Exploring Integrative Medicine in Swedish Primary Care

Summary

Research over the last years have reported an increased popularity of complementary therapies (CTs) and an integration of CTs into mainstream medical settings, health care organizations and insurance plans. These trends may present both new challenges and new opportunities for health care provision. In Sweden and elsewhere, major challenges include the great variety and quality of CT provision within health care and a lack of national and international recommendations of how integrations of CTs with conventional care should be modelled, i.e. lack of conceptual models for delivering integrative medicine (IM). This may partly be a result of a scarce evidence base in support of IM provision within public health care services, e.g. lack of IM compared to usual care in randomised clinical trials. It remains largely unknown whether comprehensive models of IM are clinically or cost effectively different from conventional care provision.

Back and neck pain are costly, conventionally managed in primary care and two of the most common conditions treated by CTs. We have developed a comprehensive collaborative consensus model for IM adapted to Swedish primary care. The aim of this pilot study was to explore the feasibility of a pragmatic randomised clinical trial to investigate the effectiveness of the IM model versus conventional primary care in the management of patients with non-specific back/neck pain.

Conditions

• Back or Neck Pain of at Least 2 Weeks Duration

Interventions

PROCEDURE

Integrative care

In short, integrative care was up to 10 complementary therapy treatments delivered to the patient in addition to the usual care over an intervention period of up to 12 weeks. The integrative care was provided by a multidisciplinary team coordinated by a gate keeping general practitioner with clinical knowledge and experience of CTs and senior licensed/certified CT providers representing Swedish massage therapy, manual therapy/naprapathy, shiatsu, acupuncture and qigong.

PROCEDURE

Usual care

The usual care treatment was coordinated by the patient's general practitioner and complied with the clinical practice routines at the participating primary care units. Conventional procedures included but were not exclusive to advice, prescription of drugs, sick leave and physiotherapy/physical therapy. There were no constraints to the provided usual care as the study aimed to pragmatically reflect the general practitioners' standard care and treatment as usual.

Sponsors & Collaborators

• Ekhagastiftelsen

  collaborator OTHER

• Insamlingsstiftelsen för forskning om manuella terapier

  collaborator UNKNOWN

• Primary care units at Bagarmossen, Skarpnäck, Dalen and Björkhagen

  collaborator UNKNOWN

• Svensk förening för vetenskaplig homeopati

  collaborator UNKNOWN

• HRQL gruppen, Göteborgs universitet

  collaborator UNKNOWN

• Karolinska Institutet

  lead OTHER

Principal Investigators

• Torkel Falkenberg, PhD · Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Nursing

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

18 Years

Max Age

65 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2004-09-30

Primary Completion

2007-11-30

Completion

2007-11-30

Countries

• Sweden

Study Locations