Agishi, Tetsuzo. Incentive for a shift from modern scientific medicine to integrative medicine. J Artif Organs 2006, 9, 123–129.
Abstract Medicine has been evaluated in recent years both quantitatively and qualitatively. Contemporary medicine has been assumed to be conceptually based on modern science. However, there is a problem that quantity and quality are hard to evaluate using only scientific parameters. It is, therefore, the aim of this article to emphasize that the quantity and quality of medicine need to be evaluated not only from the standpoint of modern scientific medicine but also in terms of integrative medicine. Integrative medicine is postulated to be comprehensive in its fundamental doctrine, emphasizing a holistic approach including technical, artistic, social, religious, philosophical, and ethical elements. However, in evaluating carefully and seriously actual performance, it was noted that contemporary medicine has been giving greater emphasis to aspects of integrative medicine where increasing concern is paid to patients’ personal preferences, as indicated by their quality of life. An incentive for a shift from exclusively scientific to integrative medicine, which started as early as the 1970s, is revival emotion toward a prime modality of medicine.

Chong, Ooi-Thye. An Integrative Approach to Addressing Clinical Issues in Complementary and Alternative Medicine in an Outpatient Oncology Center. Clinical Journal of Oncology Nursing 2005, 10(1), 83-88.
Complementary and alternative medicine (CAM) is popular among patients with cancer and often is used in conjunction with conventional medicine, mostly without the knowledge or guidance of healthcare professionals. The popularity of CAM has brought into sharp focus clinical issues such as the lack of disclosure and concern about interactions among dietary supplements, prescribed medications, and diseases. Those clinical issues underscore the need for a coordinated approach to integrate CAM therapies safely into conventional medicine. This article describes how an integrative CAM program in an outpatient oncology center addresses some of the clinical issues. The CAM program uses a nurse specialist to interface between CAM and conventional medicine. An interesting aspect of the CAM program is the provision of patient consultation and the creation of an individualized complementary therapies plan.

Clement, Jan P./ Chen, Hsueh-Fen/ Burke, Darrell/ Clement, Dolores G./ Zazzali, James L. Are Consumers Reshaping Hospitals? Complementary and Alternative Medicine in U.S. Hospitals, 1999–2003. Health Care Management Review 2006, 31(2), 109-118.
Abstract: All types of acute care hospitals across the U.S. are becoming increasingly involved in offering CAM services. Hospitals appear to be responding to consumer demand, CAM specific market forces, and their organizational missions but not to regulatory mandates.

Davis, Karen. Consumer-Directed Health Care: A Panacea or the Wrong Prescription? The Physician Executive Sept/Oct 2006.

Dillard, James N./ Knapp, Sharon. Complementary and Alternative Pain Therapy in the Emergency Department. Emerg Med Clin N Am 2005, 23, 529–549. 

Donnelly, Gloria F. The Transformation of Healthcare: A Wicked Problem, Holistic Nursing Practice Sept/Oct 2006, 215.

Fleck, Leonard M. The Costs of Caring: Who Pays? Who Profits? Who Panders? Hastings Center Report 2006, 36(3), 13-17.

Flower, Joe. Who Owns Health Care’s Most Valuable Information? The Physician Executive Sept/Oct 2006, 54-55.

Hemming, Laureen/ Maker, David. Complementary therapies in palliative care: a summary of current evidence. British Journal of Community Nursing 10(10).
Abstract
Complementary therapies are often cited as a possible alternative to the management of symptoms in palliative care, as another element in the armoury for coping with unmanageable problems. But how efficacious are these therapies, and what is the evidence to support their use in symptom management? Patients who are in the terminal stages of illness or require palliative care are in a very vulnerable position, so are they being exploited or are there real benefits from using complementary therapies? This article review some of the evidence currently available.

Lafferty, William E./ Tyree, Patrick T./ Bellas, Allen S./ Watts, Carolyn A./ Lind, Bonnie K./ Sherman,  Karen J./ Cherkin, Daniel C./ Grembowski, David E.  Insurance Coverage and Subsequent Utilization of Complementary and Alternative Medicine Providers. Am J Manag Care 2006, 12(7), 397-404.
Background: Since 1996, Washington State law has required that private health insurance cover licensed complementary and alternative medicine (CAM) providers.
Objective: To evaluate how insured people used CAM providers and what role this played in healthcare utilization and expenditures.
Study Design: Cross-sectional analysis of insurance enrollees from western Washington in 2002.
Methods: Analysis of insurance demographic data, claims files, benefit information, diagnoses, CAM and conventional provider utilization, and healthcare expenditures for 3 large health insurance companies.
Results: Among more than 600 000 enrollees, 13.7% made CAM claims. This included 1.3% of enrollees with claims for acupuncture, 1.6% for naturopathy, 2.4% for massage, and 10.9% for chiropractic. Patients enrolled in preferred provider organizations and point-of-service products were notably more likely to use CAM than those with health maintenance organization coverage. The use of CAM was greater among women and among persons 31 to 50 years of age. The use of chiropractic was more frequent in less populous counties. The CAM provider visits usually focused on musculoskeletal complaints except for naturopathic physicians, who treated a broader array of problems. The median per-visit expenditures were $39.00 for CAM care and $74.40 for conventional outpatient care. The total expenditures per enrollee were $2589, of which $75 (2.9%) was spent on CAM.
Conclusions: The number of people using CAM insurance benefits was substantial; the effect on insurance expenditures was modest. Because the long-term trajectory of CAM cost under third party payment is unknown, utilization of these services should be followed.

Lind, Bonnie K./ Abrams, Chad/ Lafferty, William E./ Diehr, Paula K./ Grembowski, David E. The Effect of Complementary and Alternative Medicine Claims on Risk Adjustment. Med Care 2006, 44, 1078–1084.
Objective: We sought to assess how the inclusion of claims from complementary and alternative medicine (CAM) providers affects measures of morbidity burden and expectations of health care resource use for insured patients.
Methods: Claims data from Washington State were used to create 2 versions of a case-mix index. One version included claims from all provider types; the second version omitted claims from CAM providers who are covered under commercial insurance. Expected resource use was also calculated. The distribution of expected and actual resource use was then compared for the 2 indices.
Results: Inclusion of claims from CAM providers shifted 19,650 (32%) CAM users into higher morbidity categories. When morbidity categories were defined using claims from all providers, CAM users in the highest morbidity category had average (±SD) annual expenditures of $6661 (±$13,863). This was less than those in the highest morbidity category when CAM provider claims were not included in the index ($8562 ± $16,354), and was also lower than the highest morbidity patients who did not use any CAM services ($8419 ± $18,885).
Conclusions: Inclusion of services from CAM providers under third-party payment increases risk scores for their patients but expectations of costs for this group are lower than expected had costs been estimated based only on services from traditional providers.  Risk adjustment indices may need recalibration when adding services from provider groups not included in the development of the index.

O’Connor, Edward J./ Fiol, C. Marlena. Moving from Resistance to Support. The Physician Executive Sept/Oct 2006.

Schaible, Todd D./ Thomlinson, R. Paul/ Susan, Peppa. COLLABORATION IN ACTION The Discipline of Managing Value in Collaborative Health Care. Families, Systems, & Health 2004, 22(3), 376-382.

Schidlow, Daniel V. Musings on the Nature of Academic Medical Leadership. The Physician Executive Mar/Apr 2007.

Sukantarat, Kannika/ Greer, Steven/ Brett, Stephen/ Williamson, Robin. Physical and psychological sequelae of critical illness. British Journal of Health Psychology 2007, 12, 65–74.
Objectives. To measure levels of anxiety, depression and post-traumatic stress among survivors of a critical illness and to relate these symptoms to general health parameters.
Design. A prospective study of patients who had spent a minimum 3 days (median 9 days) in a general intensive care unit (ICU). Of these patients, 51 were interviewed 3 months after discharge and 45 of them were reviewed at 9 months.
Methods. General health was assessed by a physical symptom score, the EuroQol ‘thermometer’ and the Short Form 36 (SF-36) questionnaire. Physical and mental component summary measures (PCS, MCS) were calculated from the SF-36 data. Psychological health was assessed using both the Hospital Anxiety and Depression Scale and the Impact of Events Scale.
Results. At both 3 and 9 months after ICU discharge 24% of patients qualified as a ‘case’ of anxiety, while similar figures were seen for intrusion (24 and 20%). The incidence of depression (35 and 47%) and avoidance (36 and 38%) was higher on each occasion. Four of the eight SF-36 domains improved with time, as did PCS (from 29.0 to 35.4), but there was no significant difference in physical symptom score, EuroQol value or MCS. Strong correlations were seen between the physical and psychological parameters at each time point.
Conclusions. A substantial proportion of patients who survive a critical illness show evidence of anxiety and depression up to 9 months later, and most of them also have symptoms indicative of post-traumatic stress. Delayed physical recovery may contribute to this psychological morbidity. ICU follow-up clinics should be able to detect patients suitable for psychological intervention.

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