Collaborating with medicine? Perceptions of Australian naturopaths on integrating within the conventional medical system

Barriers and Facilitators to the Inclusion of Naturopaths in Interprofessional Health Care Teams: A Scoping Review

Objective: The growing population of individuals with chronic pain presents a challenge to a globally overburdened health care workforce. Naturopaths are trained as primary health care providers who manage patients with chronic pain and, yet, are often overlooked in health care teams. This scoping review aims to identify barriers and facilitators affecting naturopathic inclusion into interprofessional health care teams managing patients with chronic pain. Methods: This study protocol was registered a priori through Open Science (https://doi.org/10.17605/OSF.IO/2G3JT). A search was conducted using databases AMED, CINAHL, MEDLINE, SCOPUS, Web of Science, APA PsycInfo, and Health Business Elite. Search limits included English language from 2012 to 2023. Included publications were from academic and gray literature. Search terms used included the following: "Naturopath*" OR "Integrative medicine" AND "Health care system*" OR "Health system*" OR "Models of health care" OR "Professional autonomy" OR "Professional regulation" OR "Professional govern*" OR "Interprofessional practice (IPP)" OR "Multidisciplinary communication." The scoping review utilized Covidence software and was analyzed using thematic analysis. Themes were identified following Arksey and O'Malley's (2005) framework to inform a narrative approach. Results: Five themes emerged that relate to the inclusion of naturopaths in health care teams as follows: (1) perceptions of naturopathy, (2) practice standards, (3) legitimacy, (4) resources, and (5) shifting power dynamics and cooperation. Conclusions: Barriers for naturopathic inclusion into health care teams are influenced by perceptions of naturopathy, naturopathic education standards, regulations, research, and patient equity and access. Facilitators for inclusion include the growing shift toward person-centered care, greater interprofessional education, and shared assets, including colocation.

"There is a way to work together": A qualitative study on complementary medicine therapists' perceptions of their role in the Swiss healthcare system

BACKGROUND AND PURPOSE

Complementary medicine has been undergoing a process of regulation and professionalization in many countries where the biomedical model is dominant. However, little is known about therapists' opinions regarding these changes. The aim of the study was thus to explore therapists' views on the regulation of their practice and on collaboration between CM and biomedicine.

MATERIALS AND METHODS

We conducted this qualitative descriptive study by means of focus groups consisting of non-physician acupuncturists, naturopaths, and osteopaths in two cantons of Switzerland. A qualitative content analysis was carried out on the verbatim transcripts of the focus groups.

RESULTS

Four main themes were identified: contributions to the healthcare system, collaboration with biomedicine, pathways to recognition, and integrative medicine. Therapists defined their role in the healthcare system in comparison to biomedicine, allowing them to highlight how they could complement it. They also noted an improved relationship with biomedicine, while highlighting the remaining barriers to optimal collaboration. Different ways were mentioned to achieve a higher level of recognition: better educating and informing physicians about CM, structured training of therapists that is federally recognized, state regulation, and development of scientific research on CM. Finally, although unfamiliar with the concept, therapists defined integrative medicine as horizontal collaboration between CM and biomedicine.

CONCLUSION

Despite the differences between the three CM practiced by the therapists, they produced fairly similar discourse regarding aspirations and concerns in the face of integration. This discourse should be considered in order to facilitate the integration of CM in the Swiss healthcare system.

Disclosure of conventional and complementary medicine use to medical doctors and complementary medicine practitioners: A survey of rates and reasons amongst those with chronic conditions

Chronic conditions are prolonged and complex, leading patients to seek multiple forms of care alongside conventional treatment, including complementary medicine (CM). These multiple forms of care are often used concomitantly, requiring patient-provider communication about treatments used in order to manage potential risks. In response, this study describes rates and reasons for disclosure/non-disclosure of conventional medicine use to CM practitioners, and CM use to medical doctors, by individuals with chronic conditions. A survey was conducted online in July and August 2017 amongst the Australian adult population. Participants with chronic conditions were asked about their disclosure-related communication with CM practitioners (massage therapist, chiropractor, acupuncturist, naturopath) and medical doctors. Patients consulting different professions reported varying disclosure rates and reasons. Full disclosure (disclosed ALL) to medical doctors was higher (62.7%-79.5%) than full disclosure to CM practitioners (41.2%-56.9%). The most strongly reported reason for disclosing to both MDs and CM practitioners was I wanted them to fully understand my health status, while for non-disclosure it was They did not ask me about my CM/medicine use. Reasons regarding concerns or expectations around the consultation or patient-provider relationship were also influential. The findings suggest that patient disclosure of treatment use in clinical consultation for chronic conditions may be improved through patient education about its importance, direct provider inquiry, and supportive patient-provider partnerships. Provision of optimal patient care for those with chronic conditions requires greater attention to patient-provider communication surrounding patients’ wider care and treatment use.

Development and preliminary evaluation of the Conventional Medicine Disclosure Index

BACKGROUND

Non-disclosure of conventional medicine use to complementary medicine health professionals may result in patient harm. Currently, no standardised validated instrument is available to measure reasons for conventional medicine disclosure or non-disclosure.

OBJECTIVE

The aim of this study was to develop and evaluate a multidimensional index for identifying reasons for conventional medicine disclosure and non-disclosure by patients.

METHODS

Drawing upon a sub-sample of the Complementary and Alternative Medicine Use Health Literacy Disclosure Study (N = 520), a formative measurement approach was used to develop a Conventional Medicine Disclosure Index (CONMED-DI). Variance-based structural equation modelling employing partial least squares evaluated multicollinearity, significance and relevance of the formative indicators to their associated primary constructs.

RESULTS

The CONMED-DI demonstrated adequate construct validity suggesting the CONMED-DI is a pragmatic measure to determine the reasons why people choose to disclose (or not) their conventional medicine use. The CONMED-DI contains 2 second-order measurement models, both with three sub-domains.

CONCLUSION

The CONMED-DI serves as a preliminary instrument primarily of value to researchers interested in exploring the complementary medicine clinical encounter. The development of targeted interventions that promote disclosure of conventional medicine can be facilitated through understanding patients' reasons for disclosure and non-disclosure and optimise patients' safe use of medicines.

Australian Naturopaths' Approach to Caring for People with Cardiovascular Disease and Associated Risk Factors: A Qualitative Study of the Providers' Perspective

Objectives: To date, no formal research has evaluated how naturopathic practitioners approach the care of people living with CVD and associated CVD risk factors. The primary aim of this research was to collect qualitative data from Australian Naturopathic practitioners about their clinical practices for CVD. Design: Semi-structured interviews were conducted, recorded, transcribed, and ultimately coded by three independent researchers using the Framework Approach. Subjects: 10 Australian Naturopathic practitioners. Results: The key emergent themes from the responses of naturopathic practitioners embodied the elements of patient-centered care (PCC). Numerous factors, including regulation, barriers to service access, and interprofessional communication, were cited as hurdles to additional effectiveness as PCC practitioners. Conclusion: Future research should assess whether the principles of PCC are reported directly from the patients who utilize naturopathy for CVD to determine if their experience mirrors the reports by practitioners.

The naturopathic profession in Australia: A secondary analysis of the Practitioner Research and Collaboration Initiative (PRACI)

INTRODUCTION

This study provides the most detailed empirical examination of the naturopathic profession and naturopathic practice in Australia.

METHODS

Naturopaths from the Practitioner Research And Collaboration Initiative (PRACI) were invited to participate in an online workforce survey.

RESULTS

The baseline survey was completed by 281 naturopaths and 155 (55.2%) completed the second survey. Respondents were predominantly female (86.7%), with a mean age of 45.5 years (SD 10.4). A diverse range of clinical interest topics were disclosed; most frequent were digestive (84.0%) and women's (79.4%) health. Diet/nutrition (91.1%), sleep (90.2%), stress management (85.3%) and physical activity/fitness (79.4%) were commonly discussed during consultation.

CONCLUSION

Although respondents reported a varied scope of practice, there was a notable emphasis on lifestyle prescriptions. Given lifestyle diseases are the leading cause of death in Australia, a more in-depth examination of the preparedness of the naturopathy workforce to integrate into community-based health care teams is now warranted.

Use of Complementary and Alternative Medicine by Patients with Irritable Bowel Syndrome According to the Roma IV Criteria: A Single-Center Italian Survey

Aim: This study was conducted to evaluate the impact of complementary and alternative medicine (CAM) in patients with irritable bowel syndrome (IBS) as assessed by the Rome IV criteria. Methods: Consecutive patients referring for IBS were re-evaluated according to the Rome IV criteria. Demographic features and characteristics potentially associated with the use of CAM were collected. A validated, self-administered, survey questionnaire dealing with CAM and patients’ level of knowledge, motivation, perception, and information seeking-behavior toward the use of CAM was analyzed. Multivariate logistic regression analysis was performed in order to identify predictors of CAM use among participants. Results: Among 156 patients claiming IBS, 137 (88%) met the Rome IV criteria, and 62 of them (45%) were CAM users. Biologically based therapy was the most chosen CAM (78%). Significant risk factors (adjusted odds ratio, 95% confidence interval) for the use of CAM were female gender (7.22, 2.31–22.51), a higher BMI (1.16, 1.02–1.33), and a good knowledge of CAM (4.46, 1.73–11.45), while having children was a protective factor (0.25, 0.07–0.95). Only 19% of patients used CAM due to medical advice and over half (51%) thought it was a “more natural” approach. Although a minority of patients (16%) had full satisfaction from CAM, 81% of users would repeat the CAM experience for their IBS symptoms. Conclusions: The widespread use of CAM in IBS, the patients’ belief in its safety, and their willingness to re-use it suggest that knowledge of health-care providers and patient education should be improved.