An approach for integrating complementary-alternative medicine into primary care.
BACKGROUND
Despite family practitioners frequently being requested to assist their patients with advice on or referrals to complementary-alternative medicine (CAM), there is an absence both of evidence about the efficacy of nearly all specific treatments or modalities and of guidelines to assist with the integration of conventional and CAM therapies.


OBJECTIVE
The aim of this article is to suggest a comprehensive and rational, best-evidence strategy for integrating CAM by primary care practitioners into primary care, within the context of the limitations of the current knowledge base and the local milieu.


METHODS
The suggested approach was developed by a combination of literature review, key informant interviews, focus groups, educational presentations for family practice residents and practitioners, and field testing. An iterative model was utilized whereby more refined drafts of the suggested approach were subjected to later discussants and groups, as well as further field testing. Drafts of the strategy were utilized in consultations of patients requesting advice on alternative medicine in a primary care setting and in a CAM clinic.


RESULTS
Both family physicians and CAM practitioners provided useful comments and recommendations throughout the process. These can be categorized in terms of knowledge, attitudes and skills. Our strategy suggests that patients requesting advice on the use and integration of CAM modalities as part of their health care should be evaluated initially by their primary care physician. The physician's responsibilities are to evaluate the appropriateness of that use, and to maintain contact, monitoring outcomes. Advice on referrals should be based on the safety of the method in question, current knowledge on indications and contraindications of that modality, and familiarity and an open dialogue with the specific therapist.


CONCLUSIONS
Given patients' demands and utilization of CAM therapies, despite the lack of evidence, there is an increasing need to address how CAM therapies can be integrated into conventional medical systems. These suggestions should respond to patient's expectations and needs, but at the same time maintain accepted standards of medical and scientific principles of practice.
Department of Family Practice, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. frenkelm@netvision.net.il
Moshe A
MA
Frenkel
Jeffrey M
JM
Borkan
D001291:Attitude of Health Personnel; D000529:Complementary Therapies / Q000458:organization & administration*; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D033183:Interdisciplinary Communication; D007400:Interprofessional Relations; D010353:Patient Education as Topic / Q000379:methods; D010819:Physician's Role; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000458:organization & administration*; D011364:Professional Practice / Q000458:organization & administration*; D006113:United Kingdom