Towards a model for integrative medicine in Swedish primary care

Abstract

Background: Collaboration between providers of conventional care and complementary therapies (CTs) has gained in popularity but there is a lack of conceptualised models for delivering such care, i.e. integrative medicine (IM). The aim of this paper is to describe some key findings relevant to the development and implementation of a proposed model for IM adapted to Swedish primary care.

Methods: Investigative procedures involved research group and key informant meetings with multiple stakeholders including general practitioners, CT providers, medical specialists, primary care administrators and county council representatives. Data collection included meeting notes which were fed back within the research group and used as ongoing working documents. Data analysis was made by immersion/crystallisation and research group consensus. Results were categorised within a public health systems framework of structures, processes and outcomes.

Results: The outcome was an IM model that aimed for a patient-centered, interdisciplinary, non-hierarchical mix of conventional and complementary medical solutions to individual case management of patients with pain in the lower back and/or neck. The IM model case management adhered to standard clinical practice including active partnership between a gate-keeping general practitioner, collaborating with a team of CT providers in a consensus case conference model of care. CTs with an emerging evidence base included Swedish massage therapy, manual therapy/naprapathy, shiatsu, acupuncture and qigong.

Conclusion: Despite identified barriers such as no formal recognition of CT professions in Sweden, it was possible to develop a model for IM adapted to Swedish primary care. The IM model calls for testing and refinement in a pragmatic randomised controlled trial to explore its clinical effectiveness.

Figures

Figure 1

Processes and structures. Key processes (P), i.e. research group activities, and structures (S), i.e. organisational elements, created by the research group in the development and implementation of the integrative medicine model adapted to Swedish primary care.

Figure 2

Outcome, the integrative medicine model. The integrative medicine model adapted to Swedish primary care illustrated as a clinical case management flowchart: 1) The patient with sub-acute to chronic low back pain or neck pain consults the general practitioner gatekeeper at the primary care unit.; 2) The patient and the general practitioner develop a treatment plan.; 3) The patient is offered conventional care, i.e. treatment as usual.; 4) Should complementary therapies be considered appropriate, these are integrated into the treatment plan by way of a consensus case conference with the integrative medicine provider team.; 5) The patient is offered complementary therapies as part of the treatment plan, i.e. integrative care.; 6) When the treatment plan is completed the case management is finished. Please note that integrative care was only delivered for up to 12 weeks.