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Integrative Medicine: The Hopkins Perspective
JHI Partners Forum, 2012
Linda A. Lee, MDJohns Hopkins Integrative Medicine & Digestive CenterDivision of Gastroenterology and Hepatology
Johns Hopkins Integrative Medicine & Digestive Center
Primary location at Green Spring Station Consultative services also available at the Hospital Staff
Four physicians (internist, GYN, GI, rheumatologist)
Two acupuncturists (TCM)
Four licensed massage therapists
Two psychotherapists – hypnotherapy, CBT, guided imagery
One nutritionist – individual consultations and group classes
Goals
To create an inviting, comfortable, safe environment
Allow lengthy appointments so there is more time to understand the multiple dimensions of illness, to educate the patient, and discuss the full range of evidence-based therapies
Offer services within the Center that would be readily accessible to patients as well as referring providers
Johns Hopkins Integrative Medicine & Digestive Center
4000 visits to the Center in FY12 Open Mon-Sat, evening hours until 9
pm 6 examination rooms, all
multipurpose Staff offer personal, concierge-type
service Is the only integrative medicine
center in the US based in gastroenterology
JHIMDC: Our Patient Programs
www.hopkinsintegrative.org
Finding practitioners
What training or education did she receive? Is the practitioner licensed in the state? Is certification by a professional
organization required for state licensure? (e.g. NCCAOM)
What clinical and research experience does she have?
Is the practitioner integrative, or disintegrative?
Integrative Medicine Approach: Principles
Engage the patient as an active participant
Provide education about health, symptoms, and diseases
Counsel in appropriate nutrition practices and supplement use
Discuss evidence-based pharmacologic and mind-body therapies
The patient-provider interaction is a vital part of the healing process
An example: Gastroesophageal Reflux
Conventional Strategy
Medical therapy Additional testing Lifestyle changes
Low fat diet Avoid caffeine Avoid carbonated
beverages Limit your alcohol
intake Stop smoking Raise the head of your
bed
Trends in usage of antacid and gastroprotective agents over 5 years
Gastroesophageal reflux: cause
Stress and esophageal hypersensitivity
Esophageal hypersensitivity has been implicated as a cause of reflux symptoms
Psychosocial factors are known to mediate both peripheral and central hypersensitivity and play a role in symptom perception among patients with GERD
Behavioral medicine techniques (CBT and hypnotherapy) may be a useful adjunct to other anti-reflux therapy in those who experience increased symptoms during stressMcDonald-Haile, J, et al. Gastroenterology, 1994;107(1):61-9
Van Peski-Oosterbaan, AS, et al. Am J Med 1999; 106: 424–9Miwa, H et al. J Neurogastroenterol Motil, Vol. 16 No. 4 October, 2010
The Integrative Medicine Approach
Understand and treat the symptoms in the context of the patient’s home and work life
Educate the patient as to why GERD occurs
Discuss weight loss as a long-term management strategy
Discuss evidence-based acupuncture
Answer questions about the use of supplements
Determine if stress is a trigger for symptoms and identify strategies for addressing stress
Medical therapy Additional testing Lifestyle changes
Low fat diet Avoid caffeine Avoid carbonated
beverages Limit your alcohol
intake Stop smoking Raise the head of your
bed
PLUS THIS:
Acupuncture for persistent reflux symptoms
Dickman, R. et al. Aliment Pharmacol Ther 2007. 26: 1333–1344
Traditional Remedies for reflux
no scientific evidence… yet
Fennel seed
Licorice
Apple Cider Vinegar
PhysicianConventional care
Acupuncturist
Psychotherapist
Nutritionist
Massage Therapist
Physician
JHIMDC
Is integrative medicine cost-effective?
Cost savings could be realized by Decreasing utilization of expensive
medical interventions such as pharmaceuticals, or reducing trips to the ER
Reducing provider visits by offering group interventions, such as stress reduction, nutrition education, and mind-body skills training
If nothing changes and the current trends continue…
By the year 2022, 80% of the US population will be overweight or obese (currently 66%)
Projected healthcare spending related to overweight and obesity by the year 2020 is estimated to be $437.6 billion (was $81.5 billion in 2000)
Yang, F. et al Obesity (2008) 16 10, 2323–2330
Challenges to Integrative Medicine
Current healthcare reimbursement favors procedures and pharmaceuticals over education, adequate face-to-face time, mind-body therapies
Conventional practitioners lack knowledge about evidence-based healing practices and practitioners, and how to identify them