Early lessons from establishing the Centre for Integrative Medicine at the University of Toronto Lynda G. Balneaves. RN, PhD

Transcription

1 Early lessons from establishing the Centre for Integrative Medicine at the University of Toronto Lynda G. Balneaves. RN, PhD Associate Professor Leslie Dan Faculty of Pharmacy University of Toronto

2 Disclosure I have no relationships with commercial interests to disclose beyond having a Mitacs student fellowship at UBC co-sponsored by: Canadian Association of Medical Cannabis Dispensaries Canadian Consortium for the Investigation of Cannabinoids Aphria (licensed producer) I am a board member of the Society for Integrative Oncology and the International Society for Complementary Medicine Research but receive no financial compensation.

3 A little background Discussions among various interested faculty members at U of T re: establishment of a Centre focused on integrative medicine (IM) in 2013 Proposal developed to create an EDU-D Centre and eventually an EDU-C with partnership between Medicine and Pharmacy A donor was identified in the community with an interest in IM Endowed chair was created Following search, chair was filled in September 2014 Centre officially opened Oct 2014

4 Centre for Integrative Medicine (CIM) Major collaboration among: University of Toronto s Faculty of Medicine and the Leslie Dan Faculty of Pharmacy The Scarborough Hospital Canadian Memorial Chiropractic College Canadian College of Naturopathic Medicine Schools of Chinese Medicine in Hong Kong Our Vision: To create an interdisciplinary Centre that supports internationally recognized research and education in complementary and integrative medicine.

5 Transformative Health Care Introduce CAM therapies and practitioners to Western health care settings, as well as patient and HCP education on CAM/IM Care that is holistic, comprehensive, patient-centred Patient-reported outcomes Emphasis on health promotion and prevention Develop integrative models of care

6 Cutting-Edge Research Natural health product discovery and development Rigorous clinical research on the efficacy and costeffectiveness of promising CAM therapies Acupuncture Chinese Medicine Mind-body therapies Chiropractic care Natural health products Evaluating the impact of integrative models of care on patients and the health care system

7 Translation of Evidence Research evidence will be shared with: Practicing health professionals Next generation of clinicians Patients and general public Development of interprofessional undergraduate, graduate and continuing education curricula and training opportunities Change culture of Western health care More inclusive and open to potential offered by CAM

8 Initial Steps

9 Phase 1 Strategic planning/community consultations Environmental scan Existing CAM therapies an at TSH and in the community Regulations, standards of practice, competencies, etc. = Regulatory Framework for CAM Practice Infrastructure, processes and policies at TSH Needs assessment Health professionals and patients CAM use, feasibility of CAM clinic at TSH Business plans

10 Health Care Provider Needs Assessment 226 responses 59% of respondents were female 62% were engaged in clinical practice with RNs (35%) making up the largest health professional group 8% of respondents were physicians Key Findings: Clinical 46% of respondents requested access to CAM therapies Massage therapy (85%) Mindfulness (62%) Movement therapy (61%) Therapies identified for patients included massage therapy (79%), acupuncture (63%) and mind-body therapies (65%)

11 Health Care Provider Needs Assessment Key Findings: Education A variety of education programs & resources were requested: Best practice guidelines (63%) Education on specific therapies & related evidence (63%) Information about how to integrate CAM therapies into conventional care (58%) The most popular specific CAM therapies that HCPs were interested in learning more about included: acupuncture natural health products massage therapy traditional Chinese Medicine (TCM)

12 Preferred Modes of Education Online learning (49%) In person workshops (44%) Website with evidence-informed CAM information (40%) Written information (39%) Lunch & learn (32%) Conferences (31%) 12

13 CAM Education Required by Patients 13 CAM Education N (%) In-person lectures on specific CAM therapies In-person lectures on making informed decisions about CAM therapies In-person workshops on how to evaluate claims about CAM therapies One-on-one decision support for patients interested in CAM therapies Website with CAM information and links to CAM resources Written information on specific CAM therapies Other (e.g., TV channel in hospitals, telephone/ online support, translated written material) 70 (31.0) 84 (37.2) 62 (27.4) 102 (45.1) 80 (35.4) 113 (50.0) 13 (5.8)

14 Patient Needs Assessment 593 responses across two hospital campuses Majority were female (57.9%) Spoke English as first language (61.6%) Mean age of 56.1 years Reported variety of health conditions (heart disease, chronic pain, diabetes, kidney disease) 53.6% were currently using some form of CAM therapy: Vitamins and minerals (80.5%) Other biological supplements (20.5%) Spiritual therapies (17.5%) 24% were currently seeing a CAM professional: Massage therapist (43.6%) Chiropractor (36.8%) Acupuncturists (23.3%)

15 Patient Needs Assessment 66.5% of patients were spending between 0-$49/month on CAM therapies and professionals, with 72.7% doing so out-ofpocket 67.1% expressed interest in receiving CAM therapies at the hospital, with most interest being in: Massage therapists Chiropractors Acupuncturists Nutrition classes Natural health products Movement therapies Mind-body therapies BUT.just 1 in 5 patients expressed willingness to pay for CAM services at the hospital.

16 Communication/Education about CAM Over half of patients were interested in an education program on CAM at the hospital, including 1:1 consultations, group education sessions, online course and website material However, less than 20% reported being asked about CAM use or consulting a hospital HCP about CAM Those individuals who did not report English as a first language were least likely to speak with an HCP about CAM use

17 Phase 2 Proof of Concept Projects Based on Phase 1 data: Identify promising CAM therapies and practitioners Integrate into appropriate chronic disease and primary care programs in TSH and surrounding community Examples include: acupuncture, massage, mind-body therapies, as well as whole systems, such as TCM Allow feasibility to be assessed and development of clinical policies, resources, & infrastructure Development of evaluation and research protocols

18 Phase 3 Integrative Care Teams Addition of CAM practitioners and therapies to conventional care teams Establishment of training opportunities for CAM and conventional health professional students interested in integrative medicine Expansion of research program: Pilot studies of integrative care models Data registry established for big data studies Beginning clinical studies

19 Ultimate Goal Out-patient integrative care clinic at TSH Providing care to patients, families and health professionals Offer evidence-informed integrative health care Research and training embedded within clinic Aligned with core principles: Patient-centredness Evidence-informed Quality Feasibility and sustainability Provide model for future integrative clinics throughout GTA and Canada

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21 Shift in Priorities & Interest New leadership at U of T Loss of key champions Conflict of interest Competing Vision and Mission between partners Health care system restructuring within the GTA

22 and then there was the skeptics!

23 Re-Structuring Underway The Centre for Natural Health Products and Traditional Medicine at the Leslie Dan Faculty of Pharmacy Under the leadership of Dean Heather Boon and Dr. Natalie Bozinovski Visiting Scholar in traditional Chinese medicine is being sought Maintaining student exchanges with Chinese University of Hong Kong Launching education seminar on gut health this fall Strategic planning is underway

24 Lessons Learned Agreement on mission, vision, values and scope of Centre between all partners Start small!!! Address a need that exists among the partners Ensure champions are committed and persuasive with the Powers that Be Need to include MDs and key administrators Provide stable support to Centre and leadership Tenure-track positions with protected time Long-term funding model through philanthropic, grant, and administrative sources Written commitment from key partners for future initiatives (e.g., MOUs)

25 Lessons Learned Include administrative support in funding model to provide sufficient support to leadership to manage interest from various communities and to move forward research grants, training programs, and deal with the influx of community and clinical interest Create strategic communication messaging to calm the skeptics and reassure the supporters Health promotion and prevention Harm reduction and risk management Knowledge translation and evidence-informed practice Engage the public in Centre s mandate and to provide a real face to IM Identify COI early on and develop strategies to manage

26 Lessons Learned There is overwhelming interest within the public in IM! A growing number of clinicians (both allopathic and CAM) are interested in being part of an academic centre for excellence in IM There is passion for the topic of IM within various stakeholder communities, including the media, private insurance, and adminstrators - we must learn to harness this passion and direct it appropriately Significant gaps in knowledge about IM continue to exist

27 Challenges to IM Moving Forward Funding issues Positioning of a fee-for-service therapy/practitioner within a publicly funded institution Canadians expectations related to universal health care Lack of overall funding for the Canadian health care system Limited evidence for some therapies vs. EBM Power Who are the gatekeepers to health care in Canada? Who are the decision-makers? Conflicts of interest and shifting priorities Competing paradigms Existing struggles re: interprofessional care

28 Summary Integrative health care is a burgeoning area of interst in Canada The policy and resource implications of integrating CAM therapies and practitioners within a publicly funded health care system must be considered Evidence is needed to obtain/retain key stakeholders Efficacy Effectiveness Cost-effectiveness Patient satisfaction Strategic communication and PR plan is needed to address skeptics and overcome power dynamics

29 November 5-7, 2016

30 November 5-7, 2016