Geintegreerde Geneeskunde in Zweden

In het juli nummer van BMC Health Services Research 2007 staat een leuk verhaal over hoe de Zweden denken te komen tot geintegreerde geneeskunde. Duidelijk is dat men in Zweden de grenzen tuusen alternatieve of complementaire geneeskunde en behandelwijzen en de reguliere geneeskunde niet meer serieus nemen. Centraal stat de wens van de patient om goed geholpen te willen worden. Onderzoekers van het bekende Karalinska instituut spraken met een groot aantal gezondheidswerkers, op verschillende niveaus en van verschillende richtingen, inclusief de reguliere gezondheidszorg. Ze kwamen tot een mooi werkzaam model voor geintegreerde geneeskunde bij simpele klachten zoals rug en nekpijn. Het geintegreerde en niet hierarchische samenwerkingsmodel tussen regulier en alternatief laat zien dat geintegreerde geneeskunde ook binnen de huisartsenpraktijk en de eerste lijns gezondheidszorg mogelijk is.

We laten de auteurs zelf aan het woord:

IM is an emerging area of relevance for providers of conventional and complementary care in Sweden. We have described some key findings from the development and implementation of a proposed IM model adapted to the Swedish primary care setting.

The IM model builds on active partnership between a gate-keeping general practitioner with an informed knowledge of CT models and practice, having overall medical management responsibilities, collaborating with and coordinating a team of selected CT providers by means of consensus case conferences.

The proposed IM model needs testing and refinement in pragmatic, randomised controlled trials before integration into the Swedish primary care system can be recommended.

De lessen die de auteurs uit alle interviews trokken waren:

1. It was possible to develop a model for IM adapted to Swedish primary care despite various identified barriers.
2. Both a centralised and a decentralised clinic possible for delivering IM in primary care, the latter requiring less primary care unit resources.
3. Time and funding are essential to enable staff commitment, routines and resources as within normal primary care practice.
4. Need for a general practitioner with complementary therapy interest, knowledge and/or experience to coordinate the IM provider group.
5. IM case management slightly more time consuming, but improved case conference experience contributed to more efficient case management.
6. Continuing seminars and discussions can improve understanding, knowledge, motivation and recognition between stakeholders and different medical models.
7. Together with a shared knowledge of basic biomedicine this facilitate interdisciplinary dialogue and collaboration.
8. Clinical practice and communication were smooth within the IM group but written documentation procedures were more difficult to standardise.

De aanbevelingen voor de toekomst waren:

1. Funding and resource allocation beforehand important to improve provider participation and planning.
2. Health economic evaluation of IM management vs. treatment as usual needed to motivate management decision.
3. Availability of general practitioners’ specialist training IM important.
4. Common IM documentation should reflect multi-modular management, and preferably be computer-based.
5. Combination of qualitative and quantitative research methods useful.

Bron

Sundberg T, Halpin J, Warenmark A, Falkenberg T. Towards a model for integrative medicine in Swedish primary care.,BMC Health Serv Res. 2007 Jul 10;7:107.

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