HEALTH SERVICE RESEARCH POSTER PRESENTATION ABSTRACTS
Please note: All posters will be displayed in
Salons 10-12.
FRIDAY, 10:15-11:00 AM
Adler S, Wrubel J, May S, Hughes E, Beinfield H.
Integrating healthcare relationships: emerging configurations
of older patients, physicians, and complementary and alternative medicine
practitioners.
University of California, San Francisco adlersh@dahsm.ucsf.edu
PURPOSE: Older patients are increasingly likely
to be under the simultaneous care of physicians and CAM practitioners,
often for treatment of the same condition. Most patients do not inform
their physicians of their concurrent use of CAM and, typically, their
healthcare strategies are not formally integrated. Despite the growing
use of CAM for chronic conditions, as well as the predicted expansion
of the aged population over the next decades, little is known about
the impact of evolving healthcare relationships on older patients. The
Integrating Healthcare Relaltionships qualitative study examines the
ways in which contemporary healthcare interactions are understood by
older women diagnosed with breast cancer, their physicians, and their
CAM practitioners. The present analysis focuses on older patients' understandings
of their relationships with different realms of healthcare practitioners.
METHODS: Using tumor registry case listings,
we recruited a population-based, ethnically diverse sample of 40 women,
aged 60-80, diagnosed with breast cancer within the previous 5 years,
and being treated simultaneously by a physician and a CAM practitioner.
Participants completed 2 one-hour semistructured, tape-recorded interviews
focusing on their health beliefs, healing strategies, and healthcare
relationships. We conducted thematic analyses of perceptions of age
and aging in relation to healthcare strategies and views of healthcare
interactions.
RESULTS: The qualitative analysis yielded themes
regarding participants' understandings of healthcare interactions: most
of the women did not discuss their CAM treatment with their physicians,
but did discuss their biomedical treatment with their CAM practitioners;
participants expressed concern that their age adversely affected their
physicians' (but not their CAM practitioners') views of them; participants
did not characterize themselves as "old," based primarily on their activity
levels; and participants felt that engaging both biomedicine and CAM
was critical for the successful management of activity-limiting health
concerns.
CONCLUSIONS: Concepts of "externally" integrated
care were not central to the healthcare goals of the older breast cancer
patients in our study. The participants were actively involved in maintaining
their health and in combining CAM and biomedical resources to prevent
limitations of their meaningful life activities. Participants were comfortable
assuming responsibility for managing the interface between different
systems of healthcare. Emerging conceptual models of integrated care
should be considered in the context of the healthcare needs and goals
of age groups and age cohorts.
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