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Supporting Integrative Medicine research through an Australasian practice-based research network

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Abstract

Integrative Medicine (IM) where evidence-based traditional, natural and complementary medicine is combined with conventional medicine is widely practiced in both Australia and New Zealand, mostly in the primary care setting. Whilst IM incorporates a number of practices, Integrative Medical Practitioners is a term that is generally used in Australasia to describe medical practitioners who integrate conventional and complementary medicine to provide holistic, patient-centred, multidisciplinary care. There is a paucity of research in both countries and internationally describing current practice and clinical outcomes of IM.

This paper presents the case for establishing the first practice based research network (PBRN) for self-identified Australasian IM practitioners and IM clinics. The network would aim to link IM healthcare providers with academics to undertake relevant research able to inform clinical practice and policy. The opportunities, challenges and lessons learnt from other PBRNs are discussed and a way forward is proposed.

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.

References (46)

  • C.C.L. Xue et al.

    Complementary and alternative medicine use in Australia: a national population-based survey

    J. Altern. Complement. Med.

    (2007)
  • R. Reid et al.

    Complementary medicine use by the Australian population: a critical mixed studies systematic review of utilisation, perceptions and factors associated with use

    BMC Complement. Altern. Med.

    (2016)
  • M.J. Pledger et al.

    Health service use amongst users of complementary and alternative medicine

    N. Z. Med. J.

    (2010)
  • M. Pirotta et al.

    Complementary medicine in general practice – a national survey of GP attitudes and knowledge

    Aust. Fam. Physician

    (2010)
  • J. Brown et al.

    Complementary Medicines Information Use and Needs of Health Professionals: General Practitioners and Pharmacists

    (2009)
  • J. Hunter et al.

    The challenges of establishing an integrative medicine primary care clinic in Sydney, Australia

    J. Altern. Complement. Med.

    (2012)
  • NHMRC

    Talking with Your Patients About Complementary Medicine – A Resource for Clinicians

    (2014)
  • Australian Integrative Medicine Association, What is integrative medicine?...
  • J. Hunter

    ntegrative Medicine Directions Report

    (2009)
  • S. Grace et al.

    Integrative medicine: enhancing quality in primary health care

    J. Altern. Complement. Med.

    (2010)
  • J. Hunter et al.

    The integrative medicine team—is biomedical dominance inevitable?

    J. Altern. Complement. Med.

    (2012)
  • S.J. Grant et al.

    Process of care in outpatient integrative healthcare facilities: a systematic review of clinical trials

    BMC Health Serv. Res.

    (2015)
  • B. Gray et al.

    Investigation into factors influencing roles, relationships, and referrals in integrative medicine

    J. Altern. Complement. Med.

    (2014)
  • Cited by (0)

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