Integration between orthodox medicine, homeopathy and acupuncture for inpatients: Three years experience in the first hospital for Integrated Medicine in Italy

10.1016/j.jtcme.2015.03.006

Simonetta Bernardini；Franco Cracolici；Rosaria Ferreri；Massimo Rinaldi；Roberto Pulcri

Orthodox (conventional) medicine ； CAM (Complementary and Alternative Medicine) ； Integrated Medicine hospital clinical setting ； Public Health Service ； Inter-disciplinary approach in medicine

Journal of Traditional and Complementary Medicine

5卷4期（2015 / 10 / 01）

234 - 240

英文

The hospital in Pitigliano (Tuscany) is the first hospital in Italy to put into practice a model of Integrated Medicine. This clinical setting caters for the use of complementary medicine (homeopathy and acupuncture (針灸zhēn jiǔ)) alongside orthodox therapies (conventional medicine). The therapeutic model implicates doctors who are experts in complementary and alternative medicine (CAM; 補充與替代醫學bǔ chōng yǔ tì dái yī xué) and the rest of the hospital personnel working together as equals. This contribution explains the difficulties, critical aspects and potential of this innovative setting. The clinical setting for Integrated Medicine was evaluated in part through observation and in part through the analysis of approval questionnaires. The writers of the questionnaires were the orthodox medical personnel and the hospital patients. The project is still evolving today in spite of the initial partial contrariety of some doctors in the hospital and some external doctors in the area. However, it can already be considered a positive experience, as confirmed by the high approval gained from many health workers and most of the hospital patients. Moreover, the follow-up carried out through specific surgeries dedicated to CAM is extremely positive. Up to now 532 inpatients suffering from acute illnesses, relapse of a chronic illness or neurological or orthopaedic rehabilitation following strokes, brain haemorrhage, neurological illness or limb prosthesis operations have been treated. This work has tried to illustrate the innovative and positive experience for the Italian public health authorities so that it may also be useful to anyone who would like to promote similar initiatives within its public health Institution.

1. Manifesto on Integrated Medicine. http://www.siomi.it/apps/news.php?id=1118; Last Accessed 12.02.15.
2. Integrated Medicine Video. www.asl9.toscana.it/Pitigliano http://www.usl9.grosseto.it/default.asp?idLingua=1&idContenuto=939; Last Accessed 12.02.15.
3. Bell, I,Caspi, O,Schwartz, G(2002).Integrative medicine and systemic outcomes research: issues in the emergence of a new model for primary healthcare.Arch Intern Med.,162,133-140.
4. Ben-Arye, E,Lev, E,Schiff, E(2011).Complementary medicine oncology research in the Middle-East: shifting from traditional to integrative cancer care.Eur J Integr Med.,3,29-37.
5. Bernardini, S,Cracolici, F,Pulcri, R,Ferreri, R,Lucenti, C,Rinaldi, M(2012).Integrated medicine setting at the Hospital of Pitigliano (Italy), Public Healthcare Service, Tuscany Region.Eur J Integr Med,4S,41.
6. Boon, H,Verhoef, M,O'Hara, D,Findlay, B(2004).From parallel practice to integrative health care: a conceptual framework.BMC Health Serv Res,4,15.
7. Brien, S,Howells, E,Leydon, GM,Lewith, G(2008).Why GPs refer patients to complementary medicine via the NHS: a qualitative exploration.Prim Health Care Res Dev,9,205-215.
8. Broom, A,Tovey, P.(2007).Therapeutic pluralism? Evidence, power and legitimacy in UK cancer services.Sociol Health Illn,29,551-569.
9. Cohen, MM(2004).CAM practitioners and "regular" doctors: is integration possible?.Med J Aust,180,645-646.
10. Coulter, ID,Ellison, MA,Hilton, L,Rhodes, HJ,Ryan, G(2007).Hospital-based Integrative Medicine a Case Study of the Barriers and Factors Facilitating the Creation of a Center.Santa Monica: Calif.:RAND Corporation.
11. Coulter, ID,Herman, PM,Nataraj, S(2013).Economic analysis of complementary, alternative, and integrative medicine: considerations raised by an expert panel.BMC Complement Alternat Med,13,191.
12. Cramer, H,Cohen, L,Dobos, G,Witt, CM(2013).Integrative oncology.Evid Based Complement Alternat Med,2013,124032.
13. Dobos, GJ(2009).Integrative medicine - medicine of the future or ‘Old Wine in New Skins’?.Eur J Integr Med,3,109-115.
14. Ernst, E(2004).Disentangling integrative medicine.Mayo Clin Proc,79,565-566.
15. Ernst, E(2006).Integrated medicine: good intentions, poor logic?.J R Soc Promot Health,126,206-207.
16. Frass, M,Strassl, RP,Friehs, H,Müllner, M,Kundi, M,Kaye, AD(2012).Use and acceptance of complementary and alternative medicine among the general population and medical personnel: a systematic review.Ochsner J,12,45-56.
17. Grace, S,Higgs, J(2010).Interprofessional collaborations in integrative medicine.J Altern Complement Med,16,1185-1190.
18. Herman, PM,Dodds, SE,Logue, MD(2014).IMPACT-Integrative Medicine PrimAry Care Trial: protocol for a comparative effectiveness study of the clinical and cost outcomes of an integrative primary care clinic model.BMC Complement Alternat Med,14,132.
19. Herman, PM,Poindexter, BL,Witt, CM,Eisenberg, DM(2012).Are complementary therapies and integrative care cost-effective? A systematic review of economic evaluations.BMJ Open,2
20. Hoffmann, B,Moebus, S,Michalsen, A(2004).Health-related control belief and quality of life in chronically ill patients after a behavioral intervention in an integrative medicine clinic-an observational study.Forsch Komplementarmed Klass Naturheilkd,11,159-170.
21. Hollenberg, D(2007).How do private CAM therapies affect integrative health care settings in a publicly funded health care system?.J Complement Integr Med.,4,33-234.
22. Hollenberg, D(2006).Uncharted ground: patterns of professional interaction among complementary/alternative and biomedical practitioners in integrative health care setting.Soc Sci Med.,62,731-744.
23. Italian Society of Homeopathy and Integrated Medicine. www.siomi.it; Last Accessed 12.02.15.
24. Maizes, V,Rakel, D,Niemiec, C(2009).Integrative medicine and patient-centered care.Explore,5,277-289.
25. McLachlan, JC(2010).Integrative medicine and the point of credulity.BMJ,341,c6979.
26. Michalsen, A,Hoffmann, B,Moebus, S,Bäcker, M,Langhorst, J,Dobos, GJ(2005).Incorporation of fasting therapy in an integrative medicine ward: evaluation of outcome, safety, and effects on lifestyle adherence in a large prospective cohort study.J Altern Complement Med,11,601-607.
27. Mizrachi, N,Shuval, JT,Gross, S.(2005).Boundary at work: alternative medicine in biomedical settings.Sociol Health Illn,27,20-43.
28. National Center for Complementary and Alternative Medicine: Complementary, Alternative, or Integrative Health: What’s In a Name? http://nccam.nih.gov/health/whatiscam/index.htm#3; Last Accessed on 12.02.15.
29. Rees, L,Well, A(2001).Integrated medicine.BMJ,322,119-120.
30. Roberti di Sarsina, P,Iseppato, I(2011).Why we need integrative medicine.EPMA J,2,5-7.
31. Schroeder, CA,Likkel, L(1999).Integrative health care: the revolution is upon us.Public Health Nurs,16,233-234.
32. Shuval, JT,Mizrachi, N,Smetannikov, E(2002).Entering the well-guarded fortress: alternative practitioners in hospital settings.Soc Sci Med.,55,1745-1755.
33. Siddiqui, MJ,Min, CS,Verma, RK,Jamshed, SQ(2014).Role of complementary and alternative medicine in geriatric care: a mini review.Pharmacogn Rev,8,81-87.
34. Sundberg, T,Falkenberg, T(2014).Using hospital data and routines to estimate costs and effects of integrative care programmes for chronic pain and stress disorders - a feasibility study.Forsch Komplementmed,21,164-170.
35. Sundberg, T,Halpin, J,Warenmark, A,Falkenberg, T(2007).Towards a model for integrative medicine in Swedish primary care.BMC Health Serv Res,7,107.
36. Sundberg, T,Petzold, M,Kohls, N,Falkenberg, T(2014).Opposite drug prescription and cost trajectories following integrative and conventional care for pain-a case-control study.PLoS One,9,e96717.
37. Thomas, KJ,Coleman, P,Weatherley-Jones, E,Luff, D(2003).Developing integrated CAM services in Primary Care Organisation.Complement Ther Med,11,261-267.
38. Verhoef, MJ,Mulkins, A,Boon, H(2005).Integrative health care: how can we determine whether patients benefit?.J Altern Complement Med,11S,57-65.
39. von Rosenstiel, IA,Schats, W,Bongers, K,Jong, MC(2011).Integrative paediatrics: a Dutch experience.Focus Altern Complement Ther,16,22-27.
40. Witt, CM(2008).Quality, safety and costs of integrative medicine.Eur J Integr Med,1S
41. Yin, CS,Ko, SG(2014).Introduction to the history and current status of evidence-based korean medicine: a unique integrated system of allopathic and holistic medicine.Evid Based Complement Alternat Med,2014,740515.