Lecture Clinical procedures for medical assisting (4/e): Chapter 13 – Booth, Whicker, Wyman

Chapter 13 - Complementary and alternative medicine. After studying this chapter you will be able to: Explain CAM, distinguish between complementary and alternative medicine and conventional medicine, summarize how cam and conventional medicine are used together, identify various types of complementary and alternative medicine,…

Complementary and Alternative Medicine

Learning Outcomes

13.1 Explain CAM.

13.2 Distinguish between complementary and

alternative medicine and conventional medicine.

13.3 Summarize how CAM and conventional

medicine are used together.

13.4 Identify various types of complementary and

alternative medicine.

Learning Outcomes (cont.)

13.5 Describe how a medical assistant may use his

or her knowledge of CAM

13.6 Explain why patients and health-care

practitioners are turning to complementary treatments.

13.7 Compare insurance and payment for CAM

treatments.

13.8 Explain how CAM is regulated.

13.9 Describe health fraud.

Introduction

• More than 30% of adults use

complementary and alternative therapies

– Relieve problems

– Promote wellness

– No relief from traditional treatments

• Some physicians use a combination of

CAM and traditional therapies

What Is CAM?

• A group of practices and products that are

not part of conventional medicine

common and usual practice

conventional medicine

conventional medicine

What Is CAM? (cont.)

• Scientific evidence concerning safety and

effectiveness

– Available for some CAM therapies

– Research continues, so information changes

• Integrative medicine

– Evolves as CAM therapies are adopted by

conventional medicine – Combination of both

Apply Your Knowledge

Define CAM and state why these therapies are

not in wide use by practitioners of conventional

medicine.

ANSWER: CAM is a group of practices and products not

considered part of conventional medicine They are not widely

used by physicians because there is not a lot of scientific

evidence of their safety and effectiveness.

Types of CAM

• Shared similarities

– Individualized

treatments, good nutrition, and

preventive health practices

– Holistic

– Promote self-care and

self-healing– Recognition of one’s

spiritual nature

• Categories

– Alternative medical systems

– Mind-body interventions– Biologically-based therapies

– Manipulative and body-based methods– Energy therapies

Alternative Medical Systems

• Evolved apart from conventional medicine

• Homeopathic medicine

– Treating syndromes and conditions with

remedies that produce similar syndromes and conditions in healthy people

– Remedy

• Produces the symptoms it is given to treat in order

to stimulate the body’s natural defenses to heal itself

• Must meet FDA standards

Alternative Medical Systems (cont.)

• Homeopathic medicine

– Looks at individuals, not diseases

• Initial in-depth assessment

• Follow-up – how they are responding

– Medical assistant role

• Similar to other medical offices

• Have knowledge of common remedies

Alternative Medical Systems (cont.)

• Naturopathic medicine

– Relies on the healing power of the body to

establish, maintain, and restore health – Primary health care

Alternative Medical Systems (cont.)

• Naturopathic medicine

– Medical assistant – understanding of

treatments

– Traditional Chinese medicine

• Balanced qi (vital energy)

• Flow of qi along meridians (energetic pathways)

• Acupuncture – insertion of hollow needles along meridians

– Ayurveda – provides guidance regarding food and lifestyle; India

Mind-Body Interventions

• Enhance the mind’s capacity to affect

bodily function and symptoms

• Support groups and cognitive-behavioral

therapy now part of traditional medicine

• Scientific support

– Placebo effect – WW II

– 35% of therapeutic response is due to belief

Mind-Body Interventions (cont.)

• Most commonly used forms

Biologically Based Therapies

• Use substances found in nature

patients

Biologically Based Therapies (cont.)

Biologically Based Therapies (cont.)

• Patient education for using supplements

– Report all supplements as they would

prescription medications – Take supplement bottles to appointments

• Document patient’s use of

supplements in the

medical record

Manipulative and Body-Based Methods

• Based on the manipulation and/or movement of

one or more parts of the body

– Trager bodywork– Tui Na

• Massage

– Pressure, kneading, stroking, vibration,

and tapping to positively affect health – Effects

• Improves concentration

• Promotes restful sleep

• Helps the mind relax

– Trigger point therapy

• Seated massage

– Focuses on back and neck

• Chiropractor

– Performs an exam and takes a history – Tests

• X-rays

• Muscle testing

• Analyzes posture

Energy Therapies

• Bioelectromagnetic-based therapies

– Balances the electromagnetic fields of the

body – No scientific evidence of efficacy

– Magnetic therapy

• Most common type

• Magnets are used to correct disturbances of electromagnetic fields and restore health

• FDA – no medical value but relatively harmless

• Avoid for patients with pacemaker or defibrillator

Energy Therapies (cont.)

– Visualization and touch

balance energy flow to bring healing energy

to organs and glands

• Therapeutic touch

– “Laying-on of hands” – Hands direct human energies to help or heal

– No scientific evidence

of efficacy

Apply Your Knowledge

Match to types of CAM:

_ Therapeutic touch A Energy therapies

_ Chiropractic medicine B Mind-body therapies

_ Dietary supplements C Body-based therapies

_ Yoga and meditation D Biologically-based therapies

_ TCM E Alternative medical systems

Patients Seeking CAM Therapy

• Use is increasing

– Less expensive

– Have fewer side

effects– More accessible

– Increase in spirituality

– Personal growth

– Environmentalism

– Preventive health care

• Reasons for seeking CAM therapy

– Failure of traditional medical interventions– Treat side effects of conventional

medicine’s treatments

Patients Seeking CAM Therapy (cont.)

• Patients with chronic debilitating

conditions

– Improve quality of life

– Improve ability to cope with stress and illness

• Cultural differences in CAM use

– Hispanics

– Native Americans

• Accept patient’s right to choose CAM

therapy

Patients Seeking CAM Therapy (cont.)

• Use of CAM in children on the increase

– Safety – children respond differently– Efficacy in children not established

– Identify and document

if CAM is used

Apply Your Knowledge

Mr State is complaining about chronic back pain He says

that the medication only helps a little and asks you if there

is anything else you could recommend that will help him

What should you tell him?

ANSWER: If your employer is not averse to CAM therapies, you

can tell him that there are CAM therapies that may help with the

pain or at least help him cope better with it He could try

mind-body techniques, acupuncture, manipulative and mind-body-based

techniques, or energy therapies.

Insurance and CAM

• Coverage varies

– Lack of research and documentation of

efficacy – Emphasis on physiological or biochemical

response to therapies

• Alternative health insurance companies

emerging in response to need

Insurance and CAM (cont.)

• Medical assistant

– Know whether or not CAM

treatments are covered by insurance

– Resources

• Insurance companies

• State agency that regulates the insurance industry

Regulation of CAM Therapies

• National Center for Complementary and

Alternative Medicine (NCCAM)

– Research

– Training and career development

– Conferences and educational programs

– Integration of scientifically proven CAM

therapies into conventional medicine

Regulation of CAM Therapies (cont.)

• White House Commission on

Complementary and Alternative Medicine

Policy (WHCCAMP)

– Funding for research

– Communication between CAM and

conventional practitioners – Availability of CAM practitioners

– State review and evaluation of CAM

practitioners – Insurance coverage options

Apply Your Knowledge

1. Why do insurance companies not reimburse for most CAM therapies?

ANSWER: Insurance companies do not reimburse for CAM therapies

because of the lack of research and documentation of effectiveness of

Health Fraud

• Articles of unproven effectiveness

promoted to improve health, well-being, or

appearance

– Deception or trickery for profit

– Plays on emotions and desperation

• Regulation

– FDA – safety, manufacturing, and labeling

– FTC – advertising

Health Fraud (cont.)

• Based on scientific evidence

• Only reduces risk/does not treat or cure

Health Fraud (cont.)

Reduce risk for

hypertension • Low-sodium diets• Potassium

Reduce risk for

osteoporosis

• Calcium

Health Fraud (cont.)

FDA-Approved

Health Claim Supplement/Food

Reduce risk of heart

disease

• Low-sodium diets

• Decreased saturated fat and cholesterol

• Soluble fiber and whole grains

• Soy protein/plant sterols/stanol esters

Reduce risk for

neural tube defects

• Adequate folate Reduce tooth decay • Decreasing between-meal consumption

of foods high in sugars and starches

Health Fraud (cont.)

• Recognizing health fraud

– Check with the BBB or attorney general’s

office – Check with appropriate health-care group

– Contact the FDA

– If it sounds to good to be true, it probably is

not true – If unproven, get a second opinion

– Beware of “secret cures”

Apply Your Knowledge

Why do people fall victim to fraudulent health

claims?

ANSWER: These claims target people who are emotional and

desperate They are hoping to find a cure, improve their health, or

just look better.

Bravo!

In Summary

13.1 Complementary and alternative medicines are

practices and products outside the scope of traditional

or conventional medicine

13.2 Complementary medicine is used in conjunction with

conventional medicine Alternative medicine is typically used as a replacement for conventional medicine

In Summary (cont.)

13.3 A new type of medicine called integrative medicine

has emerged, in which conventional medicine and scientifically proven CAM therapies are used together

13.4 There are five classifications for CAM They include

alternative medical systems, mind-body interventions, biologically-based therapies, manipulative and body-based methods, and energy Each of these

classifications has various types of products and therapies associated with it

In Summary (cont.)

13.5 As a medical assistant, it is your responsibility to have

basic knowledge of CAM therapies If you work with a practitioner that provides CAM therapies, you will be responsible to assist in many cases Additionally, understanding insurance reimbursement for CAM and health fraud are important aspects of the medical

assistant’s role

In Summary (cont.)

13.6 In many cases, patients are looking for low-cost

products and services that help to maintain health and prevent disease, so they turn to CAM Other patients that are offered no effective treatment or cure from conventional medicine are turning to CAM for

additional options Health-care practitioners are using many types of complementary therapy as they

become accepted and, in many cases, scientifically proven

In Summary (cont.)

13.7 In general, the insurance industry provides little or no

coverage for CAM therapies To find out if coverage is provided, you can contact the insurance company

directly, obtain information from the association’s web site for the type of therapy provided, or contact the

state insurance commissioner

In Summary (cont.)

13.8 The NCCAM conducts and supports CAM research

and provides CAM information to health-care providers and the public Some state and federal laws have been enacted to help regulate CAM, and more laws and regulations are expected as research is conducted

13.9 Health fraud as defined by the FDA as “articles of

unproven effectiveness that are promoted to improve health, well being, or appearance.” Health fraud is monitored by the FDA and the FTC

There is a magnet in your heart  that will attract true friends. 

That magnet is unselfishness,  thinking of others first; when  you learn to live for others,  they will live for you. 

~ Paramahansa Yogananda

End of Chapter 13