Integrative Care: A Case Study

Dr. Tieraona Low Dog, Fellowship Director, Arizona Center For Integrative Medicine explains how we want to expose clinicians to a broader way of seeing the patient a deeper understanding of healing and a larger toolbox from which to choose for therapies. She talks about how if patients were treated with different procedures such as acupuncture or holistic healing, we as consumers would not have to pay out so much on treatment. Procedures such as these would actually benefit us because we would not need to see doctors nearly as much as we do now, because we would not be “treating” the diseases with chemicals (pharmaceutical drugs) which have many side effects. Also, the pharmaceutical companies and insurance companies would never let this happen because then they would be out of money because people would not have to see their doctors nearly as much in hence means that these “cattle runners” would not be making the money they are.

In the article, “Our Big Appetite for Healthcare” written by Daniel J. Stone was in the March 31 2013 issue for Los Angeles Times. Doctor Stone intended audience are the reader of the Los Angeles Time. Stone’s purpose in this article is to persuade his readers that he wants to change the healthcare culture from “more is better” to “do what is medically indicated to provide the best outcome”. Stone supports his argument with strategies and evidence.

The current health care sector is too costly and too fragmented with a lot of variation in care even with established evidence based guidelines. Providers lack the tools, support and information they need to offer the coordinated health management that can reduce cost and improve outcomes. Primary Care Physicians are constrained in their abilities to perform any proactive care that involves avoiding Hospital or ER visits, and influencing healthy lifestyles.

Throughout the career of a Viterbo University Student Nurse, one sees a variety of clinical settings to enrich one’s own knowledge base and skills practice to ultimately become a well- rounded and exceptional nurse. One of the experiences that we are able to have is to be a part of the Caring Clinic at the Salvation Army. In this setting we care for a population of impoverished and homeless individuals to assess blood pressures, health history, and do a mental health screening. This setting is like no other in the sense of we go to where the individuals that need our help instead of them coming to us. I have learned how it takes a special kind of nurse and group of student nurses to make the Caring Clinic happen to provide care and advocate

Evidence based care- There are mask, tissue and hand sanitizers are provided at all doors and elevators to reduce germs (hand sanitizers kill 99.9% of the germs and are most useful to reduce the microbial load, thus controlling the rate of infection (Vidyashankar, Varma, & Payki, 2011).

Escape Fire: The Fight To Rescue American Healthcare by Matthew Heineman and Susan Froemke addressed many issues seen in the American Healthcare system that have gone uncorrected for years. The importance of primary care physicians was noted and this view continued to make more and more sense as the film went on. The lifestyle choices that Americans are and have been making do not promote wellness and actually make the jobs of primary care physicians much more difficult. Also discussed in the film, was the severe issue of the overuse of narcotics in the military. The thought that alternative therapies can actually make a significant difference in people’s lives is to most people something that sounds completely insane. But, these therapies have been working for those that need them most. What truly impacted me during the film was how interconnected all of our problems in the American healthcare system are. The fixes seem to be possible and not as difficult as some would have others believe. After seeing this film I feel that I have gained a new respect and understanding of the system that I will be a part of in the not too distant future.

While discussions of integrated care are not new in the United States, the research literature has largely been about blending mental and chemical health into physical health systems. Using a critical hermeneutic application of interpretive phenomenology, this study aims to address that gap by interviewing adults with serious mental illness about their experience receiving physical health services within a community mental health center. Nine individuals, five clients and four providers, interviewed for this study were selected using the critical case criterion in partnership with the community mental health center. Interviews were digitally recorded and transcribed. Data analysis was conducted within-case followed by cross-case analysis technique.

Other benefits of reverse integrated care ranges from clinical outcomes through patient -centered care and population-based treatment approaches (Auxier, Farley, & Seifert, 2011) to financial incentives with value-based payment and shared revenue stream (Enthoven, 2009). Achieving these benefits requires changes in the cultural dynamics, workflow, and operational processes. For example, implementing new screening tools, the introduction of warm hands-off, huddles and collaboration between physical and behavioral health teams (Buche et al.,

Written about the structure and culture of biomedical heath care and a society that is attempting to prolong aging, Medicare funding, funding and development of research, and today’s definition of standard care, Sharon Kaufman brings to light the many dilemmas posed to the American health care system. Her ethnographic story, Ordinary Medicine: Extraordinary Treatments, Longer Lives and Where to Draw the Line reveals the booming biomedical research and clinical trials industry, the power held by Medicare and private insurance, and a rapidly changing standard of care once a medical treatment is considered reimbursable. This leads to systematic changes in the standard of care result in a massive amount of pressure being placed upon doctors, patients and families to make an ethically and medically sound decision in refusing or accepting therapy. Kaufman exposes the driving forces behind the expansion of biomedicine, society’s response to the growing industry on a personal and bureaucratic level.

From a young age, I wanted to be a conventional physician, but as I grew older, I became more disillusioned with our current medical system. As I became more disillusioned, I was more drawn to the naturopathic field and the opportunities it presented to treat problems naturally. In addition, I felt that the naturopathic field offered more personalized care to the patient as they struggled with their different health problems. The way that conventional medicine practices tries to treat as many patients as possible in the shortest amount of time. The field seems not to respect the patient as a person, and I feel like every person should experience a favorable level of respect when interacting with medical professionals. In addition, I feel that patients should know that their doctor cares for them and their health, and that is difficult to convey in a 15-minute appointment, especially when compared with a 45-minute appointment. As a Naturopathic Physician, I feel that I will be able to provide my patients with the care that they deserve.

An integration of care study was conducted by a Doctor of Behavioral Health Intern at Michael R. Zent (MRZ)Healthcare Clinic in Phoenix, Arizona. MRZ is a reverse co-located integrated medical and behavioral clinic that provides services to about 4000 children and 4000 adults annually. MRZ provides laboratory, pharmacy, behavioral and physical health services together under one roof. The clinic utilizes an integrated electronic health record to document the treatment of members. The focus of the integration of care study was to understand and assess the barriers and challenges of the integration of care methodology at MRZ.

According to Armitage et al, integrated delivery systems (IDSs) are systems that provide a means to build a more effective and efficient health care system that takes a patient-center focus and better meets the needs of the population served (Armitege, 2008). Although there are myriad types of IDSs within the American health care system, there are a few systems that take precedent within the healthcare policy conversation. Peter Kongstvedt writes that although there are a number of systems to consider, the basic elements of each system remain the same, and the common denominator is the physician (Kongstvedt, 2013).

The seminar that I am leading is the integrated and managed health care systems. One the lessons I’ve learned from watching the documentary “The Good News on American Medicine” is that as doctors we can make a difference in the way we deliver health. That is an important message with all the uncertainty that lie around. That is easier said than done, however. What separate Grand Junction and Seattle and other town mentioned in the video was that the doctors worked collaboratively to ensure low-cost quality care. To accomplish that it means that we must make sacrifices, time and/or monetary, to achieve the same goal.

Dr. James Marcum, a cardiologist at the Chattanooga Heart Institute in Tennessee claims, “Pharmaceutical drugs don’t heal people.” In fact, he states, “Much of the time they do more harm than good”(Milner). U.S. Citizens need to stop taking harmful pills and start using more natural, holistic healing methods. Everyone has probably used a pill before to relieve their pain, but there are healthier ways to feel just as good. According to the results of the National Health Interview Survey, “In 2012, 33.2% of U.S. adults used complementary health approaches”(What Complementary and Integrative Approaches Do Americans Use?). While some people believe conventional medicine is a better choice, it is clear that holistic healing can replace prescription drugs because they are more safe and effective than prescription drugs, and they are more practical in many ways.

The purpose of a constitution is vital to the state and organizations, it provides rules the state must follow as a framework; it’s the supreme law of the country. The constitution has different functions; the most important are; Empowering states, Establishing unifying values and goals, Provide government stability, Protect freedom, and Legitimize regimes.