4 Logistics of IHC: Issues and Collaborative Problem Solving
You have a right to good health care that is effective, accessible, and affordable,
that serves you from infancy through old age,
that allows you to go to practitioners and facilities of your choosing,
and that offers a broad range of therapeutic options.
– Andrew Weil, MD, Founder & Scholar of Integrative Medicine
The logistics involved in safe, evidence-informed integration of healing systems and modalities are complex and dynamic as we navigate this time of great challenge and change in the healing practices available to us (Avillo et al., 2020; Graham et al, 2023). This chapter highlights issues and responsibilities for healthcare consumers and professionals to consider in the facilitation of Integrative Health Care (IHC). Related resources and guidelines are included.
Logistical Issues and Resources to Address Them
Safety, cost, and access to evidence-informed resources are key issues that need to be addressed, keeping in mind that individual consumers will identify other ones, especially when asked.
Safety
Many potential safety issues were discussed in Chapter 3’s exploration of healing options. However, it is important to explore in more depth the risks associated with finding safe, qualified practitioners when such a range of qualifications currently exists. While unscrupulous practitioners may exist in any discipline, consumers may be especially vulnerable when healing practitioners are unregulated or are not recognized by or accountable to a professional association (Avillo et al., 2020).
See Appendix C that includes …
… Traditional and Complementary (T & CM) Practitioner Associations in Canada (which identifies the nature of regulated/unregulated occupations and lists the kinds of associations by which qualified practitioners should be recognized, regardless of whether their occupation is regulated).
… Canada Health regulations around food, drugs, and NHPs.
… considerations in relation to Traditional Indigenous Healing.
Being aware of required qualifications, organizations, and communities to which practitioners and their NHPs are accountable can help avoid unsafe situations and offer supportive resources should an unsafe situation be encountered.
Cost
Finances can be a significant barrier to accessing some healing modalities if their practitioners are not members of publicly funded healthcare or recognized by private insurers. As more HCPs are able to integrate relevant healing modalities into their professional practices, this barrier will become significantly less formidable. In the meantime, the services of most T & CM practitioners are covered only by private insurance or not at all.
Therefore, collaborative conversations about associated costs need to be integrated into discernment of priority healing practices, taking into consideration individual economic circumstances and resources. Amidst a health crisis, an individual may not think to check whether they have an insurance plan that covers certain modalities or if there is a publicly-funded HCP who integrates a given healing modality into their professional practice. Similarly, they may not realize there are free, open access resources for some modalities (such as the exemplars in Chapter 3) that can be very effective in supporting healing. HCPs can play a vital role in helping consumers to identify affordable, effective healing practices.
Accessibility
As with any form of health care, many individuals and communities face limited access to the services they need and want. Such limitations are accentuated in relation to healing modalities and practitioners who currently are smaller in number than HCPs. Geographic location, capacity to attend appointments, and internet access are among the many barriers individuals may face.
For those unable to attend office visits, it is important to explore virtual care options and safe ways of using mobile services (e.g. mobile body work practices such as massage or therapeutic touch, assuming a support person can be present for the individual receiving the treatment in their own/a trusted individual’s home). It is vital to explore all feasible options, recognizing that priority selections may need to be based on who and what individuals can access, whilst keeping safety the number one priority.
Shared Responsibilities in Navigating Logistics
Clearly, much innovative, collaborative problem-solving may currently be required to mobilize IHC (Avillo et al.). Consumers can, of course, initiate their own problem-solving where possible; we can also ask family and friends to help explore viable options, especially when our own capacity and energy may be limited. Often, our significant others are looking for practical ways to be helpful as we navigate health challenges. Their involvement also ensures support even if HCPs are unable to engage in detailed problem-solving at a given time. Any of our personal or professional support people can also help us stay mindful that it may take time to find the right modality(ies)and practitioner(ies). Keeping this reality in mind may soften the disappointment and frustration associated with discovering that something or someone isn’t the right fit for us.
As is evident throughout this handbook, HCPs’ key responsibility is to offer education and resources that facilitate consumers’ informed decision-making (NCCIH; Therapeutic Research Centre). Ultimately, it is the consumer’s responsibility to choose what they wish to include in their IHC plan. However, the stronger the therapeutic alliance between consumer and care provider, the less vulnerable consumers will be to making unsafe choices amidst today’s confusing set of logistics (Jonas, 2018; Weil, n.d.)
Additionally, HCPs may serve as advocates when it comes to helping those logistics become less daunting. Many are engaged in research which can help validate specific healing modalities’ safety and efficacy in treating certain health conditions (Weil, n.d.). This research is needed for HCPs/their regulatory bodies to be able to legally and ethically integrate those modalities into their professional scope of practice (NCCIH). Such research, in and of itself, involves challenging logistics (e.g. limited research funding and the challenge of validating certain modalities that don’t easily lend themselves to conventional scientific evidence because they are so individualized.) (Verhoef, 2005). As such, health researchers are increasingly exploring how they can draw upon a variety of ways of knowing to validate the safety and efficacy of a variety of modalities and systems (Ijaz et al., 2019; WHO, 2019). Some of this research is finding its way into publication. A few such examples are included throughout Appendix G. Of course, a thorough literature search on the current evidence base for a given modality is necessary on an ongoing basis.
The following two scenarios exemplify how care providers and consumers can find safe innovative ways to navigate the often complex logistics involved in offering Integrative Health Care. They are intended to illustrate the safety, cost and accessibility issues that need to be addressed, along with innovative ways of addressing them.
Examples of Navigating Complex Logistics within IHC
A COMMUNITY-BASED SCENARIO
Thomas, a man with a slow-healing wound tells his public health nurse that he has been reading about Manuka honey and asks the nurse if he should purchase some for them to use on his next dressing. He tells his nurse he is getting so tired of his sore wound and is worried that another infection is starting. He adds that he doesn’t want to be on antibiotics again, given the reading he has also been doing about the growing number of antibiotic-resistant infections.
The nurse is aware that Manuka honey is expensive, so she suggests they look online at its price and Thomas indicates he can afford it. The nurse tells Thomas that she will learn more about it herself, consult with his doctor, and follow up with him before her next visit.
The nurse does a literature search and finds the following two recent journal articles:
Honey in wound healing: An updated review – PMC (nih.gov)
When she contacts the physician, along with the local pharmacist, they concur that their sources, too, offer safe and promising evidence in relation to Manuka honey. A physician’s order is written, Thomas begins having the honey applied to his dressings, and the nurse observes ongoing results similar to those reported in the research that she read.
AN ACUTE CARE SCENARIO
A physician is finalizing his orders after admitting Gloria to hospital. Gloria is a Dene woman who wishes to continue using the Medicines given to her by the Traditional Healer in her remote community. Being unfamiliar with the Medicines, the physician asks Gloria for information about them, but she provides few specifics to him or the nurses. The physician tells Gloria he wants to honour her wishes to use the Medicines but is concerned about possible drug-herb interactions because he is also prescribing pharmaceuticals that are necessary for her treatment.
The physician consults a hospital pharmacist who has a strong background in both First Nations Traditional Medicines and herb-drug interactions. The pharmacist meets with the patient and discovers that she is feeling very frightened by the unfamiliar hospital environment and does not trust the physician or nurses with information about the Medicines. This mistrust has grown since she heard one nurse say, “There is no way I am giving her that witch medicine and putting my license on the line.” However, as the patient observes the pharmacist’s knowledge of and respect for her Traditional Medicines, she shares the information needed for him to sufficiently research them and to assure the physician that prescribing them would be safe in this instance.
The pharmacist also seeks and receives Gloria’s permission to have a health navigator from First Nations and Metis Health Services to come and see her. He explains that this person would be an Indigenous nurse or social worker who serves as a liaison between patients and staff as needed. The patient agrees and the health navigator spends time with Gloria, discussing her concerns and introducing her to various First Nations traditional healing practices available to her within the hospital (e.g. smudging; Elder visits).
The nursing unit manager spends time with the nurse who demonstrated bias and was fearful toward administering the Traditional Medicines. The manager tells the nurse that she has confirmed with their provincial nursing association/regulatory body that nurses are legally covered for administering Traditional Medicines and other herbs for which there is a physician’s order. She also discovers that the nurse is remorseful about her biased and unprofessional comment. The nurse apologizes to Gloria after she learns that she had heard the comment. The nurse, her manager, the unit educator, pharmacist, and client navigator collaborate to arrange for a hospital-wide in-service about protocol and policies in relation to Traditional Medicines, along with resources and opportunities for exploring personal biases and ways to engage in anti-oppressive practices. (See Appendices A or B for resources on the latter).
The ’L’ in WHOLE Care, of course, prompts collaborative conversation about the logistics most applicable to each consumer throughout the course of care. In the next chapter, our exploration will broaden to explore relevant environmental considerations.
