The integration of complementary therapies in Australian general practice: results of a national survey.

The integration of complementary therapies in Australian general practice: results of a national survey.

Cohen, M. Penman, S., Pirotta, M., Da Costa, C. The Integration of Complementary Therapies in Australian General Practice: Results of a National Survey. Journal of Alternative and Complementary Medicine. 2005 11(6), 995-1004 

Abstract

 

METHODS:
Australian general practitioners’ (GPs) attitudes toward and use of a range of complementary therapies (CTs) were determined through a self-administered postal survey sent to a random sample of 2000 Australian GPs. The survey canvassed GPs’ opinions as to the harmfulness and effectiveness of CTs; current levels of training and interest in further training; personal use of, and use in practice of, CTs; referrals to CT; practitioners; appropriateness for GPs to practice and for government regulation; perceived patient demand and the need for undergraduate education.
RESULTS:
The response rate was 33.2%. Based on GPs’ responses, complementary therapies could be classified into: nonmedicinal and nonmanipulative therapies, such as acupuncture, massage, meditation, yoga, and hypnosis, that were seen to be highly effective and safe; medicinal and manipulative therapies, including chiropractic, Chinese herbal medicine, osteopathy, herbal medicine, vitamin and mineral therapy, naturopathy, and homeopathy, which more GPs considered potentially harmful than potentially effective; and esoteric therapies, such as spiritual healing, aromatherapy, and reflexology, which were seen to be relatively safe yet also relatively ineffective. The risks of CTs were seen to mainly arise from incorrect, inadequate, or delayed diagnoses and interactions between complementary medications and pharmaceuticals, rather than the specific risks of the therapies themselves.
CONCLUSIONS:
Nonmedicinal therapies along with chiropractic are widely accepted in Australia and can be considered mainstream. GPs are open to training in complementary therapies, and better communication between patients and GPs about use of CTs is required to minimize the risk of adverse events. There is also a need to prioritize and provide funding for further research into the potential adverse events from these therapies and other therapies currently lacking an evidence base.

The challenges and future direction for integrative medicine in clinical practice

The challenges and future direction for integrative medicine in clinical practice

Cohen, M. The Challenges and Future Direction for Integrative Medicine in Clinical Practice. Evidence Based Integrative Medicine. 2005 2(3)117-122

Abstract

 

The best medical practice involves the integration of the therapies taken from the full range of available healthcare options, applied after considering the circumstances of each individual patient. This requires a knowledge of both conventional and non-conventional therapies along with a consideration of the personal preferences of both the practitioner and the patient in the context of informed consent, the strength of the available scientific evidence, the range of possible alternatives, the associated costs and risks versus the potential benefits of treatment, as well as the availability, accessibility and immediacy of treatment. Effective integration is often difficult to achieve as there are many obstacles to the implementation of complementary and alternative medicine (CAM) in mainstream practice. These include the credentialing and regulation of complementary therapists, the development of appropriate funding models for supporting the delivery of CAM services within the mainstream health system, along with obstacles around the production, dissemination and use of evidence about CAM, as the hurdles for producing and evaluating evidence are often placed considerably higher for CAM than for conventional medicine. A further obstacle to integration relates to interdisciplinary collaboration that is hampered by differences in philosophy and nomenclature between disciplines, few interdisciplinary associations or forums where interdisciplinary issues can be discussed, along with competition for clients and unequal status and access to public funding. Despite these obstacles, progress is being made. The research base for CAM is continually expanding, there is a growing recognition of the need for cross-training of conventional and complementary practitioners, and complementary therapies such as yoga, massage, meditation and hypnosis appear to be widely accepted in mainstream general practice. However, this acceptance may be based on the perception that these therapies are relatively safe and do not threaten to usurp the role of the general practitioner rather than scientific evidence of their efficacy and safety. Collaboration requires an environment of shared understanding, mutual respect and trust. The fostering of interdisciplinary collaboration therefore requires open communication between patients, conventional medical practitioners and complementary therapists along with appropriate education and training programmes. As the practice of medicine is also intricately linked with the socio-political and cultural environment, the successful implementation of integrative medicine will also require a cultural shift across the public and private sector that creates an imperative for all health professionals to work together for the benefit of their patients and the wider community.

The practice and regulatory requirements of naturopathy and western herbal medicine in Australia

The practice and regulatory requirements of naturopathy and western herbal medicine in Australia

Lin, V., McCabe, P., Bensoussan, A., Myers, S, Cohen, M, Hill, S., Howse, G., The practice and regulatory requirements of naturopathy and western herbal medicine in Australia, Risk Management and Health Care Policy 2009:2 1–13

Abstract

 

Australian health workforce regulation is premised on the need to protect public health and safety. Specific criteria are set out by governments to ascertain the degree of risk and the need for government intervention. A study was undertaken to understand the current state of usage and the practice of naturopathy and western herbal medicine, and to ascertain whether statutory regulation was warranted. We found increased use of these complementary therapies in the community, with risks arising from both the specific practices as well as consumers negotiating a parallel primary health care system. We also found highly variable standards of training, a myriad of professional associations, and a general failure of current systems of self-regulation to protect public health and safety. Statutory regulation was the preferred policy response for consumers, insurers, general practitioners, and most of the complementary therapists. While we found a case for statutory registration, we also argue that a minimalist regulatory response needs to be accompanied by other measures to educate the public, to improve the standards of practice, and to enhance our understanding of the interaction between complementary and mainstream health care.

Best practice for integrative medicine in Australian medical practice

Best practice for integrative medicine in Australian medical practice

Kotsirilos, V., Cohen, M.,  Hassed, C., Phelps, K, Pirotta, M.., Prince, M., Sali, A., Singleton, G., Thomas, L., Warnecke, E.,(2014)Best Practice for Integrative Medicine in Australian Medical Practice: Australasian Integrative Medicine Association Position Paper Advances in Integrative Medicine. 69-84.

Abstract

 

The ‘Best Practice for Integrative Medicine in Australian Medical Practice’ is an Australasian Integrative Medicine Association (AIMA) endorsed document as principles to assist medical practitioners for the safe and appropriate integration of evidence-based complementary medicine into medical practice. In Australia, the use of Integrative Medicine (IM) by medical practitioners, particularly general practitioners (GPs) as a part of routine clinical practice is increasing. A National Prescribing Survey (NPS) survey indicated that approximately 30% of GPs in Australia describe themselves as practising IM. About two thirds of Australian consumers have used one or at least one CM in the previous 12 months, with 28% on a regular basis. The document is designed to assist the understanding of IM by the medical profession and for authorities to refer to when seeking guidelines in this field of medicine. The authors undertook an extensive consultation process to develop these principles.