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.

Responses of established healthcare to the professionalization of complementary and alternative medicine in Ontario.

This paper examines the reactions of leaders of established health professions in Ontario, Canada to the efforts of selected complementary and alternative (CAM) occupational groups (chiropractors, naturopaths, acupuncture/traditional Chinese doctors, homeopaths and Reiki practitioners) to professionalize. Stakeholder theory provides the framework for analysis of competing interests among the various groups in the healthcare system. The data are derived from personal interviews with 10 formal leaders from medicine, nursing, physiotherapy, clinical nutrition and public health. We conceived of these leaders as one group of stakeholders, with both common and conflicting interests. The findings demonstrate that these stakeholders are reluctant to endorse the professionalization of CAM. They propose a series of strategies to contain the acceptance of CAM groups, such as insisting on scientific evidence of safety and efficacy, resisting integration of CAM with conventional medicine and opposing government support for research and education. These strategies serve to protect the dominant position of medicine and its allied professions, and to maintain existing jurisdictional boundaries within the healthcare system. The popular support for CAM will require that health professional stakeholders continue to address the challenges this poses, and at the same time protect their position at the apex of the healthcare pyramid.

Operational and resource management of an RCT: some of the pitfalls and lessons learned.

Nurses frequently fulfil important functions within a research team involved in clinical trials. This paper describes the challenges inherent in developing and managing a large clinical trial involving the evaluation of homoeopathy and asthma. Teamwork, a clear and comprehensive understanding of the research protocol, marketing the project, and the ability to manage human resources within both a primary and secondary care environment are all essential aspects of clinical research. Our experience in establishing and managing this project has suggested to us that a high standard of clinical research demands an open approach to problem-solving as well as the realization that efficient research is as much about the management of people as it is about scientific rigour.

Complementary practitioners as part of the primary health care team: consulting patterns, patient characteristics and patient outcomes.

BACKGROUND: Complementary medicine is increasingly popular with patients and with GPs, although it still remains mainly in the private sector. Few data are available from the private sector about patient-consulting patterns and outcome. OBJECTIVES: We aimed to describe detailed consulting patterns, help-seeking behaviour and outcome of care for patients attending a group of private complementary practitioners in a single general practice surgery. METHOD: Prospective data on consulting patterns were collected from all 147 new patients attending complementary practitioners over a 12-month period. For the first 30 weeks of this period, additional information on help-seeking behaviour and outcome, as measured by the SF-36 health survey and Measure Yourself Medical Outcome Profile (MYMOP), was collected by questionnaires from 46 out of the 68 new patients. The same information was collected from a systematic one-in-seven sample of GP patients. RESULTS: Patients seen by complementary practitioners did not vary significantly in sex and age from GP patients, except in the low numbers of children. Almost half the patients had been symptomatic for over a year and musculoskeletal disorders accounted for 66% of problems; but there was much variation between the therapies. The average number of visits per patient was three for osteopathy and homeopathy but eight for acupuncture and reflexology. The change in MYMOP scores after four weeks showed a statistically significant improvement in both complementary and GP patients, which was to similar degrees except that the mean change in well-being was significantly greater for complementary patients. CONCLUSION: Prospective data collection in single settings adds valuable information to a little-researched area. This study illustrates how individual each complementary therapy is in its patient characteristics, problem category and length of treatment. The particular improvement in well-being with complementary therapy requires confirmation in other studies.