea, a mixture of Rooibos tea (Aspalathus linearis) plus sunflower oil (Helianthus annuus) and prayed for. In conclusion, only 8.9% of HIV-infected patients on ART in this study used a limited range of over-the-counter products as well as those from traditional, complementary and alternative medicine practices.
PMCID: PMC2816484  PMID: 20161889
Traditional; complementary; medicines; HIV
8.  Changing Academic Medicine: Strategies Used by Academic Leaders of Integrative Medicine—A Qualitative Study 
In Western countries, complementary and alternative medicine (CAM) is more and more provided by practitioners and family doctors. To base this reality of health care provision on an evidence-base, academic medicine needs to be included in the development. In the study we aimed to gain information on a structured approach to include CAM in academic health centers. We conducted a semistructured interview study with leading experts of integrative medicine to analyze strategies of existing academic institutions of integrative medicine. The study sample consisted of a purposive sample of ten leaders that have successfully integrated CAM into medical schools in the USA, Great Britain, and Germany and the Director of the National Center for Alternative and Complementary Medicine. Analysis was based on content analysis. The prerequisite to foster change in academic medicine was a strong educational and professional background in academic medicine and research methodologies. With such a skill set, the interviewees identified a series of strategies to align themselves with colleagues from conventional medicine, such as creating common goals, networking, and establishing well-functioning research teams. In addition, there must be a vision of what should be needed to be at the center of all efforts in order to implement successful change.
doi:10.1155/2012/652546
PMCID: PMC3475364  PMID: 23093984
9.  Integrating complementary and alternative medicine into academic medical centers: Experience and perceptions of nine leading centers in North America 
Background
Patients across North America are using complementary and alternative medicine (CAM) with increasing frequency as part of their management of many different health conditions. The objective of this study was to develop a guide for academic health sciences centers that may wish to consider starting an integrative medicine program.
Methods
We queried North American leaders in the field of integrative medicine to identify initial sites. Key stakeholders at each of the initial sites visited were then asked to identify additional potential study sites (snowball sampling), until no new sites were identified. We conducted structured interviews to identify critical factors associated with success and failure in each of four domains: research, education, clinical care, and administration. During the interviews, field notes were recorded independently by at least two investigators. Team meetings were held after each visit to reach consensus on the information recorded and to ensure that it was as complete as possible. Content analysis techniques were used to identify key themes that emerged from the field notes.
Results
We identified ten leading North American integrative medical centers, and visited nine during 2002–2003. The centers visited suggested that the initiation of an integrative medicine program requires a significant initial outlay of funding and a motivated "champion". The centers had important information to share regarding credentialing, medico-legal issues and billing for clinical programs; identifying researchers and research projects for a successful research program; and strategies for implementing flexible educational initiatives and establishing a functional administrative structure.
Conclusion
Important lessons can be learned from academic integrative programs already in existence. Such initiatives are timely and feasible in a variety of different ways and in a variety of settings.
doi:10.1186/1472-6963-5-78
PMCID: PMC1343546  PMID: 16368000
10.  Experts’ opinions on terminology for complementary and integrative medicine – a qualitative study with leading experts 
Background
Integrative medicine (IM) is currently the most commonly used term to describe the integration of complementary and alternative medicine (CAM) into conventional medicine. In the definitions of IM the most important feature is the focus on evidence as crucial factor for therapeutic decision-making. However, there are discussions on the term “integrative medicine” with the most notable critique from within CAM that it describes the integration of complementary methods into conventional institutions and into a “conventional framework of thinking”. The aim of this qualitative study was to understand the thoughts of leading experts on IM and on the scientific debate in the field as well as their personal opinions about terminology in general.
Methods
We have conducted semi-standardized interviews with ten leading experts in the field of CAM and integrative medicine in the USA, England, and Germany, who have had leading positions at medical schools or the NIH in 2010 and 2011. Interviews were recorded, transcribed and analyzed using content analysis with the qualitative analysis software maxqda.
Results
Overall the current terminology was seen as a problem, although most experts agreed that the term “integrative medicine” (IM) described well what they do or they think is useful for medical care. The terminology debate was discussed from four perspectives: 1) from the perspective of medical practice, 2) from the perspective of research, 3) from the perspective of public relations, and 4) from the perspective of health care delivery. These perspectives may be used to evaluate the appropriateness of different terms in use in the field. When interviewees discussed the terminology question, they also discussed the type of health care system they envisioned. Such reflections led the interviewees to caution about too narrow a focus on the terminology question. The question of naming was one about influencing and changing medicine.
Conclusion
The discussion of the experts demonstrated that the discussion about terminology is an important debate about the shaping of medicine. The experts discussed terminology in the light of "how health care systems" should look like in the future.
doi:10.1186/1472-6882-12-218
PMCID: PMC3522550  PMID: 23151006
Integrative medicine; Complementary and alternative medicine; Terminology; Health care delivery system
11.  Complementary and Alternative Medicine (CAM) Competencies of Nursing Students and Faculty: Results of Integrating CAM Into the Nursing Curriculum 
As part of the National Center for Complementary and Alternative Medicine (CAM) R25 Education Grant Program, a faculty development program for integrating CAM into the nursing curriculum was instituted in 2003-2006. The Integrating CAM program comprised a number of elements; the primary strategy included a series of 4-week didactic and experiential summer CAM “camps,” attended by a total of 27 faculty members. Camps were designed to influence faculty integration of CAM material into course offerings. The Integrating CAM program was evaluated via a series of faculty and student surveys regarding CAM competencies, attitudes, and perceptions. For more than half of the faculty (out of the 43 who responded), the program yielded a moderate-to-strong influence on incorporation of CAM material into course content; and moderate-to-great increases in both enthusiasm for CAM and perceived CAM knowledge gains. Students at all levels (undergraduate, masters, doctoral; n = 184) reported that their courses contained CAM content; for 70% of students, their CAM knowledge increased; for 50% of students, level of CAM interest increased. Self-reported student CAM competencies were significantly greater in 2006-2007 (n = 191) than in 2003-2004 (n = 143). Results support the strategy of broadly infusing the nursing curriculum with CAM content via faculty development.
doi:10.1016/j.profnurs.2010.03.003
PMCID: PMC2947349  PMID: 20869029
Complementary medicine; Alternative therapies; Nursing curriculum; Nursing faculty; Nursing students
12.  Using a Web-based system to monitor practice profiles in primary care residency training 
Canadian Family Physician  2011;57(9):1030-1037.
Abstract
Objective
To explore the use of Web-based resident practice profiles (RPPs) as a means of tracking the clinical experiences of residents to ensure an adequate educational experience.
Design
Quantitative analysis of recorded patient encounters with residents.
Setting
The Department of Family and Community Medicine at St Michael’s Hospital in Toronto, Ont.
Participants
Twenty-seven residents enrolled in the department’s training program between July 1, 2006, and June 30, 2007.
Main outcome measures
The clinical experiences of residents with respect to patient demographic information, procedures performed, and diagnoses. Resident data were stratified by age, sex, training status, and source of medical degree, and RPPs were compared with patient profiles of physicians at the study site, at the university, and in provincial practices.
Results
A total of 9108 patient visits were recorded by the 27 residents during the academic year. Patient visit characteristics were very similar across all the resident variables except with respect to sex. The top 8 diagnoses encountered by residents were very similar to those of the comparison groups; anxiety or neurosis was the most common problem. Injections and Papanicolaou smears were the most common procedures, with 17.9 and 11.6 procedures, respectively, performed on average per resident during the study period.
Conclusion
The RPP is an excellent Web-based tool to capture the clinical experience of postgraduate trainees. The practice profiles of the resident group were very similar to those of physicians in the study site, the university, and the province, demonstrating that common diagnoses made in practice correlate well with the clinical experience in residency.
PMCID: PMC3173429  PMID: 21918150
13.  Use of complementary and alternative medicine by cancer patients at the University of Nigeria Teaching Hospital, Enugu, Nigeria 
Background
The use of Complementary and Alternative Medicine (CAM) by cancer patients is very common and varies between populations. The referenced English literature has no local study from Africa on this subject. This study was conducted to define the prevalence, pattern of use, and factors influencing the use of CAM by cancer patients at the University of Nigeria Teaching Hospital Enugu (UNTH-E), Nigeria
Method
Face-to-face interviews using semi-structured questionnaire were used to determine the use of CAM by cancer patients. All consenting cancer patients were interviewed as they presented at the core surgical units of the UNTH- E, from June 2003 to September 2005.
Results
160 patients were interviewed; 68 (42.5%) were males and 94 (57.5%) were females. Ages ranged from 13–86 years. Breast, urogenital system, gastrointestinal system, and soft tissue cancers predominated. One hundred and four patients (65.0%) have used CAM at some time during their current cancer illness; 56 (35.0%) patients have not used any form of CAM. There were more females than males among the non-CAM users. The use of CAM was not affected by age, marital status, level of education, religious affiliation, or socioeconomic status. The most frequently used CAMs were herbs (51.9%), faith/prayer healing (49.4%), aloe vera (23.1%), Forever Living Products (16.3%), medicinal tea (14.4%), and Blackstone (12.5%). Over 23% of those who used CAM were satisfied, but 68.3% were disappointed. Most users (67.3%) did not see any benefit from the CAM, but 25% could describe some specific benefits. More than 21% of users reported various unwanted effects. While 86.5% of CAM users will use orthodox medicine instead of CAM in the future, 9.6% will use the two together to help each other. Most users (79.8%) will not repeat CAM or recommend its use for cancer. The majority of patients (55.8%) did not mention their use of CAM to their doctors – mostly because the doctor did not ask.
Conclusion
CAM use is common among cancer patients in Nigeria. Most users do not obtain the expected benefits, and adverse events are not uncommon. Every clinician in the field of oncology should ask his/her patients about the use of CAM; this knowledge will enable them to better counsel the patients.
doi:10.1186/1472-6882-7-28
PMCID: PMC2034592  PMID: 17850665
14.  Personal Use of Complementary and Alternative Medicine (CAM) by U.S. Health Care Workers 
Health Services Research  2011;47(1 Pt 1):211-227.
Objective
To examine personal use of complementary and alternative medicine (CAM) among U.S. health care workers.
Data
Data are from the 2007 Alternative Health Supplement of the National Health Interview Survey. We examined a nationally representative sample of employed adults (n = 14,329), including a subsample employed in hospitals or ambulatory care settings (n = 1,280).
Study Design
We used multivariate logistic regression to estimate the odds of past year CAM use.
Principal Findings
Health care workers are more likely than the general population to use CAM. Among health care workers, health care providers are more likely to use CAM than other occupations.
Conclusions
Personal CAM use by health care workers may influence the integration of CAM with conventional health care delivery. Future research on the effects of personal CAM use by health care workers is therefore warranted.
doi:10.1111/j.1475-6773.2011.01304.x
PMCID: PMC3447237  PMID: 22092295
Complementary and alternative medicine; health care workforce; National Health Interview Survey
15.  Use of Complementary and Alternative Medicine by Cancer Patients at Zhejiang University Teaching Hospital Zhuji Hospital, China 
Complementary and alternative medicine (CAM) is garnering increasing interest and acceptance among the general population throughout the world. The use of CAM by cancer patients is very common in China. The referenced English literature has no rural community-based study from China on this subject. This study was conducted to define the prevalence, pattern of use, and reasons for using CAM by cancer patients at Zhejiang University Teaching Hospital Zhuji Hospital (ZUTH-ZJH), China. Face-to-face interviews using a structured questionnaire were used to determine the use of CAM by cancer patients. All consenting cancer patients were interviewed as they presented at the Department of Surgical Oncology of ZUTH-ZJH, from September 2009 to February 2010. One hundred and twenty one patients were interviewed; 64 (52.9%) were males and 57 (47.1%) were females. One hundred and thirteen patients (93.4%) have used CAM at some time during their current cancer illness, fifty two (46.0%) are female and sixty one (54.0%) are male patients; 8 (6.6%) patients have not used any form of CAM. Chinese medicine (73.5.0%) was the most commonly reported CAM modality. Over 71.7% of those who used CAM were satisfied, only 28.3% were disappointed. Twenty eight users (24.8%) did not see any benefit from the CAM, but eighty one patients (71.7%) could describe some specific benefits. Only one patient will use orthodox medicine instead of CAM in the future, almost all patients will continue to use CAM in the future. CAM use is very common among cancer patients in local area of China. Most users obtain the expected benefits, and adverse events are uncommon. It is imperative that oncologists should explore the use of CAM with their cancer patients and work towards an integrated model of health-care provision. This knowledge will enable oncologists to better counsel the patients.
PMCID: PMC3005395  PMID: 21731164
complementary and alternative medicine; cancer; China
16.  Integrating complementary and alternative medicine into mainstream healthcare services: the perspectives of health service managers 
Background
Complementary and alternative medicine (CAM) is increasingly included within mainstream integrative healthcare (IHC) services. Health service managers are key stakeholders central to ensuring effective integrative health care services. Yet, little research has specifically investigated the role or perspective of health service managers with regards to integrative health care services under their management. In response, this paper reports findings from an exploratory study focusing exclusively on the perspectives of health service managers of integrative health care services in Australia regarding the role of CAM within their service and the health service managers rational for incorporating CAM into clinical care.
Methods
Health service managers from seven services were recruited using purposive and snowball sampling. Semi-structured interviews were conducted with the health service managers. The services addressed trauma and chronic conditions and comprised: five community-based programs including drug and alcohol rehabilitation, refugee mental health and women’s health; and two hospital-based specialist services. The CAM practices included in the services investigated included acupuncture, naturopathy, Western herbal medicine and massage.
Results
Findings reveal that the health service managers in this study understand CAM to enhance the holistic capacity of their service by: filling therapeutic gaps in existing healthcare practices; by treating the whole person; and by increasing healthcare choices. Health service managers also identified CAM as addressing therapeutic gaps through the provision of a mind-body approach in psychological trauma and in chronic disease management treatment. Health service managers describe the addition of CAM in their service as enabling patients who would otherwise not be able to afford CAM to gain access to these treatments thereby increasing healthcare choices. Some health service managers expressly align the notion of treating the whole person within a health promotion model and focus on the relevance of diet and lifestyle factors as central to a CAM approach.
Conclusions
From the perspectives of the health service managers, these findings contribute to our understanding around the rationale to include CAM within mainstream health services that deal with psychological trauma and chronic disease. The broader implications of this study can help assist in the development of health service policy on CAM integration in mainstream healthcare services.
doi:10.1186/1472-6882-14-167
PMCID: PMC4048459  PMID: 24885066
Integrative healthcare; Integrative medicine; Complementary and alternative medicine (CAM); Health services research; Chronic disease management; Psychological trauma management; Drug and alcohol rehabilitation
17.  A tale of two cultures: examining patient-centered care in a forensic mental health hospital 
Several questions remain unanswered regarding the extent to which the principles and practices of patient-centered care are achievable in the context of a forensic mental health hospital. This study examined patient-centered care from the perspectives of patients and providers in a forensic mental health hospital. Patient-centered care was assessed using several measures of complementary constructs. Interviews were conducted with 30 patients and surveys were completed by 28 service providers in a forensic mental health hospital. Patients and providers shared similar views of the therapeutic milieu and recovery orientation of services; however, providers were more likely to perceive the hospital as being potentially unsafe. Overall, the findings indicated that characteristics of patient-centered care may be found within a forensic mental health hospital. The principles of patient-centered care can be integrated into service delivery in forensic mental health hospitals, though special attention to providers’ perceptions of safety is needed.
doi:10.1080/14789949.2012.668214
PMCID: PMC3396355  PMID: 22815648
forensic mental health; patient-centered care; recovery; stigma; empowerment
18.  Exploring the roles of librarians and health care professionals involved with complementary and alternative medicine* 
Objectives: The researcher conducted qualitative research about the role of health care professionals and librarians involved with complementary and alternative medicine (CAM). The goals were to identify resources these professionals use to explore the librarians' role as well as their approaches to teaching and searching with respect to CAM, to acquire information about CAM education, and to connect with other librarians in the CAM field.
Methods: Semi-structured interviews with open-ended questions were used.
Results: Sixteen health care and information professionals from ten different institutions in Boston, Baltimore, and Calgary were interviewed. Major themes from the interviews were: CAM funding, integration of CAM and conventional medicine, roles of librarians, “hot” CAM issues, and information access. Information about four aspects of CAM education—technology, undergraduate, graduate, and continuing—is presented. A wealth of information resources was identified.
Conclusions: A CAM librarian's role is unique; many specialize in specific areas of CAM, and opportunities exist for librarians to partner with CAM groups. CAM information professionals' major roles involve information access and retrieval and education. Further study is required concerning CAM consumer health, integrative CAM and conventional medicine models, and the librarian's role in a CAM environment. CAM funding is a major concern.
PMCID: PMC1324776  PMID: 16404474
19.  Integrated medicine in the management of chronic illness: a qualitative study 
Background
Complementary and alternative medicine (CAM) is popular with patients, yet how patients use CAM in relation to orthodox medicine (OM) is poorly understood.
Aim
To explore how patients integrate CAM and OM when self-managing chronic illness.
Design of study
Qualitative analysis of interviews.
Method
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.
Results
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.
Conclusion
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.
doi:10.3399/bjgp11X556254
PMCID: PMC3026175  PMID: 21276333
complementary medicine; chronic disease; qualitative
20.  Adverse events associated with paediatric use of complementary and alternative medicine: Results of a Canadian Paediatric Surveillance Program survey 
Paediatrics & Child Health  2009;14(6):385-387.
BACKGROUND
Despite many studies confirming that the use of complementary and alternative medicine (CAM) by children is common, few have assessed related adverse events.
OBJECTIVE
To conduct a national survey to identify the frequency and severity of adverse events associated with paediatric CAM use.
METHODS
Survey questions were developed based on a review of relevant literature and consultation with content experts. In January 2006, the Canadian Paediatric Surveillance Program distributed the survey to all paediatricians and paediatric subspecialists in active practice in Canada.
RESULTS
Of the 2489 paediatricians who received the survey, 583 (23%) responded. Respondents reported that they asked patients about CAM use 38% of the time and that patients disclosed this information before being questioned only 22% of the time. Forty-two paediatricians (7%) reported seeing adverse events, most commonly involving natural health products, in the previous year. One hundred five paediatricians (18%) reported witnessing cases of delayed diagnosis or treatment (n=488) that they attributed to the use of CAM.
CONCLUSION
While serious adverse events associated with paediatric CAM appear to be rare, delays in diagnosis or treatment seem more common. Given the lack of paediatrician-patient discussion regarding CAM use, our findings may under-represent adverse events. A lack of reported adverse events should not be interpreted as a confirmation of safety. Active surveillance is required to accurately assess the incidence, nature and severity of paediatric CAM-related adverse events. Patient safety demands that paediatricians routinely inquire about the use of CAM.
PMCID: PMC2735381  PMID: 20592974
Adverse effects; Complementary therapies; Health survey; Manipulation; Natural products; Paediatrics; Spinal
21.  Perceptions of Physiotherapy Best Practice in Total Knee Arthroplasty in Hospital Outpatient Settings 
Physiotherapy Canada  2011;63(2):234-241.
ABSTRACT
Purpose: The primary purpose of this study was to examine experienced physiotherapists' perceptions of best practices for patients following total knee arthroplasty (TKA) in publicly funded outpatient hospital settings in the Greater Toronto Area (GTA). The secondary objective was to identify the facilitators of and barriers to implementing best practices in the subacute phase of rehabilitation.
Methods: A qualitative, descriptive, focused ethnographic approach was used to explore physiotherapists' perceptions of best practices for patients with TKA. In-depth semi-structured interviews were conducted with expert physiotherapists acting as key informants. A snowball sampling method was used to recruit physiotherapists in the GTA. Interviews were conducted in person by two of the investigators.
Results: Physiotherapists from seven acute-care hospitals in the GTA participated in the study. Analysis of the 140 pages of transcripts from the interviews with 10 physiotherapists revealed that participants perceived best practices as encompassing the adoption of a client-centred approach; inter-professional collaboration; aggressive rehabilitation for patients who are unsuccessful in achieving their outcomes; the use of relevant outcome measures; and consideration of the impact of scarce resources on care.
Conclusions: The findings of this study highlight physiotherapists' perceived best practices for patients with TKA and the unique contribution that hospital-based outpatient physiotherapy can make to patients' rehabilitation.
doi:10.3138/ptc.2010-09
PMCID: PMC3076904  PMID: 22379264
best practice; osteoarthritis; physiotherapy; total knee arthoplasty; arthroplastie totale du genou; arthrose; physiothérapie; pratique exemplaire
22.  Necessary alternatives: patients’ views of asthma treatment 
This article is based on semistructured interviews and focus groups conducted with 27 asthma patients in The Netherlands who chose complementary and alternative medicine (CAM) for treatment of their condition. All subjects were contacted through an online forum for asthma patients hosted by the Dutch Asthma Foundation. Nineteen subjects (12 women and seven men) between the ages of 29 and 65 years participated in the interviews, held between June 2009 and January 2010. All of the participating subjects had experience with conventional medications, including anti-inflammatory corticosteroids and bronchodilators. For the focus group meeting, held in February 2010, the sample included seven subjects (four women and three men) between the ages of 31 and 46 years, none of whom had ever used conventional medication and all of whom were using CAM. All subjects in the sample had been diagnosed with asthma by their physician or lung specialist. The study examined the causes of patient noncompliance with the prescribed medical regime. It is argued that evidence-based rationality on the part of subjects is an overlooked dimension of their experience of asthma. This study demonstrates the role that the patients’ social network, including medical practitioners, friends, and family, and other asthmatics, plays in the process of decision-making and choices about treating asthma. It also demonstrates the role of patients’ information-searching strategies. The author concludes that patient noncompliance with commonly prescribed medication and selection of alternative medical treatment is less a matter of denial of their diagnosis or the severity of their illness, but more a matter of choice informed by evidence-based rationality.
PMCID: PMC2898120  PMID: 20622919
asthma; complementary alternative and medicine (CAM); evidence-based medicine (EBM); patient non-compliance; decision-making; indentity
23.  A survey of Canadian regulated complementary and alternative medicine schools about research, evidence-based health care and interprofessional training, as well as continuing education 
Background
While some effort has been made to integrate complementary and alternative medicine (CAM) information in conventional biomedical training, it is unclear whether regulated Canadian CAM schools’ students are exposed to research activities and continuing education, or whether topics such as evidence-based health care and interprofessional collaboration (IPC) are covered during their training. Since these areas are valued by the biomedical training field, this may help to bridge the attitudinal and communication gaps between these different practices. The aim of this study was to describe the training offered in these areas and gather the perceptions of curriculum/program directors in regulated Canadian CAM schools.
Methods
A two-phase study consisting of an electronic survey and subsequent semi-structured telephone interviews was conducted with curriculum/program (C/P) directors in regulated Canadian CAM schools. Questions assessed the extent of the research, evidence-based health care, IPC training and continuing education, as well as the C/P directors’ perceptions about the training. Descriptive statistics were used to describe the schools’, curriculum’s and the C/P directors’ characteristics. Content analysis was conducted on the interview material.
Results
Twenty-eight C/P directors replied to the electronic survey and 11 participated in the interviews, representing chiropractic, naturopathy, acupuncture and massage therapy schools. Canadian regulated CAM schools offered research and evidence-based health care training as well as opportunities for collaboration with biomedical peers and continuing education to a various extent (58% to 91%). Although directors were generally satisfied with the training offered at their school, they expressed a desire for improvements. They felt future CAM providers should understand research findings and be able to rely on high quality research and to communicate with conventional care providers as well as to engage in continuing education. Limited length of the curriculum was one of the barriers to such improvements.
Conclusions
These findings seem to reinforce the directors’ interest and the importance of integrating these topics in order to ensure best CAM practices and improve communication between CAM and conventional providers.
doi:10.1186/1472-6882-13-374
PMCID: PMC3877872  PMID: 24373181
Complementary and alternative medicine; Continuing education; Curriculum development; Evidence-based health care training; Interprofessional training; Research training
24.  New Canadian natural health product regulations: a qualitative study of how CAM practitioners perceive they will be impacted 
Background
New Canadian policy to regulate natural health products (NHPs), such as herbs and vitamins were implemented on January 1st, 2004. We explored complementary and alternative medicine (CAM) practitioners' perceptions of how the new regulations may affect their practices and relationships with patients/consumers.
Methods
This was an applied ethnographic study. Data were collected in fall 2004 via qualitative interviews with 37 Canadian leaders of four CAM groups that use natural products as a core part of their practises: naturopathic medicine, traditional Chinese medicine (TCM), homeopathic medicine and Western herbalism. All interviews were transcribed verbatim and coded independently by a minimum of two investigators using content analysis.
Results
Three key findings emerged from the data: 1) all CAM leaders were concerned with issues of their own access to NHPs; 2) all the CAM leaders, except for the homeopathic leaders, specifically indicated a desire to have a restricted schedule of NHPs; and 3) only naturopathic leaders were concerned the NHP regulations could potentially endanger patients if they self-medicate incorrectly.
Conclusion
Naturopaths, TCM practitioners, homeopaths, and Western herbalists were all concerned about how the new NHP regulations will affect their access to the products they need to practice effectively. Additional research will need to focus on what impacts actually occur as the regulations are implemented more fully.
doi:10.1186/1472-6882-6-18
PMCID: PMC1481533  PMID: 16686960
25.  Complementary medicine use among Moroccan patients with cancer: A descriptive study 
Background
Complementary and alternative medicine (CAM) is a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine. As cancer incidence rates and survival time increase, use of CAM will likely increase. However, little is known about the use of CAM in cancer patients, specifically in emerging countries.
Methods
We conducted a study in the medical oncology department at the University Hospital of Fez on the use of complementary medicine among cancer patient. The aims of this study were to estimate and describe the reasons of use of complementary medicine (CM) in patients with a cancer treated in a Moroccan oncology department. A specially designed questionnaire was completed for patient during treatment or follow-up in the oncology department after formal consent was obtained. It was a descriptive study among 100 patients over a period of 6 months between September 2008 and February 2009.
Results
A total of 100 patients participated in the study, 46 of them were identified as users of complementary medicine. The most substances used were plants 24%, pure honey 13% and water of Zem Zem (holy water from Mecca) 11%. Concerning techniques, religious practices 37%, special diets 22% and recourse to traditional healers 11% were most commonly used. No specific user profile was observed depending of different sociodemograhics and clinical parameters. The majority of the users of complementary medicine were not revealing their habits to their oncologist because the question was not raised in consultation.
Conclusion
It seems that medical doctors should ask patients about their use of complementary medicine when they obtain medical history and they need to know more about complementary medicine to offer better consultation. Complementary medicine must benefit, as well as conventional medicine, from scientific studies to evaluate potential benefits, toxicity and interactions with the conventional treatment to enable the oncologist better inform his patients.
PMCID: PMC3240925  PMID: 22187618
Complementary medicine; cancer; alternative medicine; Morocco

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