Integrative Medicine The Integrative Medicine Program at the Department of Family Medicine and Community Health is a collaboration with The Institute for Family Health, a network of 32 health centers in Brooklyn, the Bronx, Manhattan, and Dutchess and Ulster Counties in the Mid-Hudson Valley.
Our work in family medicine is based on treating the whole person - the biomedical, psychological, social, economic, and environmental determinants of health. Systemic racism profoundly affects the health of the people we treat and their communities.
Racism is a long-standing and deeply rooted public health crisis that we must address within each one of us and in the system at large. The Integrative Medicine Program affirms that Black Lives Matter.
We join with the aspirations of all who seek to create a culture where each person feels seen, heard and supported.
Education,health services, and research initiatives all support our core mission of providing access to safe, cost-effective and evidence-based integrative primary care, with a focus on those who are medically underserved.
We also partner with our colleagues throughout Mount Sinai Health System. As part of a large health system, we hope to bring together information on the wide-ranging clinical, educational and research initiatives onintegrative approaches offered at Mount Sinai in order to create awareness, dialogue and opportunities for collaboration.
Of Note in Integrative HealthcareHow To Measure Well-Being: Summary of Joint VA-NCCIH Forum on Enhancing Well-Being Measurement
In June 2021, the VA and NCCIH met to discuss strategies on improving measurement of holistic well-being outcomes in research, clinical care, and population health promotion. Rather than focusing on indicators of disease and dysfunction, measures of well-being can provide a common language among patients, clinicians, and policymakers to define and assess positive outcomes.
Ways of measuring well-being and its relevance were explored. The forum was co-chaired by Ben Kligler, MD, Professor of Family and Community Medicine at Icahn Mount Sinai School of Medicine and Executive Director of the VHAs Office of Patient Centered Care and Cultural Transformation, and Dawne Vogt, PhD, Research Psychologist, Womens Health Sciences Division, VA. Many prominent leaders in the field of well-being measurement research participated. The forum will impact future well-being research and the inclusion of measures of well-being in clinical trials and other intervention studies.
An essential trial milestone: the development of an acupuncture consensus intervention protocol.
Arya Nielsen, PhD of the Department of Family Medicine Community Health at Mount Sinai helped develop an acupuncture intervention protocol for an NIH-funded pragmatic randomized controlled trial (PRCT) of acupuncture for chronic low back (cLBP) in older adults. The nine member Acupuncture Panel was made up of physician-acupuncturists, licensed acupuncturists with varied work backgrounds, and an acupuncture researcher. The protocol includes steps/staging of care and recommendations for session length, number of needle insertion sites, insertion depths, needle retention times, recommended types of needles, areas of the body to be treated, acupuncture point options, auricular point options, self-care options, and minimum number of sessions considered ideal. Click here for the full text of the article.
COVID Coping: The Potential of Dot Phrases to Allow for Quick Uptake of Integrative Health Approaches. Anup Bhandiwad and colleagues, Univ of Michigan. 2021 Integrative Medicine Health Symposium Abstracts, page 26.
The Society for Integrative Oncology and the American Society of Clinical Oncology are developing three evidence-based clinical guidelines for integrative therapies in oncology care: 1) cancer-related pain management, 2) fatigue in cancer survivors, and 3) anxiety and depressive symptoms in those with cancer. These will provide clinicians and patients guidance on effective and safe treatment of common cancer symptoms and side effects using integrative approaches.
Slides of the talk Integrative Medicine Approach to COVID-19 presented to the Mount Sinai Downtown and Harlem Residents in Urban Family Medicine by Anup Bhandiwad, MD.
Of note: There is also some evidence for nasal rinsing of the sinuses to decrease the COVID-19 viral load which is being investigated at Stanford, NYU, and several other universities. Because of the concern of a risk of contamination or/or aerosolization, when a neti pot or nasal irrigator is used it should be cleaned well after each use and not shared with others.
Since January 2020, CMS has covered acupuncture for Medicare patients with chronic low back pain. It can be performed by physicians who meet state requirements as well as PAs, NPs/CNS and auxiliary personnel who are fully licensed in that state, have a masters or doctoral-level degree in acupuncture from an ACAOM-accredited school and are supervised by appropriate medical personnel.
The Dept of Family Medicine in collaboration with The Institute for Family Health (IFH) and teams at Kaiser Permanente (CA and WA) and Sutter Health (CA) are conducting research as part of the HEAL (Helping to End Addiction Long-Term) 4-year grant funded by the NCCIH. Pragmatic Trial of Acupuncture for Chronic Low Back Pain in Older Adults began with a pilot feasibility study recruiting IFH patients 65 years of age or older. As a Federally Qualified Health Center (FQHC) Network, IFH is a unique research partner providing care to underserved patients who often have poor access to non-pharmacological pain treatments. The IFH team includes Principle Investigator Ray Teets, MD and Acupuncture Research Consultant Arya Nielsen, PhD.
Drs. Raymond Teets and Hyowoun Jyung contributed a poster presentation to the IM4US Annual Conference on the smart phrase research study they conducted for the Integrative Medicine Program in the Department of Family Medicine.
Principles of Integrative MedicineIntegrative medicine, as defined by the American Board of Integrative Medicine (ABOIM) and the Consortium of Academic Health Centers for Integrative Medicine, is the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare professionals, and disciplines to achieve optimal health and healing.
Specifically, these guiding principles include:
A belief in the benefits of interprofessional collaboration and openness to new ideas and approaches that help achieve better health outcomesPartnering with patients in a context of open and honest communication and mutual respectUsing the power of the therapeutic relationship to support the healing process and to co-design a treatment plan that matches patients preferences and abilitiesSeeking to understand and address the context of illness, healing and wellness including the social, psychosocial, environmental, community, physical, mental, emotional and spiritual aspects of the patients lifeFocusing on prevention, wellness and patient health education, emphasizing the role of patient participation and self-care in both healing and preventionTaking the time to focus on what is needed on a step by step basis, utilizing effective interventions that are natural and less invasive as the first line of treatment Integrative Clinical Resources and Practice Guidelines TakeCare Part of a national campaign for whole health and well-being for all, the site focuses on mind, body, spirit and community with simple and powerful short films and a personalized health reflection tool.
HHS Report on Pain Management Best Practices. May 9, 2019 Recommends best practices for acute and chronic pain based on individualized, patient-centered care and multidisciplinary approaches including medications, restorative therapies, interventional approaches, behavioral approaches and complementary and integrative health.
NIH HEAL Initiative, Helping to End Addiction Long-Term A multi-agency effort to speed solutions to pain management and opioid use disorder. The Department of Family Medicine is participating in a feasibility study of acupuncture for chronic LBP in older adults.
VHA Recommendations on Non-Pharmacological Approaches to Chronic Musculoskeletal Pain, 2018 Includes mindfulness-based stress reduction, exercise, acupuncture, yoga, tai chi, manipulation, massage, CBT and ACT
American Academy of Pediatrics Policy on Pediatric Integrative Medicine, 2017 This policy revision recognizes the increasing use of complementary and integrative therapies for children and helps provide reliable information that supports high-quality clinical resources for pediatricians
Preparing for Surgery Online Course for Patients, Mount Sinai Beth Israel Online course to help patients learn easy stress management techniques when preparing for surgery
Integrative Medicine for the Underserved (IM4US) This multidisciplinary group of healthcare professionals provide an online Toolkit of resources for working in underserved settings.
Society for Integrative Oncology’s Clinical Practice Guidelines, 2017 Evidence-based use of integrative therapies for breast cancer treatment include music therapy, meditation, stress management, acupuncture, yoga, and massage
National Academies Proceedings on Nonpharmacological Approaches to Pain Management, 2019 Discusses effectiveness of nonpharmacological treatments and integrative models for pain management, educating health professionals on these treatments, and policies to disseminate and implement them
ACP Clinical Practice Guideline. Nonpharmacological Therapies for Low Back Pain, 2017 New evidence strengthens findings on effectiveness of yoga, exercise, psychological therapies, acupuncture, manipulation, and massage for chronic low back pain and adds tai chi and mindfulness-based stress reduction
University of Wisconsin-Madison Integrative Medicine Program Resource includes clinical learning modules and patient information handouts
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