Y khoa, dược - Complementary and alternative medicine

44Complementary and Alternative Medicine44-2Learning Outcomes44.1 Explain CAM.44.2 Distinguish between complementary and alternative medicine and conventional medicine.44.3 Summarize how CAM and conventional medicine are used together.44.4 Identify various types of complementary and alternative medicine.44-3Learning Outcomes (cont.)44.5 Describe how a medical assistant may use his or her knowledge of CAM. 44.6 Explain why patients and health-care practitioners are turning to complementary treatments.44.7 Compare insurance and payment for CAM treatments.44.8 Explain how CAM is regulated.44.9 Describe health fraud.44-4Introduction More than 30% of adults use complementary and alternative therapiesRelieve problemsPromote wellnessNo relief from traditional treatmentsSome physicians use a combination of CAM and traditional therapies44-5What Is CAM?A group of practices and products that are not part of conventional medicineAllopathy – conventional medicine or common and usual practiceComplementary medicine – used with conventional medicineAlternative medicine – used instead of conventional medicine44-6What Is CAM? (cont.)Scientific evidence concerning safety and effectiveness Available for some CAM therapiesResearch continues, so information changesIntegrative medicine Evolves as CAM therapies are adopted by conventional medicineCombination of both44-7Apply Your KnowledgeDefine CAM and state why these therapies are not in wide use by practitioners of conventional medicine.ANSWER: CAM is a group of practices and products not considered part of conventional medicine. They are not widely used by physicians because there is not a lot of scientific evidence of their safety and effectiveness.Impressive!44-8Types of CAMShared similaritiesIndividualized treatments, good nutrition, and preventive health practicesHolisticPromote self-care and self-healingRecognition of one’s spiritual natureCategories Alternative medical systemsMind-body interventionsBiologically-based therapiesManipulative and body-based methodsEnergy therapies44-9Alternative Medical SystemsEvolved apart from conventional medicineHomeopathic medicineTreating syndromes and conditions with remedies that produce similar syndromes and conditions in healthy peopleRemedy Produces the symptoms it is given to treat in order to stimulate the body’s natural defenses to heal itselfMust meet FDA standards44-10Alternative Medical Systems (cont.)Homeopathic medicineLooks at individuals, not diseasesInitial in-depth assessment Follow-up – how they are responding Medical assistant roleSimilar to other medical officesHave knowledge of common remedies44-11Alternative Medical Systems (cont.)Naturopathic medicine Relies on the healing power of the body to establish, maintain, and restore healthPrimary health care Nutritional/lifestyle counselingDietary supplements/medicinal plantsExerciseHomeopathy/traditional Chinese medicine44-12Alternative Medical Systems (cont.)Naturopathic medicineMedical assistant – understanding of treatmentsTraditional Chinese medicineBalanced qi (vital energy)Flow of qi along meridians (energetic pathways)Acupuncture – insertion of hollow needles along meridians Ayurveda – provides guidance regarding food and lifestyle; India44-13Mind-Body InterventionsEnhance the mind’s capacity to affect bodily function and symptomsSupport groups and cognitive-behavioral therapy now part of traditional medicineScientific support Placebo effect – WW II35% of therapeutic response is due to belief 44-14Mind-Body Interventions (cont.)Most commonly used forms of CAMTypesPrayer Yoga Meditation HypnosisBiofeedback 44-15Biologically Based TherapiesUse substances found in natureDietary supplementsHerbal productsFoods Medical assistantKeep up-to-date about dietary and herbal productsBe able to provide reliable resources for patients 44-16Biologically Based Therapies (cont.)Dietary supplementsManufacturers – no evidence of effectiveness or safetyNo standardization to ensure consistency and quality Types VitaminsMinerals Herbals – no established recommended daily amountRecommended daily amount established by the FDA44-17Biologically Based Therapies (cont.)Patient education for using supplementsReport all supplements as they would prescription medicationsTake supplement bottles to appointmentsDocument patient’s use of supplements in the medical record44-18Manipulative and Body-Based MethodsBased on the manipulation and/or movement of one or more parts of the bodyTypes Massage therapyChiropractic manipulation ReflexologyAlexander techniqueBowen techniqueCraniosacral therapyFeldenkrais methodRolfingTrager bodyworkTui Na44-19Manipulative and Body-Based Methods (cont.)Massage Pressure, kneading, stroking, vibration, and tapping to positively affect health Effects RelaxationCounteracts effects of stressLowers heart rate and blood pressureReduces pain/relaxes muscle spasmsImproves concentrationPromotes restful sleepHelps the mind relax44-20Manipulative and Body-Based Methods (cont.)Swedish massageStimulates circulation and lymph flow5 basic strokesNeuromuscular massageReleases tension, relieves pain and pressure on nerves, and increases blood flowTrigger point therapy Seated massageFocuses on back and neck44-21Manipulative and Body-Based Methods (cont.)Chiropractic medicine Adjustments Manual treatments to re-align the vertebra and restore function of spinal nervesChiropractor Performs an exam and takes a historyTests X-raysMuscle testingAnalyzes posture 44-22Energy TherapiesBioelectromagnetic-based therapiesBalances the electromagnetic fields of the bodyNo scientific evidence of efficacyMagnetic therapyMost common typeMagnets are used to correct disturbances of electromagnetic fields and restore health FDA – no medical value but relatively harmlessAvoid for patients with pacemaker or defibrillator44-23Energy Therapies (cont.)Biofield therapiesManipulate energy field surrounding the bodyReiki Based on qiVisualization and touchbalance energy flow to bring healing energyto organs and glandsTherapeutic touch“Laying-on of hands”Hands direct human energies to help or healNo scientific evidence of efficacy44-24Apply Your KnowledgeMatch to types of CAM:___ Therapeutic touch A. Energy therapies___ Chiropractic medicine B. Mind-body therapies___ Dietary supplements C. Body-based therapies___ Yoga and meditation D. Biologically-based therapies___ TCM E. Alternative medical systems___ Herbal supplements___ Homeopathy/naturopathy___ Magnetic therapy___ Hypnosis___ MassageEEDDANSWER:ACCBBAExcellent!44-25Patients Seeking CAM TherapyUse is increasingLess expensiveHave fewer side effectsMore accessibleIncrease in spiritualityPersonal growthEnvironmentalism Preventive health careReasons for seeking CAM therapyFailure of traditional medical interventionsTreat side effects of conventional medicine’s treatments44-26Patients Seeking CAM Therapy (cont.)Patients with chronic debilitating conditionsImprove quality of lifeImprove ability to cope with stress and illnessCultural differences in CAM useHispanics Native AmericansAccept patient’s right to choose CAM therapy44-27Patients Seeking CAM Therapy (cont.)Use of CAM in children on the increaseSafety – children respond differentlyEfficacy in children not establishedIdentify and document if CAM is used44-28Apply Your KnowledgeMr. State is complaining about chronic back pain. He says that the medication only helps a little and asks you if there is anything else you could recommend that will help him. What should you tell him?ANSWER: If your employer is not averse to CAM therapies, you can tell him that there are CAM therapies that may help with the pain or at least help him cope better with it. He could try mind-body techniques, acupuncture, manipulative and body-based techniques, or energy therapies.Super job!44-29Insurance and CAMCoverage varies Lack of research and documentation of efficacyEmphasis on physiological or biochemical response to therapies Alternative health insurance companies emerging in response to need44-30Insurance and CAM (cont.)Medical assistantKnow whether or not CAM treatments are covered by insuranceResources Insurance companiesState agency that regulates the insurance industry44-31Regulation of CAM TherapiesNational Center for Complementary and Alternative Medicine (NCCAM)Research Training and career developmentConferences and educational programsIntegration of scientifically proven CAM therapies into conventional medicine44-32Regulation of CAM Therapies (cont.)White House Commission on Complementary and Alternative Medicine Policy (WHCCAMP)Funding for researchCommunication between CAM and conventional practitionersAvailability of CAM practitionersState review and evaluation of CAM practitionersInsurance coverage options44-33Apply Your KnowledgeWhy do insurance companies not reimburse for most CAM therapies?ANSWER: Insurance companies do not reimburse for CAM therapies because of the lack of research and documentation of effectiveness of these therapies.What are the federal agencies tasked with regulation of CAM therapies? ANSWER: They are the NCCAM and WHCCAMP. Yippee! 2 for 2! ANSWER: They are the NCCAM and WHCCAMP. 44-34Health FraudArticles of unproven effectiveness promoted to improve health, well-being, or appearanceDeception or trickery for profitPlays on emotions and desperationRegulation FDA – safety, manufacturing, and labelingFTC – advertising44-35Health Fraud (cont.)Health claimsUnproven claims must include a disclaimerFDA-approved claims for food and supplementsBased on scientific evidenceOnly reduces risk/does not treat or cure44-36Health Fraud (cont.)FDA-Approved Health ClaimSupplement/FoodReduce risk of some cancers Low-fat diets Fruits, vegetables, fiber-containing grain products Whole grainsReduce risk for hypertension Low-sodium diets Potassium Reduce risk for osteoporosis Calcium44-37Health Fraud (cont.)FDA-Approved Health ClaimSupplement/FoodReduce risk of heart disease Low-sodium diets Decreased saturated fat and cholesterol Soluble fiber and whole grains Soy protein/plant sterols/stanol estersReduce risk for neural tube defects Adequate folateReduce tooth decay Decreasing between-meal consumption  of foods high in sugars and starches44-38Health Fraud (cont.)Recognizing health fraud Check with the BBB or attorney general’s officeCheck with appropriate health-care groupContact the FDAIf it sounds to good to be true, it probably is not trueIf unproven, get a second opinionBeware of “secret cures”44-39Apply Your KnowledgeWhy do people fall victim to fraudulent health claims?ANSWER: These claims target people who are emotional and desperate. They are hoping to find a cure, improve their health, or just look better.Bravo!44-40In Summary44.1 Complementary and alternative medicines are practices and products outside the scope of traditional or conventional medicine.44.2 Complementary medicine is used in conjunction with conventional medicine. Alternative medicine is typically used as a replacement for conventional medicine.44-41In Summary (cont.)44.3 A new type of medicine called integrative medicine has emerged, in which conventional medicine and scientifically proven CAM therapies are used together. 44.4 There are five classifications for CAM. They include alternative medical systems, mind-body interventions, biologically-based therapies, manipulative and body-based methods, and energy. Each of these classifications has various types of products and therapies associated with it. 44-42In Summary (cont.)44.5 As a medical assistant, it is your responsibility to have basic knowledge of CAM therapies. If you work with a practitioner that provides CAM therapies, you will be responsible to assist in many cases. Additionally, understanding insurance reimbursement for CAM and health fraud are important aspects of the medical assistant’s role. 44-43In Summary (cont.)44.6 In many cases, patients are looking for low-cost products and services that help to maintain health and prevent disease, so they turn to CAM. Other patients that are offered no effective treatment or cure from conventional medicine are turning to CAM for additional options. Health-care practitioners are using many types of complementary therapy as they become accepted and, in many cases, scientifically proven. 44-44In Summary (cont.)44.7 In general, the insurance industry provides little or no coverage for CAM therapies. To find out if coverage is provided, you can contact the insurance company directly, obtain information from the association’s web site for the type of therapy provided, or contact the state insurance commissioner. 44-45In Summary (cont.)44.8 The NCCAM conducts and supports CAM research and provides CAM information to health-care providers and the public. Some state and federal laws have been enacted to help regulate CAM, and more laws and regulations are expected as research is conducted. 44.9 Health fraud as defined by the FDA as “articles of unproven effectiveness that are promoted to improve health, well being, or appearance.” Health fraud is monitored by the FDA and the FTC. 44-46There is a magnet in your heart that will attract true friends. That magnet is unselfishness, thinking of others first; when you learn to live for others, they will live for you. ~ Paramahansa YoganandaEnd of Chapter 44