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Whole Health in Your Practice ‐ Complementary and Integrative Health (CIH)
March 2017
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12. COMPLEMENTARY ANDINTEGRATIVE HEALTH (CIH)
Whole Health in Your Practice
PREVENTION & TREATMENT
CONVENTIONAL & COMPLEMENTARY APPROACHES
March 2017
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VETERANS HEALTH ADMINISTRATION
Definitions
1960s• Holistic
• Complementary & Alternative
• Integrative
Present• Whole Health
VETERANS HEALTH ADMINISTRATION
An Important Point About Whole Health…
Whole Health is inclusive of conventional clinical treatment and prevention, self‐care strategies, and complementary practices.
Whole Health in Your Practice ‐ Complementary and Integrative Health (CIH)
Whole Health in Your Practice ‐Complementary and Integrative Health (CIH)
March 2017
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VETERANS HEALTH ADMINISTRATION
2015 HAIG Report – Complementary and Integrative Health
Healthcare Analysis & Information Group (HAIG)A Field Unit of the Office of Strategic Planning & Analysiswithin the Office of the ADUSH for Policy and Planning
VETERANS HEALTH ADMINISTRATION
What About CIH at the VA? 2015 HAIG Report
2015 HAIG Report
The following table indicates how many CIH modalities (in increasing blocks of 5 modalities) are offered by facility count. The “n” represents the entire population of facilities reporting they offer CIH to Veterans in each year indicated. The number of modalities offered by VA facilities has been steadily increasing during the periods surveyed. The number of facilities offering 11 to 20 CIH modalities has substantially increased since 2002, as indicated in the following table.
Whole Health in Your Practice ‐Complementary and Integrative Health (CIH)
March 2017
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VETERANS HEALTH ADMINISTRATION
CIH and Veterans?
76% of veterans report they
would use CAM modalities if
offered at their VA facility.
CAM services in high
demand, high rates of
satisfaction with care, and
improvements in physical and
mental health symptoms.
BMC Complement Altern Med. 2006;6:34.
J Rehabil Res Dev. 2006;43:99–110.
Global Adv Health Med. 2014;3:27–31.
Complementary and Alternative Medicine.
Healthcare Analysis and Information Group.
Washington DC: Department of Veterans
Affairs; 2011.
VETERANS HEALTH ADMINISTRATION
What CIH Approach is Most Commonly Used in VA?
• Mind-Body Medicine
• Biologically Based Practices
• Manipulative Body-Based Practices
• Energy Medicine
• Other Systems of Healing
(See glossary on pages 67-71 in your binders)
Healthcare Analysis & Information Group (HAIG)
A Field Unit of the Office of Strategic Planning & Analysis within the Office of the ADUSH for Policy and Planning
http://shfwire.com/files/pdfs/2011CAM_FinalReport.pdf
Whole Health in Your Practice ‐Complementary and Integrative Health (CIH)
March 2017
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The five most common conditions treated at the VA:
» Stress Management
» Anxiety
» PTSD
» Depression
» Pain
2015 Data
Whole Health in Your Practice ‐Complementary and Integrative Health (CIH)
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VETERANS HEALTH ADMINISTRATION
What About CIH at the VA? 2015 HAIG Report
Top 10 Integrative Health Services :
1. Stress Management Relaxation Therapy (SMRT)
2. Mindfulness
3. Guided Imagery
4. Yoga
5. Progressive Muscle Relaxation Therapy (PMRT)
6. Art Therapy
7. Acupuncture
8. Music Therapy
9. Biofeedback
10. Animal Assisted Therapy
Whole Health in Your Practice ‐Complementary and Integrative Health (CIH)
March 2017
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VETERANS HEALTH ADMINISTRATION
Checking in With Yourself About CIH
VETERANS HEALTH ADMINISTRATION
ECHO Mnemonic
• Efficacy
• Co$t
• Harms
• Opinions
Whole Health in Your Practice ‐Complementary and Integrative Health (CIH)
March 2017
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VETERANS HEALTH ADMINISTRATION
Acupuncture & Traditional Chinese Medicine (TCM)
16marniejoyce via Foter.com / CC BY
Whole Health in Your Practice ‐Complementary and Integrative Health (CIH)
March 2017
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VETERANS HEALTH ADMINISTRATION
Acupuncture
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VETERANS HEALTH ADMINISTRATION 18
Auricular Acupuncture
sushiphotos via Foter.com / CC BY
Whole Health in Your Practice ‐Complementary and Integrative Health (CIH)
March 2017
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VETERANS HEALTH ADMINISTRATION
Evidence Map
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Acupuncture
VETERANS HEALTH ADMINISTRATION
Acupuncture for PTSD
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Whole Health in Your Practice ‐Complementary and Integrative Health (CIH)
March 2017
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Acupuncture, black line; counseling, grey line; usual care, dashed line.
PLoS Med 10(9): e1001518. doi:10.1371/journal.pmed.1001518
Acupuncture in the Management of Depression
VETERANS HEALTH ADMINISTRATION
Acupressure Wrist Bands
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Whole Health in Your Practice ‐Complementary and Integrative Health (CIH)
March 2017
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VETERANS HEALTH ADMINISTRATION
Jin Shin - Acupressure
Study subjects with mild traumatic brain injury (TBI) treated with acupressure showed improved cognitive function, scoring significantly better on tests of working memory when compared to the TBI subjects in the placebo control group.
J Neurotrauma 2011;28:21.
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VETERANS HEALTH ADMINISTRATION
TCM – Other Modalities
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Whole Health in Your Practice ‐Complementary and Integrative Health (CIH)
March 2017
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VETERANS HEALTH ADMINISTRATION
Manual Medicine / Energy Medicine
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VETERANS HEALTH ADMINISTRATION
Chiropractic
Chiropractors provide up to
40% of the low back pain care
in the United States.
Before 1999 it was not
common for the VA to provide
chiropractic services to
Veterans.
South Med J 2010;103:738–747.
Chiropractic services in the department of veterans affairs. Hearing before the Subcommittee on Health of the Committee on Veterans Affairs. House of Representatives, One Hundred Sixth Congress, Second Session. October 3, 2000. United States Government
Printing Office, Serial No. 106‐51.
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Whole Health in Your Practice ‐Complementary and Integrative Health (CIH)
March 2017
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VETERANS HEALTH ADMINISTRATION
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Massage Therapy
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VETERANS HEALTH ADMINISTRATION
Energy Medicine
Modalities include:
Reiki
Healing Touch
Therapeutic Touch
Quantum Touch
Polarity Therapy
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Whole Health in Your Practice ‐Complementary and Integrative Health (CIH)
March 2017
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VETERANS HEALTH ADMINISTRATION
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Music Therapy
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VETERANS HEALTH ADMINISTRATION
©2015 by American Society of Clinical Oncology
Music Therapy and Anxiety
Jaclyn Bradley Palmer et al. JCO 2015;33:3162-3168.
Whole Health in Your Practice ‐Complementary and Integrative Health (CIH)
March 2017
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VETERANS HEALTH ADMINISTRATION
Mind Body Therapies
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VETERANS HEALTH ADMINISTRATION
Breathing Biofeedback Device Lowers Blood Pressure
125 men and women (average age = 59) reduced systolic blood pressure 16 mmHg vs. 6 mmHg in control group.
Treatment group used the device for ~ 30 mins / week for 8 weeks.
Presented at the American Society of Hypertension annual meeting, 2002.
Whole Health in Your Practice ‐Complementary and Integrative Health (CIH)
March 2017
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VETERANS HEALTH ADMINISTRATION
Vitamins, Supplements and Herbs
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VETERANS HEALTH ADMINISTRATION
Vitamins, Supplements and Herbs
The U.S. National Archives via Foter.com / No known copyright restrictions 35
Whole Health in Your Practice ‐Complementary and Integrative Health (CIH)
March 2017
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VETERANS HEALTH ADMINISTRATION
Vitamins, Supplements and Herbs
CDC:
50% of Americans use supplements; majority of cancer patients use supplements during all phases of treatment
Can augment / interfere with drug therapy
AARP study:
high level of supplement use age > 50; 69% did not tell their doctors
What is “natural” is not synonymous with what is safe.
VETERANS HEALTH ADMINISTRATION
Vitamins, Supplements and Herbs – Why People Use Them
• Maintain health, support self‐healing mechanisms
• Relieve symptoms, shorten duration of self‐limited disease
• Boost short‐term immunity
• Used for chronic conditions not easily treated
• Alternative to prescription drugs
• Reduce side effects with prescription drugs
• May not have access to conventional health care
Whole Health in Your Practice ‐Complementary and Integrative Health (CIH)
March 2017
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VETERANS HEALTH ADMINISTRATION
Use of Vitamins, Supplements and Herbs Among Veterans
Significant number of primary care patients in VA
system use vitamins and supplements.
Prevalence of medication substitution is high, strongly
associated with prescription rationing due to cost.
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Med Care 2014;52: S65–S69
VETERANS HEALTH ADMINISTRATION
Vitamins, Supplements and Herbs
ConsumerLab –
good source of credible supplement information, product
quality testing results (www.consumerlab.com)
USP –
indicator of higher quality; absence does not imply poor
quality (relatively small # of companies participating)
NSF International
GMPs (as of 2010)
Whole Health in Your Practice ‐Complementary and Integrative Health (CIH)
March 2017
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VETERANS HEALTH ADMINISTRATION
Herbal Preparations
Infusion – tea (pour near‐boiling water over herb, steep covered)
Decoction – tea prepared by placing herb in cold water, bringing water to boil,simmer covered (stronger than infusion)
Tincture – herbs placed in mixture of alcohol and water (menstruum), steeped forseveral weeks (maceration) or percolated through a funnel
Long shelf life
1:5 indicates 1 kg herb mixed with 5 liters of menstruum
Fluid extract – similar to tincture, but is by definition a 1:1 extract (1:1 fluidextract is 5 times stronger than 1:5 tincture)
Glycerites – tinctures where solvent is mixture of glycerin and water
Standardized extract – allows for more accurate dosing
Adapted from work of T. Low Dog, MD
VETERANS HEALTH ADMINISTRATION
Vitamins, Supplements and Herbs –A Few to Know
Black Cohosh
Calcium
Coenzyme Q10
Echinacea
Fish Oils
Probiotics
Red Yeast Rice
Turmeric
Vitamin D