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 Table of Contents  
EDITORIAL
Year : 2022  |  Volume : 7  |  Issue : 3  |  Page : 101-103

Mainstreaming of integrated medicine in health-care delivery system to combat chronic noncommunicable diseases


Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Date of Submission16-Sep-2022
Date of Decision16-Sep-2022
Date of Acceptance20-Sep-2022
Date of Web Publication15-Oct-2022

Correspondence Address:
Dr. J S Thakur
Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jncd.jncd_64_22

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How to cite this article:
Thakur J S, Paika R. Mainstreaming of integrated medicine in health-care delivery system to combat chronic noncommunicable diseases. Int J Non-Commun Dis 2022;7:101-3

How to cite this URL:
Thakur J S, Paika R. Mainstreaming of integrated medicine in health-care delivery system to combat chronic noncommunicable diseases. Int J Non-Commun Dis [serial online] 2022 [cited 2023 Jan 26];7:101-3. Available from: https://www.ijncd.org/text.asp?2022/7/3/101/358634



Integrated medicine here refers to a holistic strategy which involves comprehensive patient-centered integrated care. Integrated medicine has a larger meaning and mission, its focus being on health and healing rather than disease and treatment.[1] It views patients as whole people with minds and spirits as well as bodies and includes these dimensions into diagnosis and treatment. It involves patients and doctors working to maintain health by paying attention to lifestyle factors such as diet, exercise, quality of rest and sleep, and the nature of relationships. It is about restoring core values which have been eroded by social and economic forces. It involves multiscale, multimodal, and multilevel systems approaches to tackle noncommunicable diseases (NCDs) as a common group of diseases.[2] As per WHO, estimates suggests that 80% of the world's population use traditional medicine, such as herbal medicines, yoga, indigenous therapies, and various others.[3] As per the WHO global report on traditional and complementary medicine 2019, 88% of Member States use traditional and complementary medicine, which refers to 170 Member States.[3] The priorities identified for the use of traditional and complementary medicine include evidence and data generation to inform policies, standards and regulatory frameworks for safe, cost-effective, and equitable use of traditional medicine.[3] The use of an integrated approach will aid in implementing a road map for predictive, preventive, personalized, and participatory medicine based on robust and extensive knowledge management in health-care delivery system. For example, a diabetic patient might get benefit from dietary and fitness advice or as an alternative or adjuvant to insulin and other treatments. An integrative approach of health-care practice also considers the psychological effects of a diagnosis on the patient and addresses habits that may have contributed to its onset or development.[3] This will take a holistic approach to disease and allows the results to be used globally by considering the needs and specificities of local economies and health-care delivery system.

World Health Organization identifies traditional medicine (alternatively used as complementary medicine in various countries) as the sum total of the knowledge, skill, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement, or treatment of physical and mental illness.[4] Furthermore, Complementary medicine refers to a broad set of healthcare practices that are not part of that country's own tradition or conventional medicine and are not fully integrated into the dominant health-care system. The WHO also focused on enhancing traditional medicine and developed the WHO traditional medicine strategy 2002–2005 and then updated the same for 2014–2023, it focuses on prioritizing health services and systems, including traditional and complementary medicine products, practices, and practitioners.[4],[5],[6] By 2018, more than 85% of the total Member States in the WHO African Region and South-East Asia Region reported having a national policy for Traditional and complementary Medicine, South-East Asia reported the highest percentage of countries (91%) with a national program.[6]

There are five models of the Integrated Medicine practice approach, which includes coexistence, cooptative, cooperative, collaborative, and patient-centered care (PCC), based on the literature review.[7],[8],[9] The independent models include the coexistence model and cooptative model. The coexistence model or parallel system that involves minimal interaction between the two medical systems and each one working independently in practice and clinical decision-making. The cooptative model includes the incorporation of complementary and alternative medicine (CAM) but is based on the diagnostic methods of conventional medicine.[7],[8] The independent models include cooperative, collaborative, and patient centred care. The cooperative model refers to that each one makes their own clinical decisions but engages in a formalized interaction (conventional and CAM), for example, communication, and sharing of patient data between teams. The collaborative model refers to working together to develop a consensus for patient care.[9] The PCC model characteristics of both independent and integrative systems with separate integrative medicine clinics that preserve the respective systems but integrates around shared decision-making. PCC model values both paradigms, facilitates collaboration between team members, and places the patient as the focus of primary importance.[10] However, in terms of integration, none of the countries or regions has defined the health-care delivery system.

There are various studies published indicating the importance and evidence of the effectiveness of CAM in NCD. For cardiovascular events, the monitoring and actualization of noetic therapy clinical trials assessed the feasibility and effcacy of these therapies of stress relaxation, imagery, touch therapy, and prayer in patients with acute coronary interventions compared to usual care.[11] There was a reduction (25%–30%) in the absolute incidence of major adverse cardiovascular events (i.e. mortality, myocardial infarction, congestive heart failure, and urgent or repeat revascularization) or adverse clinical events in patients treated with any Noetic therapies compared to usual care (control).[11],[12]

In the case of breast cancer patients, for quality-of-life of women treated with anthroposophic therapy: An individually composed therapies consisting of natural products, Iscador, diets, art therapy, eurhythmic therapy, therapeutic massage, hydrotherapy after surgery as compared to usual care. At 1-year follow-up, there was a significant (P < 0.05) increase in quality-of-life/life satisfaction (EORTC QLQ-C30 and LSQ) compared to the usual care alone. After 5-year follow-up, there were improvements in overall quality of life and in emotional and social functioning.[13]

However, still, there are insufficient evidence from trials which can strongly support the efficacy of integrative medicine compared with usual care. Additional high-quality randomized controlled trials and conditional cash transfers are therefore needed to build a stronger evidence-based body of knowledge. In India, the Ministry of Health and Family Welfare, Government of India, is trying to develop an integrated model in the implementation of AYUSH (Ayurveda, Yoga, Unani, Siddha and Homeopathy) with the NPCDCS (National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke) at the primary health care level, an initiative for integrated medicine in primary healthcare settings.[14] A task force has been developed as multidisciplinary task force for AYUSH implementation at Ayushman Bharat Health and Wellness Centres for NCD. An important component of the National Health Policy (NHP) 2017 was “Integration with AYUSH” for mainstreaming of AYUSH and promoting pluralism in healthcare through cross-referrals across all systems of medicines.[15],[16] The Government of India has launched National AYUSH Mission with a focus to promote AYUSH medical systems through cost-effective AYUSH services, strengthening of educational systems, facilitate the enforcement of quality control of Ayurveda, Siddha and Unani and Homoeopathy (ASU and H) drugs and sustainable availability of ASU and H raw-materials.[17] The AYUSH systems advocate holistic wellness approach aiming at the prevention of diseases and promotion of health and well-being. The NHP 2017 emphasizes developing protocols for mainstreaming AYUSH as integrated healthcare.[18] This has a huge potential for effective prevention and therapy that is safe and cost-effective. Mainstreaming of AYUSH systems with modern medicine and healthy lifestyle measures has a great potential to facilitate primary healthcare to achieve better outcomes and universal health coverage.

The key challenges in the implementation of integrated medicine include lack of research data, the mechanism to control and regulate advertising and claims of traditional and complementary medicine, financial support, expertise within national authorities and control agencies, cooperation channels between national health authorities to share information, monitor safety of products, education, and training.[5]

The key aspects of integration include the familiarisation with complementary therapies that need to start in medical schools and other institutes of higher education, research with the focus on integrated medicine, evidence base practice of integrated medicine, standardization of the terminology and nomenclature, training, and education. The other aspect which needs to be addressed in the implementation of integrated medicine includes the provision of authoritative guidance and standards on the quality, safety, and efficacy of health products through pretesting services, essential medicines, and diagnostic lists.

Therefore, there is a need for comprehensive policy to promote integrative health care in the country, making provision for expanding the scope of integration in medical education, research and development, clinical practice, and public health.[19] In this era of the rising burden of noncommunicable and lifestyle disorders, with political support for traditional therapies in primary health care and recognition by international bodies such as the WHO, it appears appropriate to incorporate the different systems of medical practice, i.e. integrated medicine for primary and secondary prevention of various NCDs including diabetes, cardiovascular disease, cancer, etc.

Acknowledgment

Centre for Sustainable Development Health and Wellness, World NCD Federation, Chandigarh, India.



 
  References Top

1.
Rees L, Weil A. Integrated medicine. BMJ 2001;322:119-20.  Back to cited text no. 1
    
2.
Bousquet J, Anto JM, Sterk PJ, Adcock IM, Chung KF, Roca J, et al. Systems medicine and integrated care to combat chronic noncommunicable diseases. Genome Med 2011;3:43.  Back to cited text no. 2
    
3.
World Health Organization. WHO Global Report on Traditional and Complementary Medicine 2019. Geneva: World Health Organization; 2019. Available from: https://www.who.int/publications/i/item/978924151536. [Last accessed on 2022 Sep 12].  Back to cited text no. 3
    
4.
World Health Organization. Traditional, Complementary and Integrative Medicine. Available from: https://www.who.int/health-topics/traditional-complementary-and-integrative-medicine#tab=tab_1. [Last accessed on 2022 Sep 12].  Back to cited text no. 4
    
5.
World Health Organization. The WHO Traditional Medicine Strategy 2014-2023. Geneva: WHO; 2014. Available from: https://www.who.int/publications/i/item/9789241506096. [Last accessed on 2022 Sep 12].  Back to cited text no. 5
    
6.
World Health Organization. WHO Global Report on Traditional and Complementary Medicine 2019. Available from: https://apps.who.int/iris/handle/10665/312342. [Last accessed on 2022 Sep 12].  Back to cited text no. 6
    
7.
Kailin DC. Initial strategies. In: Faass N, editor. Integrating Complementary Medicine into Health Systems. Gaithers-Burg, MD: Aspen Publications; 2001. p. 44-58.  Back to cited text no. 7
    
8.
Boon HS, Kachan N. Integrative medicine: A tale of two clinics. BMC Complement Altern Med 2008;8:32.  Back to cited text no. 8
    
9.
Leckridge B. The future of complementary and alternative medicine – Models of integration. J Altern Complement Med 2004;10:413-6.  Back to cited text no. 9
    
10.
Lim EJ, Vardy JL, Oh BS, Dhillon HM. A scoping review on models of integrative medicine: What is known from the existing literature? J Altern Complement Med 2017;23:8-17.  Back to cited text no. 10
    
11.
Krucoff MW, Crater SW, Gallup D, Blankenship JC, Cuffe M, Guarneri M, et al. Music, imagery, touch, and prayer as adjuncts to interventional cardiac care: The Monitoring and Actualisation of Noetic Trainings (MANTRA) II randomised study. Lancet 2005;366:211-7.  Back to cited text no. 11
    
12.
Seskevich JE, Crater SW, Lane JD, Krucoffi MW. Beneficial effects of noetic therapies on mood before percuta-neous intervention for unstable coronary syndromes. Nurs Res 2004;53:116-21.  Back to cited text no. 12
    
13.
Carlsson M, Arman M, Backman M, Hamrin E. Perceived quality of life and coping for Swedish women with breast cancer who choose complementary medicine. Cancer Nurs 2001;24:395-401.  Back to cited text no. 13
    
14.
Integration of AYUSH with National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS). Ministry of Health and Family Welfare. Government of India, New Delhi; 2022.  Back to cited text no. 14
    
15.
Shrivastava SR, Shrivastava PS, Ramasamy J. Mainstreaming of Ayurveda, yoga, naturopathy, Unani, siddha, and homeopathy with the health care delivery system in India. J Tradit Complement Med 2015;5:116-8.  Back to cited text no. 15
    
16.
Shankar D, Patwardhan B. AYUSH for new India: Vision and strategy. J Ayurveda Integr Med 2017;8:137-9.  Back to cited text no. 16
    
17.
National AYUSH Mission. Government of India, New Delhi. Available from: https://namayush.gov.in. [Last accessed on 2022 Sep 12].  Back to cited text no. 17
    
18.
National Health Policy. Ministry of Health and Family Welfare, Government of India, New Delhi; 2017. Available from: https://www.nhp.gov.in/nhpfiles/national_health_policy_2017.pdf. [Last accessed on 2022 Sep 12].  Back to cited text no. 18
    
19.
Tripathy JP, Thakur JS. Integration of yoga with modern medicine for promotion of cardiovascular health. Int J Noncommun Dis 2017;2:64-8.  Back to cited text no. 19
    




 

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