An investigation of multidisciplinary complex health care interventions – steps towards an integrative treatment model in the rehabilitation of People with Multiple Sclerosis

BMC Complementary and Alternative Medicine

Kirsten Søndermark³  Karin Pedersen⁴  Frank Staalkjær⁴  Kirsten Sietam⁴  Gudrun Aa Rasmussen⁴  Birthe K Mortensen⁴  Søren Borch⁴  Anette Olsen³  Christina Mortensen³  Mai-Britt Ottesen³  Michael Nissen³  Finn Boesen³  Laila Launsø²  Charlotte Paterson⁵  Niels Haahr⁴  Liv Bjerre⁴  Lasse Skovgaard¹ 

[1] Department of Public Health Research, University of Copenhagen, Copenhagen, Denmark;The National Research Centre on Complementary and Alternative Medicine (NAFKAM), University of Tromsø, Tromsø, Norway;The Danish MS Hospital, Haslev, Denmark;The Danish MS Society, Valby, Denmark;Institute of Health Services Research, Peninsula Medical School, University of Exeter, Exeter, UK

关键词: Integrated health care;    Intervention theory;    Program theory;    Interdisciplinary health care;    Multiple Sclerosis;    CAM;   

Others  :  1232187
DOI  :  10.1186/1472-6882-12-50

 received in 2012-01-09, accepted in 2012-04-23,  发布年份 2012

【 摘 要 】

Background

The Danish Multiple Sclerosis Society initiated a large-scale bridge building and integrative treatment project to take place from 2004–2010 at a specialized Multiple Sclerosis (MS) hospital. In this project, a team of five conventional health care practitioners and five alternative practitioners was set up to work together in developing and offering individualized treatments to 200 people with MS. The purpose of this paper is to present results from the six year treatment collaboration process regarding the development of an integrative treatment model.

Discussion

The collaborative work towards an integrative treatment model for people with MS, involved six steps: 1) Working with an initial model 2) Unfolding the different treatment philosophies 3) Discussing the elements of the Intervention-Mechanism-Context-Outcome-scheme (the IMCO-scheme) 4) Phrasing the common assumptions for an integrative MS program theory 5) Developing the integrative MS program theory 6) Building the integrative MS treatment model. The model includes important elements of the different treatment philosophies represented in the team and thereby describes a common understanding of the complexity of the courses of treatment.

Summary

An integrative team of practitioners has developed an integrative model for combined treatments of People with Multiple Sclerosis. The model unites different treatment philosophies and focuses on process-oriented factors and the strengthening of the patients’ resources and competences on a physical, an emotional and a cognitive level.

【 授权许可】

   
2012 Skovgaard et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 1.

Figure 2.

【 参考文献 】

• [1]Boon HS, Kachan N: Integrative medicine: a tale of two clinics. BMC Complem Altern Med 2008, 8:32. BioMed Central Full Text
• [2]Nyborg L, Launsø L: Utprøvinger av alternativ behandling innenfor helsevesenet i møte mellom helsepersonell og alternative behandlere [Testing alternative treatment within the healthcare sector in the interface between healthcare personnel and alternative treatment providers. In Norwegian]. NAFKAM Research Report 2007. nr. 5
• [3]Gamus D, Pintov S: Integration of complementary and alternative medicine services in the hospital setting in Israel. Isr Med Assoc J 2007, 9(3):169-170.
• [4]Sundberg T, Halpin J, Warenmark A, Falkenberg T: Towards a model for integrative medicine in Swedish primary care. BMC Heal Serv Res 2007, 7:107. BioMed Central Full Text
• [5]Gamst A, Haahr N, Kristoffersen AE, Launsø L: Integrative care and bridge building among health care providers in Norway and Denmark. J Altern Complem Med 2006, 12(2):141-146.
• [6]Hollenberg D: Uncharted ground: patterns of professional interaction among complementary/alternative and biomedical practitioners in integrative health care settings. Soc Sci Med 2006, 62(3):731-744.
• [7]Vohra S, Feldman K, Johnston B, Waters K, Boon H: Integrating complementary and alternative medicine into academic medical centers: experience and perceptions of nine leading centers in North America. BMC Heal Serv Res 2005, 5:78. BioMed Central Full Text
• [8]Mulkins AL, Eng J, Verhoef MJ: Working towards a model of integrative health care: critical elements for an effective team. Complem Ther Med 2005, 13(2):115-122.
• [9]Kaptchuk TJ, Miller OMD, Franklin G: Viewpoint: What is the Best and most Ethical Model for the Relationship Between Mainstream and Alternative Medicine: Opposition, Integration or Pluralism? J Med Educ 2005, 80(3):286-290.
• [10]Shuval JT, Mizrachi N: Changing boundaries: modes of coexistence of alternative and biomedicine. Qual Heal Res 2004, 14(5):675-690.
• [11]Mulkins A, Verhoef M, Eng J, Findlay B, Ramsum D: Evaluation of the Tzu Chi Institute for Complementary and Alternative Medicine's Integrative Care Program. J Altern Complem Med 2003, 9(4):585-592.
• [12]Shuval JT, Mizrachi N, Smetannikov E: Entering the well-guarded fortress: alternative practitioners in hospital settings. Soc Sci Med 2002, 55(10):1745-1755.
• [13]Skovgaard L, Launsø L, Pedersen IK, Bjerre L, Haahr N: Combination Treatment of People with Multiple Sclerosis based on Collaboration between Conventional Healthcare Providers and Alternative Practitioners: Patient Perspectives on Outcomes. J Complem Integr Med 2011, 8(1):1-31 d.
• [14]Bjerre L, Henningsen I, Skovgaard L, Launsø L: Self-reported changes in quality of life among people with multiple sclerosis who have participated in treatments based on collaboration between conventional healthcare providers and CAM practitioners. Eur J Integr Med 2011, 3:e271-e279.
• [15]Bjerre L, Skovgaard L: Change in quality of life in people with multiple sclerosis treated by an integrated team of health-care providers and CAM practitioners. Mult Scler 2010, 16(suppl 10):183.
• [16]Skovgaard L, Bjerre L, Haahr N, Launsø L: Types of treatment collaboration between conventional and alternative practitioners – results from a research project at a Danish MS center. Int J Integr Care 2010, 10:1-16.
• [17]Paterson C, Baarts C, Launsø L, Verhoef M: Evaluating complex health interventions: a critical analysis of the ‘outcomes’ concept. BMC Complem Altern Med 2009, 18(9):18.
• [18]Kellogg Foundation: Logic model developing guide. 2004. [http://www.wkkf.org webcite]
• [19]Phillips CC, Knowlton LW: The Logic Model Guidebook: Better Strategies for Great Results. London: Sage Publications; 2008.
• [20]Tilley N, Pawson R: Realistic Evaluation. 1997. London: Sage Publications; 2008.
• [21]Pawson R, Greenhalgh T, Harvey G, Walshe K: Realist review - a new method of systematic review designed for complex policy interventions. J Health Services Res Policy 2005, 10(1):21-34.
• [22]Rogers PJ: Using programme theory to evaluate complicated and complex aspects of interventions. Evaluation 2008, 14:29-48.
• [23]Launsø L, Skovgaard L: The IMCO scheme as a tool in developing team-based treatment for people with Multiple Sclerosis. J Altern Complem Med 2008, 14(1):69-77.
• [24]Haahr N, Launsø L: Preliminary Initiatives in a Bridge Building Project between Conventional and Alternative Practitioners in Denmark. Forschende Komplementärmedizin und Klassische Naturheilkunde / Res Complem Classical Nat Med 2006, 13(5):307-312.
• [25]Launsø L, Haahr N: Brobygning mellem etablerede og alternative behandlere [Bridge building between conventional and alternative practitioners. In Danish]. Tidsskrift for Forskning i Sygdom og Samfund 2007, 6:75-96.
• [26]Launsø L, Haahr N: Bridge building and integrative treatment of people with multiple sclerosis. research-based evaluation of a team-building process. J Complementary Integr Med 2007., 4(1) Article 7
• [27]Skovgaard L, Bjerre L: Developing a conceptual model for integrated care – results from a bridge building project. J Traditional Chin med 2011, 31(suppl 1):143.
• [28]Skovgaard L: Potentials and barriers in cooperation between conventional and complementary practitioners at a Danish Multiple Sclerosis Hospital. Int J Integr Care 2011, 11:132.
• [29]Skovgaard L: Investigating negotiated treatment goals as a tool to facilitate collaboration between conventional and complementary practitioners in the treatment of people with Multiple Sclerosis. Int J Integr Care 2011, 11:133.