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Integrative Medicine: The Hopkins Perspective

JHI Partners Forum, 2012. Integrative Medicine: The Hopkins Perspective. Linda A. Lee, MD Johns Hopkins Integrative Medicine & Digestive Center Division of Gastroenterology and Hepatology. Johns Hopkins Integrative Medicine & Digestive Center. Primary location at Green Spring Station

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Integrative Medicine: The Hopkins Perspective

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  1. JHI Partners Forum, 2012 Integrative Medicine: The Hopkins Perspective • Linda A. Lee, MD • Johns Hopkins Integrative Medicine & Digestive Center • Division of Gastroenterology and Hepatology

  2. Johns Hopkins Integrative Medicine & Digestive Center • Primary location at Green Spring Station • Consultative services also available at the Hospital • Staff • Four physicians (internist, GYN, GI, rheumatologist) • Two acupuncturists (TCM) • Four licensed massage therapists • Two psychotherapists – hypnotherapy, CBT, guided imagery • One nutritionist – individual consultations and group classes

  3. Goals • To 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 therapies • Offer services within the Center that would be readily accessible to patients as well as referring providers

  4. Johns Hopkins Integrative Medicine & Digestive Center • 4000 visits to the Center in FY12 • Open Mon-Sat, evening hours until 9 pm • 6 examination rooms, all multipurpose • Staff offer personal, concierge-type service • Is the only integrative medicine center in the US based in gastroenterology

  5. JHIMDC: Our Patient Programs www.hopkinsintegrative.org

  6. Finding practitioners • What 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: Principles • Engage the patient as an active participant • Provide education about health, symptoms, and diseases • Counsel in appropriate nutrition practices and supplement use • Discuss evidence-based pharmacologic and mind-body therapies • The patient-provider interaction is a vital part of the healing process

  8. An example: Gastroesophageal Reflux

  9. Conventional Strategy • Medical therapy • Additional testing • Lifestyle changes • Low fat diet • Avoid caffeine • Avoid carbonated beverages • Limit your alcohol intake • Stop smoking • Raise 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 hypersensitivity • Esophageal hypersensitivity has been implicated as a cause of reflux symptoms • Psychosocial factors are known to mediate both peripheral and central hypersensitivityandplay a role in symptom perception among patients with GERD • Behavioral medicine techniques (CBT and hypnotherapy) may be a useful adjunct to other anti-reflux therapy in those who experience increased symptoms during stress McDonald-Haile, J, et al. Gastroenterology, 1994;107(1):61-9 Van Peski-Oosterbaan, AS, et al. Am J Med 1999; 106: 424–9 Miwa, H et al. J NeurogastroenterolMotil, Vol. 16 No. 4 October, 2010

  13. The Integrative Medicine Approach • Understand and treat the symptoms in the context of the patient’s home and work life • Educate the patient as to why GERD occurs • Discuss weight loss as a long-term management strategy • Discuss evidence-based acupuncture • Answer questions about the use of supplements • Determine if stress is a trigger for symptoms and identify strategies for addressing stress • Medical therapy • Additional testing • Lifestyle changes • Low fat diet • Avoid caffeine • Avoid carbonated beverages • Limit your alcohol intake • Stop smoking • Raise the head of your bed PLUS THIS:

  14. Acupuncture for persistent reflux symptoms Dickman, R. et al. Aliment PharmacolTher 2007. 26: 1333–1344

  15. Traditional Remedies for reflux Fennel seed no scientific evidence… yet Licorice Apple Cider Vinegar

  16. Conventional care Physician Physician Acupuncturist Nutritionist Psychotherapist JHIMDC Massage Therapist

  17. Is integrative medicine cost-effective? • Cost savings could be realized by • Decreasing utilization of expensive medical interventions such as pharmaceuticals, or reducing trips to the ER • Reducing 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 Medicine • Current healthcare reimbursement favors procedures and pharmaceuticals over education, adequate face-to-face time, mind-body therapies • Conventional practitioners lack knowledge about evidence-based healing practices and practitioners, and how to identify them

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