The IMCO scheme as a tool in developing team-based treatment for people with multiple sclerosis.

BACKGROUND: The Danish Multiple Sclerosis Society (a patient organization) has initiated a research-based bridge-building and integrative treatment project to take place from 2004 to 2010 at a specialized MS hospital. The background for initiating the project was an increasing use of alternative treatment documented among persons with multiple sclerosis (PwMS). From PwMS there has been an increasing demand upon The Danish Multiple Sclerosis Society to initiate the project. OBJECTIVE: The overall purpose of the project is to examine whether collaboration between 5 conventional and 5 alternative practitioners may optimize treatment results for people who have multiple sclerosis (MS). The specific aim of this paper is to present tools used in developing collaboration between the conventional and alternative practitioners. MATERIALS AND METHODS: Two main tools in developing collaboration between the practitioners are described: (1) the planning and conduction of 4 practitioner-researcher seminars in the prephase of the project before recruiting patients with MS; and (2) the IMCO scheme (which is an abbreviation of Intervention, Mechanism, Context, and Outcomes). This tool was developed and used at practitioner-researcher seminars to make visible the different practitioners' treatment models and the patient-related treatment courses. RESULTS: Examples of IMCO schemes filled in by the medical doctor and the classical homeopath illustrate significant differences in interventions, assumptions concerning effect mechanisms, and awareness of contexts facilitating and inhibiting the intervention to generate the outcomes expected and obtained. CONCLUSIONS: The IMCO schemes have been an important tool in developing the team-based treatment approaches and to facilitate self-reflection on the professional role as a health care provider. We assume that the IMCO scheme will be of real value in the development of effective treatment based on collaboration between conventional and alternative practitioners.

Developing and evaluating complementary therapy services: Part 1. Establishing service provision through the use of evidence and consensus development.

The integration of complementary therapies within the British National Health Service (NHS) in the context of limited evidence of effectiveness has been much debated, as has the need for the provision of health services to be more evidence-based. In June 1994, a project was launched within a South-East London NHS Hospital Trust to introduce complementary therapy (acupuncture, homeopathy, and osteopathy), in the context of an evaluation program. This followed approximately 4 years of working toward raising the profile of complementary therapies within the hospital through study days, workshops, and providing a massage and osteopathic service for staff. A survey of local general practitioners highlighted areas of complementary therapy provision and interest in referring patients to a hospital-based service. A steering group was established to draw together a proposal for funding the service. Evidence for the effectiveness of acupuncture, homeopathy, and osteopathy was presented at a multidisciplinary seminar. A consensus development process, using a modified Delphi technique to establish referral indicators followed this. This study provides a useful model of service development in the absence of good quality evidence for the effectiveness of clinical interventions.

Survey of services to patients in general practice.

Family doctors vary in the range of services they provide for their patients. Of 267 practices in Devon and Cornwall, 245 responded to a questionnaire sent in September 1989 asking for information about services to patients. Most doctors consulted at six to eight patients per hour, whether or not an appointment system operated. About two-thirds of patients had access to a female GP. Nine out of ten practices employed a practice nurse. Almost all offered a surgery on Saturday mornings. Most surgeries took the phone over at 8.30 a.m. in the week and started consulting at 9 a.m. Almost half were consulting until 6.30 p.m. or later on at least one day per week. 80% of practices were offering a non-urgent appointment on the same or next day. All practices offered childhood immunisation. 80% offered some form of personal list system. 80% offered minor operations, one-third manipulations, 10% homeopathy, 6% hypnosis and 5% acupuncture.

Using a computer-based clinical management system to improve effectiveness of a homeopathic service in a fundholding general practice.

UNLABELLED: Problems which the development attempts to address. This study's overall objectives were to determine whether: * The aims of collaboration between General Practitioner (GPs) and a homeopath can be made explicit and service delivery optimised by using computer-based data collection in a multi-disciplinary primary care team that includes a homeopathic practitioner. * Outcomes of the homeopathic service can be evaluated in a practical way, which allows quality assurance through rapid audit cycles. METHOD: The primary care team (PCT) explored the problems of developing a rational and quality assured complementary therapy service in a series of meetings in an NHS practice where complementary therapists are members of the PCT. This led to the defining of data-collection structures and processes needed. The researchers designed and supervised their implementation and evaluation through a series of action research cycles. A database was designed which allowed the clinicians to track interventions and outcomes using the Measure Your Own Medical Outcome Profile (MYMOP). Critical incidents were brought to fortnightly clinical meetings and methods were continually adapted as problems arose and new options emerged at six-weekly audit meetings. RESULTS: GPs tended to refer patients who do not fit easily into biomedical disease categories. Patients referred tend to self-rate themselves as experiencing notably poor wellbeing. MYMOP has to be used skillfully with homeopathic patients, especially where psychological distress is identified as one of their main complaints. CONCLUSIONS: It is possible to introduce rigour and reflectiveness when providing a homeopathic service in general practice by assessing the needs of patient and practitioners, agreeing intake guidelines, developing referral processes, implementing audit cycles. Clear lines of communication can be established and a patient-centred outcome measure can be introduced into the treatment cycle.