Hamilton JL, Roemheld-Hamm B, Jalba M, Young DM, Dicicco-Bloom B, Crabtree B.

Organizational features of family medicine practices which include CAM.

UMDNJ—Robert Wood Johnson Medical School, Department of Family Medicine, 1 World's Fair Dr, Somerset, NJ 08837. jennifer.hamilton@umdnj.edu

BACKGROUND: The growth of complementary and alternative medicine (CAM) has led some family medicine practices to incorporate CAM. Acupuncture, naturopathy or Reiki, for example, may be offered at these practices in addition to conventional medical care. Little is known about the development, organization, or internal structures of these integrated practices, which may be expected to form a growing share of overall primary care in the future.

PURPOSE: To identify some of the organizational patterns of family medicine practices which incorporate CAM.

METHODS: Qualitative ethnographic approach that includes structured and participant observation, key informant interviews, and in-depth interviews of providers and staff. This pilot study was conducted at five purposefully sampled family medicine practices in New Jersey and Pennsylvania.

RESULTS: Issues of payment and reimbursement are addressed in response to larger systems: practices which are closely affiliated with larger entities (e.g., universities) are more likely to accept insurance. Diverse state laws favor or prohibit provision of certain services. These practices are also shaped by internal forces. Many have reputations for special expertise which attracts patients with particular concerns; staff often consider patients to require more attention than those at other practices. Treatments are generally provided under the direction of an allopathic physician, rather than after independent assessment by a non-allopathic provider; indeed, "complementary" or "alternative" assessment and treatment are most often provided by a multiply educated allopathic physician. Management styles run the gamut from hierarchical to collegial.

CONCLUSIONS: Analysis suggests that practices vary in the ways they have organized to integrate CAM, based on such influences local laws, available reimbursement, patient population, and management styles. Both internal and external constraints influence the extent to which an integration of medical approaches, rather than a separation between "conventional" and "alternative" medicine, is fostered.

 

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