One of the most intriguing trends in healthcare improvement is the formation of initiatives that are accelerating interprofessional education (IPE) among a range of health and medical professions. One of the most promising of these is the Integrative Medicine in Preventive Medicine Education program (IMPriME) that is being managed by the American College of Preventive Medicine (ACPM).
In Oct. 2012, the Health Resources and Services Administration (HRSA) awarded a cooperative agreement to ACPM to create and manage a National Coordinating Center for Integrative Medicine (NccIM). The first task for this first federally funded organization with “integrative medicine” in its name is to support 12 simultaneously awarded Integrative Medicine Program grants made to the preventive medicine residency programs at the following medical schools.
- Loma Linda University School of Medicine
- University of California San Diego School of Medicine
- Griffin Hospital, Derby, Conn.
- Rutgers New Jersey Medical School, Newark
- Boston Medical Center
- University of New Mexico School of Medicine, Albuquerque
- Johns Hopkins Bloomberg School of Public Health, Baltimore
- University of Maryland School of Medicine, Baltimore
- University of Michigan School of Public Health, Ann Arbor
- University of North Carolina School of Medicine, Chapel Hill
- University of South Carolina School of Medicine, Columbia
- Meharry Medical College School of Medicine, Nashville
The IMPriME program is a tangible representation of the growing sentiment that cross-discipline healthcare solutions are needed to address multi-factor health conditions that are prevalent in the lifestyle-gone-wrong era of chronic disease. After a 2010 Lancet Commission report on interdependent health professional education for the 21st century, the Institute of Medicine (IOM) established its Global Forum on Innovation in Health Professional Education. This 61-member group has conducted a series of workshops that follow the Forum’s goal, “To apply an ongoing, multi-national, multi-disciplinary approach to exploring promising innovations in health education.”[1]
[See also: Marketing integrative medicine: A hospital-centered approach.]
In May of this year, the Forum released a summary of its two 2012 workshops: “Interprofessional Education for Collaboration: Learning How to Improve Health from Interprofessional Models across the Continuum of Education to Practice – Workshop Summary.”[2] The IOM website reports that “the workshops set the stage for defining and understanding IPE and provided living histories of speakers from around the world who shared experiences working in and between Interprofessional education and Interprofessional or collaborative practice.”
Like the membership of the IOM Forum, the advisory board of the NccIM represents disciplines from across the health education spectrum in the U.S. The IMPriME program is supporting faculty development and training, collecting data and conducting evaluations, and planning to disseminate best practices during the two-year program.
This year, and into 2014, IMPriME is producing a series of webinars that focus on the roles and expertise that the grantee schools bring to the program. Titles of the initial hour-long presentations include:
- Lifestyle Medicine Competencies (Loma Linda U)
- An Integrative Approach to Pain Management (U of Maryland)
- Maximizing Health – Herbal Basics for the Preventive Medicine Physician (U of Michigan)
- Incorporating Integrative Medicine Training into a Preventive Medicine/Public Health Residency: A Place for Inter-professional Education (Rutgers)
- The Short- and Long-term Health Benefits of Mindful Movement (UC San Diego)
While the passage of integrative medicine into any conventional medical precinct can be problematic, the instruction in the IMPriME program is based on a foundation of rigorously attained academic, research, and clinical experience developed and refined over many years, largely at academic health centers of integrative medicine.
The July 2013 IMPriME webinar, Integrative Pain Management, also serves as a primer on integrative medicine writ large. I cannot recommend it more highly for anyone interested in understanding how and why integrative medicine continues to gain acceptance. The presentation[3] was made by Delia Chiaramonte, MD, associate director and director of education at the Center for Integrative Medicine (CIM) at the University of Maryland School of Medicine in Baltimore. The Maryland CIM has been a leading center for research into and clinical application of integrative medicine since the National Institutes of Health first started funding investigations into complementary and alternative medicine in the early 1990s. The experience with pain has been a constant focus of this work, and the CIM has provided clinical services to other Maryland Medical System units, including the R Adams Cowley Shock Trauma Center.
Chiaramonte’s presentation is an easily understood description of the clinical and healing tenets of integrative medicine and how they apply to treating chronic pain. She explains that a great impetus for the work is to develop non-pharmaceutical pain management options, as narcotics continue to have devastating effects. (The CDC reported this past summer that painkiller overdose is increasing, especially among women: “Women are more likely to have chronic pain, be prescribed prescription painkillers, be given higher doses, and use them for longer time periods than men. Women may become dependent on prescription painkillers more quickly than men.”[4])
The “whole-person-health” ethos that underlies all of integrative medicine is on full display in the presentation. As do many integrative medicine and health practitioners and faculty, Chiaramonte employs a good old Wellness Wheel to take participants through the diagnostic and treatment-defining processes for her sample patient. As she drills down into each slice of the wheel, the fully developed and related assortment of whole-person care tools and techniques, both conventional and complementary, are vividly evident. Chiaramonte says in essence this is a matter of using “all available tools.”
Prepared for preventive medicine resident students, the presentation is also worth viewing to understand how an integrative medicine approach might be applied to other chronic conditions. It also helps explain why complementary and integrative care approaches appeal to patients and why many of these approaches—requiring multiple therapies over extended time—defy the methodologies of random controlled trials (RCTs).
The non-reimbursable nature of most integrative elements was noted by a webinar participant who raised the inevitable question attendant to any integrative intervention: the multi-faceted therapeutic treatment for pain; such treatment “… is hypothetically great, but I can’t imagine reimbursement (for all these modalities). How can this be overcome?”
“Show that the approach works better and saves money,” Chiaramonte responded. Noting that the use of even MD-prescribed painkillers often results in long, arduous, and costly complications, she said that integrative alternatives are demonstrating better cost and health outcomes. “It’s the only hope,” she said. Research into the cost-reducing outcomes of integrative approaches is evolving quickly, but it remains somewhat fragmented. The formation of the NccIM itself is a testimony to a level of acceptance of the financial value of integrative approaches.
“Part of what we do here [at the Maryland Center for Integrative Medicine],” Chiaramonte said, “is to teach medical students about the integrative approach to care. Some day all physicians will know this and it won’t be weird or different. This is why the HRSA grant is so important.”
Including integrative medicine professionals and academic programs in transformative health improvement venues—from IPE workshops to federally funded medical education programs—reflects not only the established awareness of these approaches, but it indicates the need to find a place for them as additional therapeutic tools, as Chiaramonte says, in this era that badly needs effective resolution and prevention of lifestyle-based illnesses.
NOTES
[1] A description of the Forum, with a link to its membership, is here: http://www.iom.edu/Activities/Global/InnovationHealthProfEducation.aspx
[2] The report is available at http://www.iom.edu/Reports/2013/Interprofessional-Education-for-Collabor.... (IOM workshops reflect the thinking of the participants, not any conclusions of the IOM. The most recent workshop meeting took place in Washington, DC in early October.)
[3] Dr. Chiaramonte’s slides and audio are the second on this IMPriME website: http://www.acpm.org/?IMPriMEWebinars#2
[4] “Prescription Painkiller Overdoses: A growing epidemic, especially among women,” CDC Vital Signs, July 2013 http://www.cdc.gov/vitalsigns/PrescriptionPainkillerOverdoses/index.html
Republished with permission from the Altarum Institute.