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Approaches for Integrative Medicine

Stakeholder presentation

Date: 27 February 2020

Venue: Bilik Mesyuarat Platinum

Not for circulation

Shakirah Md.Sharif, Yoon Ee Ling, Siti Nur Rifhan Kamaruddin, Shah Iskandar Ahmad Shafiee, Fun Weng Hong, Sondi Sararaks

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Prepared for Traditional and Complementary Medicine Division

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Review question & objective

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To identify various approaches/models/frameworks that could be adapted/adopted for the Malaysian context.

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What integrative medicine (IM) approaches have been described in the literature?

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Integrative medicine - definition

“The discipline concerned with using the combination of conventional allopathic medicine and alternative/complementary medicine to address the biological, psychological, social, and spiritual aspects of health and illness.”

Not for circulation

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Findings

  • Search yielded 11 articles (2 systematic reviews, 1 scoping review and 8 narrative reviews)
  • Only 1 of the included systematic review has low risk of bias
  • No explicit framework/model described for integrative medicine
  • Approaches adopted in 9 countries described

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Not for circulation

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Norway (5)

USA (1, 2, 3, 4, 5, 7, 8, 9 11)

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Canada (5, 9)

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Australia (5 6*, 11)

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Germany (3, 5, 9)

UK

(5, 9, 11)

Hong Kong (11)

Denmark (5, 11)

Switzerland (5)

*country of the author

Countries with described IM approaches

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Context of integrative medicine in included studies

Oncology

Unspecified

Lower back pain

Allergy & immunology

Acupuncture

5

3

1

1

1

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The SELFIE Framework for Integrated Care for Multi-morbidity

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Source:

Leitjen et al., 2018

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Word tree: elements from SELFIE framework

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Elements described in articles : Micro

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Elements described in articles : Meso

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Elements described in articles by health systems building block (N=11)

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Conceptual Framework for Integration of Traditional Medicine with National Healthcare Systems

Source:

Park & Canaway, 2019

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Conclusion

  • No explicit frameworks described for IM from the included studies.

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  • Majority of elements described fall under the domains of service delivery, leadership & governance and workforce.

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  • Very little description on financing and technologies.

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Limitations

  • No data available from countries with established integrative medicine (China, Hong Kong and the Republic of Korea). 
  • Formal bias risks assessment was not conducted by all of the studies (only for systematic reviews). 
  • In one of the studies, the authors did not include the remaining 24 papers that were included in the PRISMA flow diagram (total number: 53). Only results from 29 papers were synthesised and presented. The authors were not contacted and there were no clarifications made for this action.

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Recommendation

Elements from this review serves as input for consideration in TCMD’s effort to identify/develop a framework for integrative medicine in Malaysia, encompassing all levels of care.

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List of included studies

  1. Ben-Aye E, Schiff E, Zollman C, Heusser P, Mountford P, Frenkel M, Bar-Sela G, Lavie O. Integrating Complementary Medicine Supportive Cancer Care Models Across Four Continents. 
  2. Chang C, Gershwin ME. Integrative Medicine in Allergy and Immunology 
  3. Cramer H, Cohen L, Dobos G, Witt CM. Integrative Oncology: Best of Both Worlds The Theoretical, Practical and Research Issues. 
  4. Frenkel M, Cohen L. Incorporating Complementary and Integrative Medicine in a Comprehensive Cancer Centre
  5. GarcA-a-Escamilla E, RodrA-guez-MartA-nez-VizcaA-no V. Integration of Acupuncture into Conventional Medicine from Health Professionals’ Perspective: A Thematic Synthesis of Qualitative Studies 
  6. Lim EJ, Vardy JL, Oh BS, Dhillon HM. A Scoping Review on Models of Integrative Medicine: What is known from the existing literature? 
  7. Lopez G, Mao JJ, Cohen L. Integrative Oncology 
  8. Maizes V, Rakel D, Niemiec C. Integrative Medicine and Patient-Centred Care
  9. Seely DM, Weeks LC, Young S. A Systematic Review of Integrative Oncology Programmes. 
  10. Sit RW, Wong W, Law SW, Wu JC. Integrative Western and Traditional Chinese Medicine Service Model for Low Back Pain
  11. Templeman K, Robinson A. Integrative Medicine Models in Contemporary Primary Health Care

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