Integrative medicine is integral to providing patient-centered care

The Institute of Medicine’s (IOM) report Crossing the Quality Chasm details a roadmap to quality twenty-first century health care for all Americans1. This health care system of the future would be built upon six “best practice” principles; one of which is patient-centeredness. The IOM defines patient-centered care as “respectful of and responsive to individual patient preferences, needs and values and ensuring that patient values guide all clinical decisions1.” In this model of care, patients and their families are invited into the decision-making process, and their preferences for care are given weight equal to the clinician’s expertise. This model also contemplates that evidence-based decisions will use the best available research evidence (Figure 1)2. Many believe that high quality health care cannot be achieved without thusly incorporating the patient’s experience. Improved clinical outcomes, enhanced patient satisfaction and reduced costs have been achieved across a wide variety of diseases and conditions using patient-centered approaches3. Figure 1 The Evidence-based Medicine Triad First proposed in 1978, the Planetree model is identified as one of the three models most likely to accelerate the implementation of patient-centered care in ambulatory and acute care settings4. A main feature of the Planetree model is the use of integrative medicine (IM) as a method to achieve patient-centered care. IM is “ healing-oriented, and embraces conventional and complementary therapies…Definitions abound but the commonalities are a reaffirmation of the importance of the therapeutic relationship, a focus on the whole person and lifestyle—not just the physical body, a renewed attention to healing, and a willingness to use all appropriate therapeutic approaches, whether they originate in conventional or alternative medicine. Integrative medicine represents a broader paradigm of medicine than the dominant biomedical model. It comes from a growing recognition that high-tech medicine, while wildly successful in some areas, cannot fully address the growing epidemics of chronic diseases5.” ” Every five years the National Health Interview Survey (NHIS) asks tens of thousands of Americans about their health and IM use. The use of traditional healing practices is common. Thirty-eight percent of adults report using IM, and asthma and allergies rank in the top fifteen most common medical conditions for which IM is used6. In 2012, 12.1% of healthy children (no chronic conditions) aged 4-17 years used IM. Prevalence of IM use increased to 15.5% in children reporting one chronic condition and to 17.4% in those reporting two or more chronic conditions7. However, in children reporting a respiratory condition, allergies (food, respiratory, skin, hay fever) or eczema, IM use (including vitamins and minerals) increased to 64.7%, 64.1% and 62.2%7, respectively. Adults used nonvitamin, nonmineral dietary supplements more than any other approach8, and children used vitamins and minerals most often6. When folk medicines (remedies including prayer, healing touch or laying on of hands, charms, herbal teas or tinctures, magic rituals)9 are included in the broad definition of what constitutes IM, rates of use increase substantially, with 80% of adolescents diagnosed with asthma10 and 93% of adults diagnosed with asthma reporting use11. IM is costly: in 2007 $33.9 billion was spent by patients for visits to IM practitioners and the purchase of complementary products12. The scientific evidence in support of IM is limited. Despite data that indicate a correlation between low levels of vitamins, antioxidants, minerals such as magnesium, and fatty acids and greater rates of asthma and atopy, dietary supplementation has not consistently been shown to prevent or treat disease13. The best support for dietary supplementation comes from a small number of clinical trials among asthma patients whose diets were supplemented with Vitamin D14 and allergy patients whose diets were supplemented with probiotics15. A small randomized controlled trial of mindfulness meditation did not improve lung function or disease control in asthma patients16 although hyperventilation reduction breathing techniques improved asthma symptoms in two studies of children with asthma17 and in a large study (N= 600) of adults with asthma18. Cardiopulmonary fitness improves with physical training in adults with asthma despite no objective improvements in lung function19. However, no recommendations could be made for acupuncture in asthma due to a lack of evidence20. The Cochrane group is currently performing-but has not yet published-a review of yoga as a treatment for asthma21. Despite little evidence of IMs efficacy, data suggests that these approaches are well-tolerated and are not harmful. In 2009, the IOM Summit on Integrative Medicine and the Health of the Public proposed IM as a patient-centered solution to the American health care crisis4. With its high consumer demand and holistic approach to wellness and illness, IM is capable of satisfying the IOM mandate of seeking and valuing the voice of the patient in care decisions. But IM is not without limitations and many questions remain. Is IM a model of care appropriate for specialty care? Can providers’ concerns about IM’s safety and effectiveness be adequately addressed? The IOM proposed ten rules for improving health care; seven of those rules are specific to patient-centered care and provides a framework within which to consider the advantages and shortcomings of IM. Those seven rules are: