JHI Partners Forum 2012 Linda A Lee MD Johns Hopkins Integrative Medicine amp Digestive Center Division of Gastroenterology and Hepatology Johns Hopkins Integrative Medicine amp Digestive Center ID: 1043539
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1. Integrative Medicine: The Hopkins PerspectiveJHI Partners Forum, 2012Linda A. Lee, MDJohns Hopkins Integrative Medicine & Digestive CenterDivision of Gastroenterology and Hepatology
2. Johns Hopkins Integrative Medicine & Digestive CenterPrimary location at Green Spring StationConsultative services also available at the HospitalStaffFour physicians (internist, GYN, GI, rheumatologist)Two acupuncturists (TCM)Four licensed massage therapistsTwo psychotherapists – hypnotherapy, CBT, guided imageryOne nutritionist – individual consultations and group classes
3. GoalsTo create an inviting, comfortable, safe environment Allow lengthy appointments so there is more time to understand the multiple dimensions of illness, to educate the patient, and discuss the full range of evidence-based therapiesOffer services within the Center that would be readily accessible to patients as well as referring providers
4. Johns Hopkins Integrative Medicine & Digestive Center4000 visits to the Center in FY12Open Mon-Sat, evening hours until 9 pm6 examination rooms, all multipurposeStaff offer personal, concierge-type serviceIs the only integrative medicine center in the US based in gastroenterology
5. JHIMDC: Our Patient Programswww.hopkinsintegrative.org
6. Finding practitionersWhat training or education did she receive?Is the practitioner licensed in the state?Is certification by a professional organization required for state licensure? (e.g. NCCAOM)What clinical and research experience does she have?Is the practitioner integrative, or disintegrative?
7. Integrative Medicine Approach: PrinciplesEngage the patient as an active participantProvide education about health, symptoms, and diseasesCounsel in appropriate nutrition practices and supplement useDiscuss evidence-based pharmacologic and mind-body therapiesThe patient-provider interaction is a vital part of the healing process
8. An example: Gastroesophageal Reflux
9. Conventional StrategyMedical therapyAdditional testingLifestyle changesLow fat dietAvoid caffeineAvoid carbonated beveragesLimit your alcohol intakeStop smokingRaise the head of your bed
10. Trends in usage of antacid and gastroprotective agents over 5 years
11. Gastroesophageal reflux: cause
12. Stress and esophageal hypersensitivityEsophageal hypersensitivity has been implicated as a cause of reflux symptomsPsychosocial factors are known to mediate both peripheral and central hypersensitivity and play a role in symptom perception among patients with GERDBehavioral medicine techniques (CBT and hypnotherapy) may be a useful adjunct to other anti-reflux therapy in those who experience increased symptoms during stressMcDonald-Haile, J, et al. Gastroenterology, 1994;107(1):61-9Van Peski-Oosterbaan, AS, et al. Am J Med 1999; 106: 424–9Miwa, H et al. J Neurogastroenterol Motil, Vol. 16 No. 4 October, 2010
13. The Integrative Medicine ApproachUnderstand and treat the symptoms in the context of the patient’s home and work lifeEducate the patient as to why GERD occursDiscuss weight loss as a long-term management strategyDiscuss evidence-based acupunctureAnswer questions about the use of supplementsDetermine if stress is a trigger for symptoms and identify strategies for addressing stressMedical therapyAdditional testingLifestyle changesLow fat dietAvoid caffeineAvoid carbonated beveragesLimit your alcohol intakeStop smokingRaise the head of your bedPLUS THIS:
14. Acupuncture for persistent reflux symptomsDickman, R. et al. Aliment Pharmacol Ther 2007. 26: 1333–1344
15. Traditional Remedies for reflux no scientific evidence… yetFennel seedLicoriceApple Cider Vinegar
16. PhysicianConventional careAcupuncturistPsychotherapistNutritionistMassage TherapistPhysicianJHIMDC
17. Is integrative medicine cost-effective? Cost savings could be realized byDecreasing utilization of expensive medical interventions such as pharmaceuticals, or reducing trips to the ERReducing provider visits by offering group interventions, such as stress reduction, nutrition education, and mind-body skills training
18. If nothing changes and the current trends continue…By the year 2022, 80% of the US population will be overweight or obese (currently 66%)Projected healthcare spending related to overweight and obesity by the year 2020 is estimated to be $437.6 billion (was $81.5 billion in 2000)Yang, F. et al Obesity (2008) 16 10, 2323–2330
19. Challenges to Integrative MedicineCurrent healthcare reimbursement favors procedures and pharmaceuticals over education, adequate face-to-face time, mind-body therapiesConventional practitioners lack knowledge about evidence-based healing practices and practitioners, and how to identify them