CAM:INTEGRATION INTO PRIMARY
CARE
PRESENTATION BY DR CUDJOE
DIABA AND DR MARTINA
JOHNSON
MODULAR RESIDENTS SOUTH
EASTERN CLUSTER
OUTLINE
INTRODUCTION
DEFINITIONS
TRENDS OF COMPLEMENTARY & ALTERNATIVE MEDICINE (CAM) USE
REASONS FOR USE OF CAM
OVERVEIW OF SOME CAM PRACTICES
INTEGRATED MEDICINE
WHY THE NEED FOR INTEGRATIVE MEDICINE IN PHC
GUIDELINES FOR USE OF INTEGRATIVE MEDICINE IN PHC
CONCLUSION
REFERENCES
INTRODUCTION
 Conventional medicine is having to deal with the outcome of global epidemiological transition of diseases from infectious
diseases to more chronic diseases for decades now.
 Chronic diseases unlike infectious diseases require lifelong treatment and lifestyle modifications to manage and this has
led to the constant search for cure that conventional medicine is unable to offer.
 In the United States almost 40% of adults and 12% of children use complementary and alternative medicine (CAM)
therapies.
 The number of adult Americans using CAM rose by 38% between 1990 and 1997 and has remained stable between 2002
and 2007.
 Most patients use CAM and conventional care together (medical pluralism).
 Most patients do not disclose CAM use to their physicians.
(National Centre for Health Statistics 2012)
SOME DATA ON GHANA
 Study by Kretchy et. al, 2014 on patterns and determinants of CAM use
 19.5% reported using CAM
 65.38% biologically based products
 70% CAM users did not disclose CAM use to their Doctors( Citing fear and lack of inquiry from
Doctors)
 Males were 2.86 times more likely to use CAM
 Inability to buy orthodox medications increases likelihood of CAM use.
 CAM users were 2.22 times more likely to be non adherent to orthodox medications.
DEFINITIONS
Various definitions have been used to describe the array of approaches and philosophies commonly
referred to as CAM. As the field has evolved, so has the terminology.
 CAM : Can be defined as a group of diverse medical and health care systems, practices and
products that are not presently considered to be part of conventional medicine (NCCAM, 2002)
 CAM is often used to mean the array of health care approaches with a history of use or origins
outside of mainstream medicine.
 Alternative medicine refers to using a non-mainstream approach in place of conventional medicine.
 Complementary medicine generally refers to using a non-mainstream approach together with
conventional medicine.
TYPES OF CAM
TYPES OF CAM
COST OF CAM
 In 2012, Americans spent
$30.2 billion dollars out of
pocket on complementary and
alternative health approaches.
Out of this, $12.8 billion was
spent on Natural products
supplement
(National Centre for Health Statistics 2012)
TRENDS IN CAM PRACTICES IN ADULTS 2012
Source: Clarke TC, Black LI, Stussman BJ, Barnes PM, Nahin RL. Trends in the use of complementary health approaches among
adults: United States, 2002–2012. National health statistics reports; no 79. Hyattsville, MD: National Center for Health Statistics,
2015.
CONDITIONS COMMONLY REQUIRING CAM
CONDITIONS COMMONLY REQUIRING CAM
WHY DO PEOPLE USE CAM
WHO WILL USE CAM?
 Prevalent among women
 Ages 30- 69
 Higher education
 Not Poor
 Former smoker
 Hospitalized in the past year
 Positively associated with number of health conditions and number of physicians visit
OVERVEIW OF SOME CAM PRACTICES
BIOLOGICALLY BASED THERAPIES
 Uses products usually found in nature.
 Dietary supplements and herbal remedies: vitamins, minerals, herbs and
enzymes.
 Examples include glucosamine, chondroitin, St. John’s Wort, ginkgo,
ginseng, fish oil, echinacea, vitamin D, garlic calcium, green tea and
cannabis.
ENERGY THERAPIES
Made up of Reiki, magnets ,Qi gong and Acupuncture.
 Reiki: Practitioners direct “reiki energy” through their hands (holding them over
your clothed body), channeling energy to areas of need in you. Reiki claims to
balance the body’s energy centers or “chakras” and dissolve energy blockages
that lead to disharmony and disease.
Qi gong: is an ancient system of movement, breathing techniques and
meditation. It's designed to develop and improve the circulation of qi, or “life
energy,” around your body
REIKI AND QI GONG
ACUPUNCTURE
 Acupuncture is an ancient Chinese system
of healthcare.
 It aims to prevent and cure specific
diseases and conditions by sticking very fine,
solid needles into points of your body.
 Acupuncture is believed to encourage the
release of endorphins which can also
increase feelings of well-being.
MANIPULATION AND BODY-BASED PRACTICES
 Includes Massage, chiropractic, osteopathic manipulations and reflexology.
 Massage therapy: a therapy where the soft tissues of the body are kneaded,
rubbed, tapped and stroked.
 Chiropractic therapy: a type of manipulation of the spine, joints and skeletal
system.
 Reflexology: type of massage in which pressure is applied to specific points on
the feet or hands, which are believed to match up with certain parts of the body.
CHIROPRACTOR
MIND-BODY MEDICINE
Eg. Meditation, Yoga, Relaxation and Deep breathing ,Tai Chi
 Meditation: is a method of relaxing and quieting your mind to relieve
muscle tension and achieve inner peace.
 Yoga; is a form of gentle exercise consisting of body postures and
breathing techniques. In the West, yoga is valued more for its physical
than spiritual benefits, such as its ability to increase suppleness and
vitality and to relieve stress and fatigue.
 Tai chi appears to help improve balance and stability, reduce back
pain and pain from knee osteoarthritis, and improve quality of life in
people with heart disease, cancer, and other chronic illnesses.
ALTERNATIVE MEDICAL SYSTEMS
Eg. Naturopathic medicine , Homeopathy, Ayurvedic Medicine
 Naturopathic medicine : a system that avoids drugs and surgery. Based on the use of natural
agents such as air, water, light, heat and massage to help the body heal by itself. It may also use
herbal products, nutrition, acupuncture and aromatherapy.
 Homeopathy: a system of complementary medicine in which ailments are treated by minute
doses of natural substances that in larger amounts would produce symptoms of the ailment.(“Like
cures like”)
 Ayurvedic medicine: Goal is to cleanse the body and restore balance to the body, mind and spirit.
It uses diet, herbal medicine, exercise, meditation, breathing and physical therapy.
CAM CENTRE’S IN GHANA
Bliss Yoga Centre – One Airport Square Accra
Beijing Clinic ( Acupuncture ) – Osu
Nova Wellness Centre ( Chiropractor ) – Osu
Pantita Thai Massage
INTEGRATED/INTEGRATIVE MEDICINE
 An approach to medical care that recognizes the benefit of combining conventional
therapies (such as drugs and surgery) with complementary therapies (such as
acupuncture and yoga) that have been shown to be safe and effective.
 For example, acupuncture may be used with certain drugs to help lessen cancer
pain or nausea and vomiting. Integrative medicine tries to address the physical,
emotional, social, spiritual, and environmental factors that can affect a person’s
health and well-being.
HISTORY OF INTEGRATIVE MEDICINE
OBJECTIVE OF INTEGRATIVE MEDICINE
The aim of integrative medicine is to achieve holistic care of clients.
Holistic medicine is the art and science of healing that addresses care of the whole
person—body, mind, and spirit.
The practice of holistic medicine integrates conventional and complementary
therapies to promote optimal health and to prevent and treat disease by addressing
contributing factors” (AHMA, 2014).
WHY INTEGRATE CAM INTO PRIMARY CARE
PHC is a set of universally accessible services that promote health, prevent disease,and provide
diagnostic, curative, rehabilitative, supportive,and palliative services.
Holistic and personalized care that lies at the heart of PHC can be better achieved by the
integration of CAM.
A logical first step in this direction of integration is to establish guidelines for the proper
integration of CAM into primary care, supported by appropriate research and clinical experience.
Unfortunately the research data on this issue are quite limited.
GUIDELINES FOR INTEGRATING CAM INTO PHC
 Patient and practitioner must become partners in the healing process.
 All factors that influence health, wellness, and disease must be taken into consideration, including mind, spirit and
community as well as body.
 Effective interventions that are natural and less invasive should be used whenever possible.
 Integrative medicine neither rejects conventional medicine nor accepts alternative therapies uncritically.
 Good medicine should based on good science, enquiry‐driven and open to new paradigms.
 Alongside the concept of treatment, the broader concepts of health promotion and the prevention of illness should
be paramount.
 Practitioners of integrative medicine should exemplify its principles and commit themselves to self‐exploration and
self‐development.
SOME INTEGRATED HERBAL PRODUCTS
Tentex Royale
Speman
Mentat syrup
Koflet syrup
CHALLENGES TO INTEGRATION
Traditional biases against CAM
Lack of evidence to support effectiveness of CAM
Poor regulation of CAM practitioners , leading to a lot of quacks
Lack of adequate knowledge of healthcare workers on the scope of Complementary
and Alternative medicine ( CAM)
CONCLUSION
 Many countries now recognize the need to develop a cohesive and integrative approach
to health care that allow governments, health care practitioners and, most importantly, those
who use health care services, to access T&CM [Traditional & Complementary Medicine] in a
safe, respectful, cost-efficient and effective manner.
 A global strategy to foster its appropriate integration, regulation and supervision will be
useful to countries wishing to develop a proactive policy towards this important—and often
vibrant and expanding—part of health care. (WHO, 2013)
REFERENCES
 Robert E. Rakel and David P. Rakel, text book of family physicians, 8th edition
 Robert E. Rakel and David P. Rakel, text book of family physicians, 9th edition
 Shirwaikar et. Al, 2013; Integrating Complementary and Alternative Medicine with Primary Health
Care
 Anand Dhruva,2019; Applying Integrative Medicine in Everyday Practice: An overview
 Kretchy, I.A., Owusu-Daaku, F. & Danquah, S. Patterns and determinants of the use of
complementary and alternative medicine: a cross-sectional study of hypertensive patients in
Ghana. BMC Complement Altern Med 14, 44 (2014).