NORPHCAM Program Outline
Stream 1: CAM use and CAM users
Gender, Ageing, Chronic Illness and CAM use: New Analysis of Population Health Datasets
CAM use Amongst Specific Patient Groups
Stream 2: CAM Practice
CAM-Primary Care Interface and Integrative Medicine
Health Economics and Cost Effectiveness Analysis
Practititioner Research Capacity Building
Stream 1: CAM use and CAM users
Stream 1A: Gender, Ageing, Chronic Illness and CM uSe: New Analysis of Population Health Datasets
Relevant funding: $450 000 NHMRC CAM grant (Australia)
This section of the program builds upon the secondary analysis of three CAM sub-studies that are currently directed/conducted by members of the network: the Australian Longitudinal Study of Women's Health (ALSWH) CM sub-study, the Hunter Community CM study (HCS) and the 45 and Up Study.
The ALSWH CAM Sub-study draws upon a national health survey of a representative sample of women (comprising young, mid-age and older cohorts) across Australia. It collects data regarding health status, health service utilisation and demographics. The ALSWH CM sub-study is the largest CM consumption database with regard to women's health in the world (n>40,000) and one of only a small number of truly longitudinal datasets on CM use and users worldwide - it provides an excellent opportunity to undertake new collaborations and to answer new research questions relating to women's health and CM consumption.
An ongoing focus is the use of CM for pregnancy and birthing amongst the young cohort, CAM for a range of women's health conditions including menopause amongst mid-age cohort, examining the longitudinal aspects of women's CM use through young to mid to older age, and examining the qualitative open-ended data on CM provided in the sub-study surveys.
The ALSWH CAM Sub-study draws upon a national health survey of a representative sample of women (comprising young, mid-age and older cohorts) across Australia. It collects data regarding health status, health service utilisation and demographics. The ALSWH CM sub-study is the largest CM consumption database with regard to women's health in the world (n>40,000) and one of only a small number of truly longitudinal datasets on CM use and users worldwide - it provides an excellent opportunity to undertake new collaborations and to answer new research questions relating to women's health and CM consumption.
An ongoing focus is the use of CAM for pregnancy and birthing amongst the young cohort, CAM for a range of women's health conditions including menopause amongst mid-age cohort, examining the longitudinal aspects of women's CM use through young to mid to older age, and examining the qualitative open-ended data on CM provided in the sub-study surveys.
The Hunter Community Study (HCS) is a regional population cohort study of the health and health service use of 3,000 older adults. Our proposed work on this analysis will explore older adults' CM use in terms of urban/rural location, self-reported, biological and physical measurements of health status, psychosocial measurements and chronic conditions.
Stream 1B: CAM use amongst specific patient groups
Despite the growing popularity of CAM within palliative care, we currently know very little about how, why and when patients use CAM. In response the Network is undertaking a qulaitative in-depth interview study of palliative care patients to examine their perceptions and experiences of CAM in their care.
This research will explore a number of themes from the perspective of these patients, including: psychosocial, medication support and the related role of CAM; points of transition (i.e to palliative care or hospice care); diversity of patient CAM needs in terms of ethnicity, religious belief, age and gender; the carer support services and the role of CAM therein.
Stream 2: CAM Practice
Stream 2A: CM-Primary Care Interface and Integrative Medicine
Relevant funding: $85 000 University of Queensland Foundation Research Excellence Award
An area that will be investigated within the Network will be the grass-roots interface between rural general practitioners and CAM. Such research will employ methods of qualitiative fieldwork to examine the competencies, characteristics and strategies that enable GPs and others in the multi-disciplinary rural primary care team (including CAM practitioners) to work effectively together to meet the health needs of rural Australians.
Stream 2B: CAM and Community Pharmacists
Research projects in progress. More details to follow
Stream 2C: Health Economics and Cost Effectiveness Analysis
Releavant funding: $300 000 University of Queensland, Symbion Health and Queensland Government
In addition to understanding the dynamics and influences of the cultural, social and political contexts upon CM practice and consumption behaviour it is also important that the CM research agenda addresses questions of cost-effectiveness and optimises public investment in health care. This is an area of work that is still very much in its infancy (Andrews 2005), yet given the relentless pressure on healthcare expenditures, the topic is of major importance. Our Network will focus significant attention upon addressing two key questions. First, is whether it is efficient to re-allocate scarce healthcare resources toward CAM and away from other less cost-effective therapies. Second, is to identify which particular interventions represent good value for money. We propose to use a mix of quantitative and qualitative methods to investigate the cost-effectiveness of a number of CM interventions/treatments for a range of conditions. We suggest five incremental steps need to be taken:
- undertake exhaustive systematic reviews to summarize the volume and quality of the evidence for CM in different settings and across different patient populations;
- develop a list of CM strategies that are clinically relevant to decision-makers in health care based on the value and quality of evidence for their effectiveness;
- estimate the change in economic costs associated with shifting resources toward the supply of each CM therapy/treatment;
- estimate the change in health benefits associated with shifting resources toward the supply of each CM therapy/treatment and
- construct economic decision models that summarise cost and health benefit outcomes, propagate parameter uncertainty and move towards model conclusions, and assess the value of missing information. This will inform the adoption decision and generate a rational basis for choosing future research programs.
This section aims to revise and refine health economics methods to the study of CAM.
Stream 2D: Practitioner Research Capacity Building
It is important that practitioners are successfully integrated into developing the CM research base - this is critical to producing enquiry that engages with and remains sensitive to practice realities. In response, the Network will collaborate with a number of national and regional practitioner representative bodies (Network research partners) to provide research capacity building workshops/activities for the members of key practitioner groups:
The Australian College of Natural Medicine