ReviewSupporting Integrative Medicine research through an Australasian practice-based research network
Introduction
Integrative Medicine (IM) is a term that has appeared alongside the growing trend of complementary medicine (CM) use in Australia and New Zealand [1], [2], [3], [4], [5], [6]. CM refers to a broad range of natural, traditional and alternative healthcare interventions, products, medicines and therapies that typically fall outside the domain of conventional medicine [7]. The boundaries can be blurred however, especially with the selective incorporation of evidence-based CM into mainstream medical practice [8]. Whilst IM incorporates a number of practices including CM (see Box 1) [9], in Australasia, the term IM Practitioners commonly refers to medical practitioners who practice IM, often in the context of a multidisciplinary IM team [8], [10], [11].
The exact number of IM doctors in Australasia is unknown. A 2008 Australia-wide survey of (General Practitioners) GPs suggests that up to a third of GPs self-identify as practicing IM that was defined as “a holistic approach to health care that integrates conventional medical care with complementary therapies” [5]. Notwithstanding concerns about selection bias, the results from this survey posit that the use of CM in clinical practice and the practice of IM by Australian GPs is significant.
Exponents of IM claim improved patient outcomes, especially for complex health problems, comorbidity, and disease prevention [12]. Little is known however about the specifics of IM practice in Australasia, particularly IM clinical and economic outcomes. Although some studies have been conducted, these have been largely descriptive, focusing on prevalence of CM use and practice, or practitioner attitudes and knowledge [4], [5], [6], [11], [13], [14], [15], [16], [17], [18].
A practice-based research network (PBRN) linking self-identified medical practitioners who are either practicing IM or working in an IM clinic, could support a wide range of research that critically and rigorously examines IM.
Section snippets
Practice based research networks
The primary focus of a PBRN is to facilitate research by connecting and matching researchers with clinicians. It enables members to propose research topics and studies, participate in research and utilise the results [19], [20] (Box 2).
One of the earliest examples of a PBRN is the Scottish Primary Care Research Network that was established in 1924 [21]. The number of PBRNs across the globe has continued to increase. For example, in 2011, the Agency for Healthcare Research and Quality's PBRN
The case for an Australasian IM-PBRN
Australasian IM practitioners are already affiliated through two IM professional bodies: The Australasian Integrative Medicine Association and the Australasian College of Nutritional and Environmental Medicine. The Royal Australian College of General Practice – Specific Interests Integrative Medicine Working Group, the Australian Medical Acupuncture Association and the Medical Acupuncture Society of New Zealand all represent Australasian IM doctors. Given that the total number of IM
Challenges and lessons learnt from existing PBRNs
PBRNs are not without their challenges. These include establishing a sense of identity; recruiting members and ensure their tangible, ongoing engagement in research; designing and conducting high quality, clinically relevant research; and securing a sustainable management and funding structure [19], [20], [21], [40], [41], [42]. Strong leadership and clear governance is needed to maintain a shared vision that recognises the unique patient population and approach to clinical management [19].
A
Organisational structure and funding
The organisational structure of a PBRN typically includes a network director, an administrative coordinator and an advisory board/committee composed of representative members of the PBRN and affiliated academics. Project managers, research assistants and statisticians are often engaged on an ad-hoc basis [19]. Larger, longstanding networks may employ practice facilitators that provide ongoing outreach and training for quality-improvement of studies and achieving other shared goals [19].
Next steps
Representatives from IM professional bodies need to meet and further discuss the possibility of establishing an Australasian IM-PBRN. The conversation could be facilitated by an academic institution who is motivated and has capacity to support the project. Following provisional endorsement, a scoping committee representing practitioners, academics and patients would need to be assembled to further the project.
The aims and objectives of the network will help determine the appropriate
Conclusions
Australasian IM practitioners and clinics are well placed to collaborate in establishing an IM-PBRN. The representative countries have strong primary care services and joint professional bodies that represent self-identified IM practitioners. Establishing this PRBN will help foster much needed high-quality research that is embedded in service delivery and is able to inform healthcare services and policy.
Authors contribution
We advise that all authors contributed significantly to this paper and are in agreement with the content of the manuscript. JH conceived and wrote the paper. The other authors provided considerable expertise and advice on the content.
Conflict of interest
The authors declare no conflicts of interest
Acknowledgements
Thank you to Dr Jon Wardle for his expert advice and to the board members of the Australasian Integrative Medicine Association and Australasian College of Nutritional and Environmental Medicine for their comments and input.
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