Federally-funded short course for integrative medicine in primary care

by John Weeks, Publisher/Editor of The Integrator Blog News and Reports

A recent seminar on the federally-funded $1.7-million National Center for Integrative Primary Heathcare (NCIPH) described a 35-hour CME course, developed originally as a pilot, that will be freely available to all, in final form, after May 1 until the end of August.

The Health Resources and Services Administration-funded project, with its mission of “enhancing interprofessional integrative health education” in primary care settings, was managed by the Arizona Center for Integrative Medicine and the Academic Consortium for Integrative Medicine and Health. They brought in multiple partners to secure their interests both in serving the underserved and meeting its interprofessional charge. A key partner for the latter was the sponsor of the April 12 webinar, the Academic Collaborative for Integrative Health (ACIH). The recording is here. This group brought chiropractors, naturopathic doctors, acupuncture and Oriental medicine and direct-entry midwives to the table. Each in their way is both part of an integrative team and directly provides forms of primary care.

As an academic program, the pilot included a measurement requirement. In pre and post surveys, the team found that the content, which includes a segment on practitioner well-being, increased measures of “resilience”, “empathy”, “overall wellness” and “ability to use self care practices”. Two-thirds (66 percent) said they had already incorporated self-care practices learned in the well-being module. Notably, in an exit survey, 72 percent believed that this module should be mandatory.

Nearly half (45 percent) of the over 2328 participants at 79 sites (57 percent academic and 43 percent clinical) who piloted the program were so significantly taken with the content that they recommended that it be imbedded in all primary care instruction as core content. Another 38 percent recommended that it be principally offered via continuing education with 17 percent suggesting that it be available in health professional education as an elective.

The webinar featured the project leaders, ACIM’s Patricia Lebensohn, MD, who directs ACIM’s Integrative Medicine in Residency program and serves as principal investigator for NCIPH, and Audrey Brooks, PhD, assessment professional and NCIPH project manager for the program. They began by describing the building of the interprofessional team, which included Myles Spar’s program, Integrative Medicine Access, to link the underserved to integrative services.

Then came the first big task of recruiting interprofessionals to describe “meta-competencies” for integrative primary health care. The team identified 10 meta-competencies. These involved such areas as engaging positive personal behaviors, practicing patient-centered and relationship-based care, and “obtain[ing] a comprehensive health history which includes mind, body, spirit, nutrition, and the use of conventional, complementary and integrative therapies and disciplines.”

A forward-thinking addition that links the work to progressive efforts to address the social determinants of health is  “incorporate integrative healthcare into community settings and into the healthcare system at large.”

The team then took a second step with the competencies and had members of their interprofessional leadership team build subcommittees through which profession-specific sub-competencies in primary health care were created. In these, professionals from internal medicine to nursing to chiropractic to naturopathic medicine began with the meta-competencies then drilled down with content for their specific field.

As an audience member, I typed in a question about whether there was much evidence of the educational program being used in Federally Qualified Health Centers or patient-centered medical homes. Lebensohn shared that one clinical site for the pilot was the Coalition of Orange County Community Health Centers. There, through a philanthropic grant, an effort is being made to integrate all community centers. The NCIPH program was utilized to “train staff, from nursing to [physicians’ assistants] to residents. They were using this as a foundation.”

Lebensohn and Brooks, in their conversation facilitated by NCIPH steering committee member and ACIH executive director Elizabeth A. Goldblatt, PhD, MPA/HA noted that the team had additional ideas about possible next steps. Yet they have not been able to secure funding to continue past the 3-year grant’s end date of August 31, 2017. At that point, to continue to offer the program, a fee will be attached.

Comment:  Many thoughts and reflections, on examining this work product. First, like many change processes, the vision some of us have had of the paradigm shift toward an integrative model in primary care frequently has more grand proportions in the imagining than have the successful steps, like NCIPH’s, that begin to lever change. Years ago, the facts of jammed curricula, overburdened health professional trainees, and of academic hours “owned” by interests with hold-tight agendas gave our fancies of rapid change a good and thorough slap-down.

Happily, the personal translation—from impatience to the wisdom that gets knocked into one—leads me to give high credit to what NCIPH accomplished in these three years. Kudos to the interprofessionalism, the inclusiveness, the interest in the underserved, and connection to community health. Great stuff. ACIM had lost a prior, parallel HRSA grant in part for not being as interprofessional as the agency that won it. They learned fast this round.

That the grant funds have nearly run out suggests that the program, if it follows the pattern of much funded work in academia that finds itself at Rio Seco, the project will most likely undergo a slow transition to salted slug form. Hopefully, however, with a fee eventually attached, and in the garden of ACIM’s multiple other efforts to educate for transformation, the program will have a long-life. It would be particularly nice if some philanthropic partner might assist with its education of professionals in community health centers nationwide.