title: Comparison of integrative medicine centers in the USA and Germany: a mixed method study.
abstract: Integrative medicine (IM) has received increasing attention since the 1990s, but few studies have explored the key factors of the IM model in health care. This study aimed to describe the IM model in leading centers operating in the USA and Germany.
  
  
  
  A 28-item structured survey and semi-structured interviews were conducted in six centers providing integrative medicine in the USA and Germany, and were analyzed using a convergent mixed-method approach.
  
  
  
  The elements in common across all six centers were the following: (1) involvement of general physicians (GP) in delivering complementary and alternative medicine (CAM) services; (2) requirement for GP or medical referral or recommendation to CAM services; (3) involvement of an integrative physician (IP) as a "gatekeeper"; (4) focus on research, education, and clinical practice; and (5) ongoing academic activities. The key elements differentiating the two countries were the following: (1) level of requirements for GP referral to CAM services; (2) differences in IM service delivery, including treatment modalities used; (3) accessibility of CAM services to patients; (4) interaction between team members and patients; (5) perception of CAM/IM; and (6) perception of patient-centered care. Themes underpinning these elements are the following: cultural aspects in conceptualizing IM health care; communication within IM programs; and resource availability for delivering IM services, which impacts patient engagement and team collaboration in the IM framework.
  
  
  
  Delivering IM health care requires a model of care that encourages interaction between all stakeholders. Developing a comprehensive conceptual framework to support IM practice is required to facilitate efficient and safe patient care.
authors.affiliation: Concord Clinical School, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
authors.forename: EunJin
authors.initials: E
authors.lastname: Lim
authors.affiliation: Concord Clinical School, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.|Concord Cancer Centre, Concord Repatriation General Hospital, Concord, Sydney, NSW, Australia.
authors.forename: Janette L
authors.initials: JL
authors.lastname: Vardy
authors.affiliation: Northern Clinical School, The University of Sydney, St. Leonard's, Sydney, NSW, Australia.
authors.forename: ByeongSang
authors.initials: B
authors.lastname: Oh
authors.affiliation: CeMPED, School of Psychology, Faculty of Science, The University of Sydney, Sydney, 2006, NSW, Australia. Haryana.dhillon@sydney.edu.au.|Center for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney Medical School, The University of Sydney, Level 6-North, Chris O'Brien Lifehouse (C39Z), Sydney, NSW, 2006, Australia. Haryana.dhillon@sydney.edu.au.
authors.forename: Haryana M
authors.initials: HM
authors.lastname: Dhillon
mesh_terms: D000529:Complementary Therapies / Q000379:methods*; D003695:Delivery of Health Care / Q000379:methods*; D005260:Female; D005858:Germany; D006801:Humans; D055048:Integrative Medicine / Q000379:methods*; D008297:Male; D014481:United States
keywords: Complementary and alternative medicine (CAM); Healthcare systems; Integrative medicine; Model of care