Pragmatic Model for Integrating Complementary and Alternative Medicine in Primary Care Management of Chronic Musculoskeletal Pain

Background: Integration of complementary and alternative medicine (CAM) into conventional care is driven by patients’ needs for holistic care. This study aimed to develop a model for integration of CAM into primary healthcare in close collaboration with patients suffering from chronic musculoskeletal pain (CMP). Methods: The study had a qualitative inductive approach following the principles of Grounded Theory, where data were collected and generated via several data sources and steps; individual and focus group interviews and meetings with patients, general practitioners (GPs), CAM practitioners, health insurers and other key informants. Results: Consensus was reached on a model in which shared decision making was introduced to facilitate discussions on CAM between patients and GPs. Guided by evidence and best-practices, GPs refer patients to one of five selected and reimbursed CAM therapies (acupuncture, homeopathy, naturopathy, osteopathy or Tai Chi) and respective practitioner within their integrative network. CAM practitioners report treatment outcome back to the GP who follows-up on the patient for further evaluation. Conclusions: In conclusion, it was feasible to develop a model for integration of CAM into primary healthcare management of CMP that was driven by patients’ needs and obtained consensus of all stakeholders. The model is the first in the Netherlands to provide for integrative health services in primary care. It needs to be tested in a study setting before further implementation is recommended.Financed by Dutch Ministry of Health, Welfare and Sports