Whole Health in Your Practice - University of Wisconsin ...projects.hsl.wisc.edu/SERVICE/sites/final/2017/Day... · Whole Health in Your Practice ‐ Complementary and Integrative

Whole Health in Your Practice ‐ Complementary and Integrative Health (CIH)

March 2017

1

12. COMPLEMENTARY ANDINTEGRATIVE HEALTH (CIH)

Whole Health in Your Practice

PREVENTION & TREATMENT

CONVENTIONAL & COMPLEMENTARY APPROACHES

March 2017

2

VETERANS HEALTH ADMINISTRATION

Definitions

1960s• Holistic

• Complementary & Alternative

• Integrative

Present• Whole Health


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

3


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


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.


March 2017

4


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.


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


March 2017

5

9

The five most common conditions treated at the VA:

» Stress Management

» Anxiety

» PTSD

» Depression

» Pain

2015 Data


March 2017

6


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


March 2017

7


Checking in With Yourself About CIH


ECHO Mnemonic

• Efficacy

• Co$t

• Harms

• Opinions


March 2017

8


Acupuncture & Traditional Chinese Medicine (TCM)

16marniejoyce via Foter.com / CC BY


March 2017

9


Acupuncture

17

Photo credit: Wonderlane via Foter.com / CC BY

Photo credit: markhillary via Foter.com / CC BY

Photo credit: jdlasica via Foter.com / CC BY‐NC

VETERANS HEALTH ADMINISTRATION 18

Auricular Acupuncture

sushiphotos via Foter.com / CC BY


March 2017

10


Evidence Map

19

Acupuncture


Acupuncture for PTSD

20


March 2017

11

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


Acupressure Wrist Bands

22


March 2017

12


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.

23


TCM – Other Modalities

24

Photo credit: Parker Knight via Foter.com / CC BY


March 2017

13


Manual Medicine / Energy Medicine

25


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.

26

planetc1 via Foter.com / CC BY‐SA


March 2017

14


ivva via Foter.com / CC BY‐SA

Massage Therapy

27


Energy Medicine

Modalities include:

Reiki

Healing Touch

Therapeutic Touch

Quantum Touch

Polarity Therapy

28

Synergy by Jasmine via Foter.com / CC BY‐SA


March 2017

15


JD Hancock via Foter.com / CC BY

Music Therapy

29

James Jordan via Foter.com / CC BY‐ND


©2015 by American Society of Clinical Oncology

Music Therapy and Anxiety

Jaclyn Bradley Palmer et al. JCO 2015;33:3162-3168.


March 2017

16


Mind Body Therapies

31

HckySo via Foter.com / CC BY‐NC


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.


March 2017

17


Vitamins, Supplements and Herbs

34veo_ via Foter.com / CC BY‐NC‐SA



The U.S. National Archives via Foter.com / No known copyright restrictions 35


March 2017

18



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.


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


March 2017

19


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.

38

Med Care 2014;52: S65–S69



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)


March 2017

20


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


Vitamins, Supplements and Herbs –A Few to Know

Black Cohosh

Calcium

Coenzyme Q10

Echinacea

Fish Oils

Probiotics

Red Yeast Rice

Turmeric

Vitamin D

Documents

Whole Health in Your Practice - University of Wisconsin ...projects.hsl.wisc.edu/SERVICE/sites/final/2017/Day... · Whole Health in Your Practice ‐ Complementary and Integrative