Process of care in outpatient Integrative healthcare facilities: a systematic review of clinical trials.
BACKGROUND
Patients currently integrate complementary medicine (CM) and allopathic, choosing a combination of therapies rather than a single therapy in isolation. Understanding integrative healthcare (IHC) extends beyond evaluation of specific therapies to encompass evaluations of multidisciplinary complex interventions. IHC is defined as a therapeutic strategy integrating conventional and complementary medical practices and practitioners in a shared care setting to administer an individualized treatment plan. We sought to review the outcomes of recent clinical trials, explore the design of the interventions and to discuss the methodological approaches and issues that arise when investigating a complex mix of interventions in order to guide future research.


METHODS
Five databases were searched from inception to 30 March 2013. We included randomized and quasi-experimental clinical trials of IHC. Data elements covering process of care (initial assessment, treatment planning and review, means for integration) were extracted.


RESULTS
Six thousand two hundred fifty six papers were screened, 5772 were excluded and 484 full text articles retrieved. Five studies met the inclusion criteria. There are few experimental studies of IHC. Of the five studies conducted, four were in people with lower back pain. The positive findings of these studies indicate that it is feasible to conduct a rigorous clinical trial of an integrative intervention involving allopathic and CM treatment. Further, such interventions may improve patient outcomes.


CONCLUSIONS
The trials in our review provide a small yet critical base from which to refine and develop larger studies. Future studies need to be adequately powered to address efficacy, safety and include data on cost effectiveness.
National Institute of Complementary Medicine, University of Western Sydney, Locked Bag 1797, Penrith, NSW, 2751, Australia. s.grant@uws.edu.au.
Suzanne J
SJ
Grant
Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Sydney, NSW, Australia. jane.e.frawley@student.uts.edu.au.
Jane
J
Frawley
National Institute of Complementary Medicine, University of Western Sydney, Locked Bag 1797, Penrith, NSW, 2751, Australia. a.bensoussan@uws.edu.au.
Alan
A
Bensoussan
D000554:Ambulatory Care Facilities; D000529:Complementary Therapies; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D003695:Delivery of Health Care; D019033:Delivery of Health Care, Integrated; D006801:Humans; D008297:Male; D010045:Outpatients; D016032:Randomized Controlled Trials as Topic