Please cite this article as: Leach MJ, Wiese M, Thakkar M, Agnew T, Integrative health care - Toward a common understanding: A mixed method study, Complementary Therapies in Clinical Practice (2018), doi: 10.1016/j.ctcp. With this changing landscape, there have been changing views in the way health care is and should be delivered. Recognizing the necessity and value of creating a common understanding of IHC, this research aimed to draw meaning from diverse sources of evidence to develop a common, stakeholder-informed definition of integrative health care.
The study represents the first phase of the Integrative Health Care Model Development and Evaluation (TIME) project, a seven-phase mixed methods research program designed to develop and evaluate a stakeholder-informed integrative health care service delivery model. Interview guides were used to gain a richer, deeper and more meaningful understanding of the term integrative healthcare.24 Although the interview guide included eleven questions on various aspects of IHC, the focus of this article (i.e. the definition of IHC) was limited to a single question: What does the term integrative healthcare mean to you?
Data analysis
Ethics
RESULTS
PHASE 1: Interviews / focus groups .1 Description of participants
The physical element meant that “all kinds of health services [are] delivered under one roof” (PS2), providers “all working together in one place” (CO6), or “being in an environment where you are exposed to other professionals" (PS6). Integration was also seen as an extension of multidisciplinarity, where there is "collaboration between practitioners of both allopathic medicine and complementary medicine" (PN1). Others considered holism from a health care delivery perspective, indicating that a holistic model of health care should cover “the four pillars of health care” (NW5)—that is, medicine, complementary medicine, bodywork, and emotional/spiritual work.
This included the need to respect "the patient's choice" (NW1) as well as the consumer's right to "go to many different people" (HC2). It also meant respect at the interprofessional level, including "being open to what other healthcare providers could offer" (HC3), the need for "all practitioners to be respected. Another core feature of IHC was that it was seen to be "patient-centred" (GP1).
Participants noted that this approach recognized that “every patient is an individual” (HC2) and providers “need to tailor it [their care]. Participants also recognized that a client-centered approach empowered individuals as “they [the client] drive it [ the care] to some degree" (GP1); it also "respected the patient's choice" (NW6). Embedded in the theme of client-centeredness was the need for client-focused outcomes, including "what they [patients] want for their health outcome" (AT3) in order to .
Participants indicated that practices included in an IHC model of care should be evidence-based.
PHASE 2: Document analysis - IHC organisation websites / documents .1 Description of documents
This was related to clients “having access to whatever form of health care the patient needs” (HO2), “wanting” (PT1, SW1) or “wishing they had done” (AT1). It also meant "everyone can access what's happening with the same customer" (PS5), whether by 'sharing' customers or 'sharing' customer information. Analysis of the definitions extracted from the IHC organization's websites revealed eight central themes related to the term integrative health care: (1) holism, (2) promotion/optimization of health, healing, wellness and prevention, ( 3) the combination of complementary and conventional medicine, (4) interdisciplinarity / collaboration, (5) evidence-based practice, (6) respectful practitioner-client relationships, (7) client-centeredness, and (8) individualization / personalization.
Fourteen organizations referred to the concept of holism in their IHC definition26-39 and stated that integrative health care “focuses on treating the whole person (mind/body/spirit)”28,38 “meeting each patient's unique physical , goals of emotional and spiritual health"34 and "addresses the entire range of physical, emotional, mental, social, spiritual and environmental influences that affect human health".32,35. More than half (13/25) of the organizations described integrative health care as a combination of approaches and treatments derived from conventional medicine and complementary and alternative medicine. One organization stated that IHC is more than just a collection of therapies, but a model of care that "combines conventional and complementary approaches in a coordinated way".46
This theme referred to a "collaborative approach to patient care among physicians"36 that "uses all relevant therapeutic approaches, health professionals and disciplines"27,29, "without subordination to any medical school".48. Others distinguished between the systems, stating that IHC “combines conventional medicine with evidence-based complementary medicine.”47 One definition was specific and inclusive, defining IHC as “the practice of conventional, complementary, and alternative health care based on on evidence". 36. For nine organizations, IHC was considered a model of care that “reaffirms the importance of the doctor-patient relationship.
These organizations viewed IHC as an approach that “uses a personalized strategy”32,35 that focuses on “individualized patient care”29 and provides “patients with individually tailored health and wellness programs.”42
PHASE 3: Document analysis - published literature 1 Description of documents
Seven organizations identified IHC as “patient-centered or putting “the patient at the center” of care32,35, with one organization considering “the patient as the most important member of the medical team”.48. AC CE PT ED. both CAM and conventional medicine”52; and “integration of various professional healthcare providers and alternative therapists practicing within different treatment models”)57. These definitions referred to IHC as a model of care that "focuses on prevention and wellness"53 and the "achievement of optimal health"67, as well as being "cure-oriented".53.
IHC was considered to "treat the whole person"52 by "addressing the biological, psychological, social and spiritual aspects of health and disease"56 in both "diagnosis and treatment".23. IHC was seen as encompassing a "relationship-centred approach"58 that valued "mutual respect"52, "a shared vision of health care"52 and an "emphasis [on] the therapeutic relationship".53. These definitions referred to IHC as "a health system that focuses on ... patient-centred care"67, which "places the patient at the center of care".53.
DISCUSSION
Another important area that IHC definitions focused on was the healthcare team. Four themes related to the healthcare team, including the provision of both complementary and conventional medicine services, 'respect' for other disciplines and approaches, 'collaboration'. An effective interdisciplinary healthcare team is therefore essential to ensure that the needs of the client and other key stakeholders can be adequately met, and that there is the capacity to deliver care in the most appropriate manner.
The clinical approach represents the third major construct in the definitions of integrated healthcare. These themes align well with current trends in healthcare, such as the push toward the adoption of evidence-based practice across all health disciplines85,86, the movement toward personalized medicine/healthcare87,88, and the increasing emphasis on disease prevention89 and wellness.90 These themes also complement the other two constructs, suggesting that the clinical approach, the client, and the healthcare team are interconnected and interdependent constructs of IHC. If existing definitions of integrative healthcare are in fact an accurate representation of current IHC practice, this suggests that IHC may have kept pace with the changing healthcare landscape.
By doing so, the field of IHC may have created a model of care that adequately represents the collective interests of the client, community, health providers, health care institutions, and government. Of course, further work is needed to operationalize, and perhaps standardize, the integrative model of health care service delivery. Integrative health care is a collaborative, coordinated, transdisciplinary, person-centered model of care informed by a holistic model of health and the best available evidence.
Integrative health care is a client-centered model of care provided by a team of biomedical, allied, and complementary health professionals who collaborate and respectfully provide accessible, holistic, evidence-based, personalized, and coordinated care that emphasizes disease and health prevention, treatment promotion, and feeling good.
CONCLUSIONS
AC CE PT ED. using a qualitative approach) may mean that the findings of Phase 1 cannot be generalized to the wider membership of these stakeholder groups. Regardless, the use of a qualitative approach can be seen as an advantage of the study, as it enabled the collection of richer and more meaningful information compared to that collected using quantitative methods. Similarly, as Phase 1 was limited to stakeholders residing in Australia, it is possible that the study findings are not representative of these stakeholder groups in other countries.
Although drawing on international data in phases two and three of the study mitigates this limitation somewhat. Care is facilitated by an interdependent, multidisciplinary team of like-minded, biomedical, allied and complementary health professionals who work together in a collegial, non-hierarchical, communicative and respectful environment to prevent disease and optimize health, healing and well-being in individual clients . Recognizing the need for a clearer description of IHC, this study has provided an evidence-based, multidisciplinary, stakeholder-informed definition of IHC that draws from multiple data sources.
The research identified seven distinct themes, which can be refined into three interrelated and interdependent constructs, which we refer to as the triad of integrative healthcare – the client, the team and the approach to care. Further work is underway to translate this definition into a standardized integrative healthcare service delivery model.
ACKNOWLEDGEMENTS
AUTHORSHIP
CONFLICT OF INTEREST
FUNDING
Integrative medicine and systematic outcomes research: issues in the emergence of a new model for primary health care. The distinction between integration and collaboration in patient care: Results from interviews of key informants working in multiprofessional health care teams. Using narrative analysis to understand the combined use of complementary therapies and biomedically oriented health care.
An integrated healthcare standard for the management and prevention of obesity in the Netherlands.
Integrative Health Care - Toward a Common Understanding: A Mixed Method Study
