General Overview
What Is Central Sensitization Syndrome?
The goal of healthcare is to improve people’s health and well-being. For this to happen, it needs to provide the right kind of care to the right patient at the right time and the right place.
But our fragmented healthcare system makes it difficult to achieve this crucial goal. Many global healthcare systems are turning to either care pathways or integrative medicine to address this issue and deliver the necessary interventions.
These medical approaches are vastly different, and each requires better understanding. This will help healthcare providers and patients select the best treatment option that aids faster recovery and provides the best long-term patient health outcomes.
Here, we discuss both approaches, their applications, and their benefits to help you choose the best one. Let’s dive in.
What Is a Care Pathway in Medicine?
A care pathway is a set of guidelines that maps out the optimal course of action in a patient’s healthcare plan. It typically appears in the form of a flow chart with a specific disease or illness, i.e. diagnosis, as the focus of the pathway.
Healthcare providers like hospitals and clinics design and use care pathways for groups of patients with the same illnesses. This management tool recommends a recognized best-practice intervention for a specific diagnosis at its different stages, thereby elevating healthcare quality.
It essentially serves as an information system that guides and monitors a patient’s care journey between various healthcare providers across different sectors. It also helps achieve the best possible health outcomes with minimal use of resources and at the lowest cost to insurers.
What Is Integrative Medicine?
Integrative medicine is a medical approach that combines conventional therapies, like medication, with complementary healthcare approaches like yoga and acupuncture based on a patient-centered approach. It integrates and improves various aspects of health and well-being for optimizing the individual’s all-around healing while using an evidence-based approach.
This medical practice focuses on the whole person and goes beyond merely treating a disease and its symptoms. It looks at a person’s mind, body, and spirit to find underlying causes for the perpetuation of their medical conditions.
This approach believes that a person’s physical, emotional, mental, and spiritual needs impact health and wellness and each need to be evaluated and addressed within the context of that individual’s story. Since these needs are closely connected, a disruption in any aspect can affect a person’s entire health and well-being.
Integrative medicine employs conventional and alternative therapies including lifestyle changes to address these various aspects of wellness. It is a collaborative approach that helps ensure alignment between various medical providers to deliver holistic healthcare with a common endpoint, and optimal healing potential for the individual.
Types of Complementary Services
Integrative medicine encompasses different complementary services, practices, and techniques which may include:
- Acupuncture
- Acupressure
- Reiki
- Massage therapy
- Chiropractic therapy
- Yoga
- Tai chi
- Mind-body techniques
- Holistic psychotherapy
- Nutritional therapy
- Supplements
- Chinese herbal therapy
8 Tenets of Integrative Medicine
Integrative medicine has eight pillars or tenets:
- The patient and the healthcare practitioner have an important relationship as they are equal partners in the healing process.
- Integrative medicine considers various aspects that impact health and wellness. It includes the mind, body, spirit, and community.
- Integrative medicine optimizes conventional and alternative therapies and interventions to promote the body’s natural healing response.
- Integrative medicine employs natural, less invasive, effective healthcare interventions as much as possible.
- This medical approach does not reject conventional therapies or accept alternative medicine unquestioningly.
- Good science guides good medicine. Good medicine is inquiry-driven, evidence-based, and open to new concepts and approaches.
- Integrative medicine does not focus solely on treatment but also considers the broader goals of health improvement and illness prevention.
- Integrative medicine practitioners must model the principles of this medical approach and dedicate their lives to self-exploration and self-development.
—Andrew Weil Center for Integrative Medicine
Applications of Care Pathways
A care pathway has applications in various medical conditions, including but not limited to:
- Musculoskeletal conditions
- Cancer
- Diabetes
- Hypertension
- Cholesterol
- Coronary artery disease
- Breathing disorders
- Mental health illnesses
Application of Care Pathways in Long-Term Medical Conditions
The application of care pathways in long-term illnesses offers guidance to primary care clinicians on the following aspects:
- The requirement of interventions at different stages of care
- Lifestyle reinforcement
- Therapeutic changes
- Examining and monitoring symptoms and complications
- Referral to other healthcare providers
- Follow-up intensity and frequency
To ensure the proper application of care pathways, clinicians must understand the various stages of long-term conditions and the representation of their practice populations. The kind of care and support a patient needs varies as they go through different stages of health.
A care pathway guides required interventions at every stage, from precursor health risks to advanced illness and palliative care but is the same for every patient, not individualized.
Applications of Integrative Medicine
People can harness the power of integrative medicine not only for the treatment of illnesses but for disease prevention and health promotion. So, healthy people and those with chronic medical conditions can use it for better optimizing the person’s natural ability to heal.
Integrative medicine offers healing potential for a wide range of medical conditions, particularly the non-acute conditions.
Benefits of Care Pathways
Care pathways have the following benefits:
- Improves the quality and safety of medical care, service delivery, and patient outcomes
- Lowers variabilities in clinical practice
- Reduces in-hospital complications
- Reduces the length of hospital stays
- Lowers medical costs
- Improves communication and coordination between healthcare professionals
- Improves documentation of treatment goals and patient communication
Benefits of Integrative Medicine
Integrative medicine has the following advantages:
- Prevents and treats diseases
- Targets the root cause of a medical condition for complete healing
- Uses powerful modalities for treatment but favors less invasive treatment modalities to start
- Supports the body’s innate ability to heal
- Helps achieve optimal holistic health
- Helps reduce stress and increases relaxation
- Focuses on long-term health and well-being
- Ensures better coordination and communication between different healthcare providers
Care Pathways vs Integrative Medicine
In this section, we compare care pathways with integrative medicine to help you understand which is better overall:
Generalized vs Individualized Approach
A care pathway typically follows a common pathway for diseases. Meanwhile, integrative medical practitioners design a treatment plan by factoring in a patient’s symptoms, health status, lifestyle habits, and other relevant aspects.
The absence of standard pathways in integrative medicine means that insurers don’t always provide reimbursements for its treatments. Nonetheless, it results in better patient satisfaction scores than care pathways. Potentially this could lead to better patient outcomes but that is yet to be scientifically proven.
Disease-Centered vs Holistic Care Care
An important difference between care pathways and integrative medicine is the former focuses only on diseases and symptoms. Meanwhile, the latter prioritizes whole-body care.
Integrative medicine practitioners consider not only the patient’s physical health but also their mental, emotional, and spiritual health. They use different therapies to heal and strengthen the mind, body, and spirit.
This holistic approach to health is one of the top reasons integrative medicine has steadily gained ground among clinicians and patients.
Disease Care versus Prevention
Care pathways focus on treating illnesses and intervene only if a patient has been diagnosed with a disease. In comparison, integrative medicine prioritizes illness prevention and health promotion along with patient-centered treatments to optimize healing from any disease process or illness and patient-centered lifestyle changes to prevent diseases from occurring in the first place.
Quality of Healthcare
Care pathways generally provide a maximum time during which patients must receive treatment. This can have a negative impact on the quality of healthcare. These time constraints can compromise the treatment and lead to the persistence of medical conditions.
If healthcare providers need more time for preparation and contact within a care pathway, it lowers the chances of an accurate diagnosis and treatment. It may also lead to poor communication between the patient and the provider.
Also, experienced healthcare providers have to depend excessively on routine, use a single care pathway, and treat mostly the same types of disorders. This may cause them to become indifferent, cynical, and less empathetic toward their patients, affecting job satisfaction and care quality.
Meanwhile, the long-term approach of integrative medicine makes it suitable for chronic diseases that need regular care and follow-up. There is no concept of maximum time so practitioners can correctly diagnose and fully treat ailments and their causes. This leads to better patient care and outcomes.
It also leads to better communication between patients and professionals and greater job satisfaction for the latter.
Personal Care and Attention From Healthcare Providers
As integrative medicine emphasizes whole-body care, practitioners typically give patients more one-on-one attention. They also offer various treatment modalities so patients can have options they feel more comfortable with.
Meanwhile, conventional providers who follow care pathways are time-pressed. They also have to deal with pressure from insurers and overflowing waiting rooms. This leads to the dehumanization of their work and less personal attention. The lack of personal focus also reduces the patient’s choices.
Scientific Research
Care pathways have a lot of scientific research behind them. In contrast, there is limited research and evidence for integrative medicine.
But this situation is slowly changing as a rising demand has led to increased funding for research on integrative medicine. Many studies are currently underway, which we hope will shed more light on the subject.
Could Care Pathways Be Implemented In Integrative Medicine?
The focus of care pathways to decrease the financial burden on insurers makes it easier for approvals of different treatment options by those insurers to ensure coverage for the patients going through treatment. Since the care pathways are diagnosis driven, how can integrative medicine use them to aid in insurance coverage for person-centered medical approaches to health and illness? This is something that integrative practitioners in hospital systems are working on with administration currently. It may look very different from the current carepaths that are designed right now and would have to include the enormous amount of time an integrative practitioner spends with their patients getting their story and then allow for various traditional and complementary treatments depending on that story. In my office it might look something like this:
- 3 hour initial intake with the patient, integrating the patient’s story with previous medical chart information (previous physician notes, interventions, labs, tests and imaging) to develop a plan towards healing and wellness:
- Anatomical/biomechanical contributors
- Diagnostic dynamic ultrasound to evaluate the soft tissues dynamically
- Internal/external environmental contributors
- Vitamin/mineral/immune/GI labs/tests
- Health coach evaluation
- Central sensitization contributors
- Anatomical/biomechanical contributors
- For each of the above contributors, a percentage of suspected contribution based on the story could be assigned by the integrative practitioner which would then determine the potential conventional medicine and/or complementary approaches that could be implemented based on the patient’s story and their input. Instead of one diagnostic test or intervention there would be a list of multiple options.
Regardless, each step would be patient-centered, individualized to that patient to achieve successful healing. In other words, every patient with low back pain would have a different pathway based on their story and their body’s healing potential, instead of the exact same pathway based on their diagnosis.
Conclusion
Integrative medicine is an excellent modality for high-quality healthcare with powerful benefits that outweigh the care pathways approach. Using integrative medicine properly can give people access to quality patient care and better support for treating and preventing their medical conditions with potentially improved outcomes. Care pathways that align with the integrative approach are crucial in order for patients to get the healing help they need, and to have the insurance company pay for their care.
