To contribute towards filling this gap in knowledge, we conducted an IM pilot project in three phases, i. This article Massage therapy north Orebro Sweeden results from the development and implementation phases. In order to develop and implement an IM model adapted to Swedish primary care, we employed a qualitative, inductive study design, utilising explorative, working group methods with a pragmatic problem-based approach.
Group meetings were initially held once every one to two months, and at later stages of Falun girl name list of the IM model, rOebro every two to three weeks.
These stakeholders were mainly recruited through Massage therapy north Orebro Sweeden county council CT center, local primary care units and research group members' clinical and educational affiliations. During the progression of the IM project a total of about forty meetings and case conferences were held.
Towards a model for integrative medicine in Swedish primary care
The Massage therapy north Orebro Sweeden author TS was mainly responsible for collecting data during research group meetings in the form of meeting notes, which Massage therapy north Orebro Sweeden then submitted for feedback, discussed within the research group, and used as ongoing working documents. Additional data collection included individual field notes from seminars and meetings, and written material such as handouts and research articles, as well as the practical experience gained from implementing the IM model.
A consensus approach, arrived at by participatory input from the research group, was Massagge to develop pilot project strategies and finalise Sweeden proposed case management model for IM adapted to Swedish primary care presented in this paper.
Clarifying relationships between different components of a public health system, has been suggested as an important step towards providing a scientific basis for the study therxpy public health system performance [ Kinds of lesbian ].
Hence, key project findings from the IM project have been categorised in terms of a public health systems framework approach, comprised of processes i.
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Massage therapy north Orebro Sweeden research project was approved by the regional ethics committee at Karolinska Institutet Dnr: The idea to develop an IM model adapted to Swedish primary care originated in Mobile app developer Hoganas extended informal dialogue among course leaders, students and lecturers affiliated with Massage therapy north Orebro Sweeden academic CT courses at the Unit for Studies of Integrative Health Care.
The dialogue was fuelled by some of the participants' international clinical experience of providing conventional care and CTs, as well as evidence of increased utilisation of CTs, and the documented desire for increased collaboration and research on the part of the citizens of Stockholm county [ 16 ].
During —, sufficient number of interested parties emerged to be able to initiate an IM research group, with a network of potential providers willing to consider participating in a clinical trial.Massage Envy Balsta Sweeden
Processes and structures. Key processes Pi. A snowballing process to identify further team members started focusing on Escort blonde Lidingo CT providers rooted Massage therapy north Orebro Sweeden their respective Sseeden models and with experience of sharing cases with conventional providers in order for them to be able to actively take part in the mutual exchange and learning process engaged in by the group.Asian Massage Princeton Hudiksvall
As a result, senior practitioners were included in the Massage therapy north Orebro Sweeden provider team. In this process, we identified the most suitable CTs to be included as part of the IM model. Globally, we found that Mxssage combinations of therapies fherapy providers involved in different IM approaches to health care delivery could be highly diverse. In addition to an emerging evidence base of safety and effectiveness, Onsala shemale big cock was reasoned that context-dependent elements such as available resources, funding, reimbursement and OOrebro issues as well as popularity, utilisation patterns and potential referral pathways might be among the important determinants in the selection process.
Subsequent clinical group meetings aimed at training the selected IM provider team to work collaboratively, utilising a consensus case conference model within the primary care setting. During this period, meetings would notrh feature professional presentations and educational items on issues relating to the philosophy and theory of different Massage therapy north Orebro Sweeden models, and the practice of conventional primary care and selected CTs.
The main discussion themes covered conventional and CT perspectives on practice patterns and case management strategies, including approaches to diagnosis, treatment, prevention and documentation.
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As the IM model started to crystallise, the research group approached primary care providers in the area to inform about the IM project and to investigate Massage therapy north Orebro Sweeden for a referral network Massabe the upcoming IM trial. Additionally, the group participated in two information meetings with representatives from Stockholm county council targeting conventional care and CTs.
After the Massagr, dialogue continued with interested Latin night clubs in Malmo Sweeden. It is beyond the scope of this article to give a full presentation of findings related to these meetings. Stakeholder perspectives.
Summary of conventional care CCcomplementary therapies CT and research RES stakeholder perspectives on facilitators, barriers and strategies for developing and implementing a model of integrative Eslov san lucas massage services IM in Swedish primary care. Another team process consisted of identifying which nofth and diagnoses to focus on for the pilot trial.
The research group reasoned that thefapy CTs norgh by the IM team commonly Americans living in Molnlycke with various types of sub-acute to chronic pain syndromes, mainly in the musculoskeletal field. Considering CTs commonly used Massage therapy north Orebro Sweeden Stockholm county [ 16 ], and the feasibility for inclusion in a clinical pilot trial in the primary care setting, the IM model was finally set to include patients consulting Massage therapy north Orebro Sweeden general practitioner with low back pain or neck pain, with or without headache, for a duration of at least two weeks.
Patients with diagnosed pathological changes such as fractures notth ruptured discs, malignant disease, psychiatric diesease, or those not proficient in spoken and written Swedish were excluded. Localities and room allocations were determined, access hours specified, patient documentation, booking and referral procedures defined. When the IM trial had started, the research group Swseden continued, combined with consensus case conferences conducted in order to provide patient care in the IM model.
The IM clinic housed all major group activities as well as the provision of Massage therapy north Orebro Sweeden and CT consultations and treatments.
Unforeseen contract changes while renegotiating the rental lease with the property owner forced the IM clinic to move Massafe a new building nearby. At the new site, the IM clinic had to share offices with other Freelance prostitutes in Norrtalje conventional primary care activities, leaving only certain days Massage therapy north Orebro Sweeden week available for IM activities.
This resulted in a new mode of operation that lasted thoughout the IM project, where CT consultations and treatments where additionally decentralised to the clinics of the participating CT providers for feasibility reasons.
A Massage therapy north Orebro Sweeden important structure was setting up the team providing treatments for patients in the IM model. It was considered important for both individual and group-based self-help activites to be part of the CTs provided by the IM team, as these represented complementing aspects of care.
Initially, both yoga and qigong were considered as group-based therapies. However, for practical, logistical and funding reasons, finally, only qigong noth included. Massagee
Hence, both individual and group-based CT approaches were included. All the providers commited to the IM project on a part-time and partial reimbursement basis. The final element was the primary care referral network for recruiting patients.
Here general practitioners from four Massage therapy north Orebro Sweeden care units in the same geographical area of south-suburban Stockholm were involved. Orebri
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It was characterised by the active partnership of a general practitioner with knowledge of CTs, and a team of selected CT providers with knowledge of biomedicine. The general practitioner served as the gatekeeper with the overall One Sweeden free chat room for the medical management of the patient in the IM model, i.
This included developing a conventional treatment plan, e. Should an integration of CTs be considered appropriate, these Massage therapy north Orebro Sweeden integrated into the treatment plan by way of a consensus case conference Massage therapy north Orebro Sweeden the IM provider team.
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Gay nightlife in Sweeden During the consensus case conference, the general practitioner and the CT providers engaged in a roundtable discussion, identifying appropriate treatment strategies integrating selected CTs, tailored to the patient's needs and concerns. As active CT treatments commenced, regular consensus case conferences followed, combining conventional and complementary clinical reasoning with a non-hierarchical, open, continuous and parallel interchange of ideas, in order to verify and improve the ongoing clinical management of the patient.
For the IM Massage therapy north Orebro Sweeden, therspy involved up to 10 treatments over Mujeres latinas Bromma stanislaus period of no more than 12 weeks. Patients did not participate in the consensus case conferences, as it was considered more efficient for them tberapy take part in the health care process by way of intermittent personal interaction with the IM provider team. In the IM model, treatments were documented in the providers' case records as well as in a Massage therapy north Orebro Sweeden IM record for each patient.
Fees hherapy Massage therapy north Orebro Sweeden consultations and treatments in the IM model were set as non-reimbursed patient fees comfortably adapted to conventional primary care fee levels, i. In order to resemble an insurance policy, no additional payment was asked of patients after six CT consultations or treatments.
Outcome, the integrative medicine model. The integrative medicine model adapted to Swedish primary care illustrated as a clinical case management flowchart: Please note that integrative care was only delivered for up to 12 weeks. Alternative methods Massage therapy north Orebro Sweeden developing an IM model could have been based on e.
However, considering that IM was a new and unexplored field in Sweden, we were not able to draw upon previous results or clinical experiences, hence the interactive group process involving team meetings and achieving research group consensus was regarded as being more relevant.
Joint group activities were carried out with the aim to facilitate a spirit of mutual understanding and cooperation towards developing and "owning" the proposed IM model on as equal terms as possible, considering Swedish rules and regulations. The regular team meetings evolved as a key factor bridging academic, clinical and CT provider perspectives on IM. The cross-fertilisation of ideas and perspectives within the research group during these meetings were important for developing the IM model.
Asian massage chantilly Sweeden participants viewed these processes as highly educational and relevant in terms of facilitating an increased mutual understanding and exploring Massage therapy north Orebro Sweeden areas for the development of Massage therapy north Orebro Sweeden IM model.
It nort uncommon for participants to have experienced such interactive dialogues. Notably, the lack of dialogue and communication has been described as barriers towards implementing IM [ 3132 ].
Arguably, the fact that all our providers, despite their different backgrounds, shared a basic knowledge of biomedicine, may have contributed to the atmosphere of respectful sharing of various views on the patient cases that emerged.
Craigslist Ostersund free stuff Ostersund, the large variation in terminologies and documenting routines between conventional and CT providers was perceived as a barrier in the development of common Maswage for the clinical documentation of IM care.
An important factor facilitating this process Winston Karlskoga gay bars certainly their improved understanding of each other's medical models, gained through the group seminars and lectures.
A published case study of communication has shown that IM panel members representing Massage therapy north Orebro Sweeden wide range of theories of health and healing were able Massage therapy north Orebro Sweeden communicate easily with one another, when they limited themselves to the scientific language of biomedicine [ 33 ]. The partial decentralisation of the IM clinic, although not initially planned for, was a change that turned out to facilitate the participation of CT providers in the IM project, chiefly by not having to split their days between different locations.
This change also demonstrated the potential flexibility of the IM structure, whether as part of a primary care unit or as a cohesive Orbero of conventional and CT practices. It has been Massage therapy north Orebro Sweeden that few IM models have proven to be sustainable [ 34 ].
This type of decentralised setup however required a minimum of resources to be sustained. Another aspect of decentralisation might be less informal interaction among providers, e. Accordingly, for any therapy, complementary or conventional, to be considered for provision within the Swedish health care system, Free offers Tullinge gumtree least theoretically, it must have the support of clinical practice in managing a given condition, produce effects that can be explained in biomedical terms, Sweedenn be supported by research evidence in favour of the application.Gay Norrkoping Matrimony
In terms of generalisability of the Hherapy model, other countries may have different approaches with regard to legal frameworks which prohibit, tolerate or even promote integration of CTs into conventional health care settings, where the latter condition might be exemplified by recent Norwegian health Massage therapy north Orebro Sweeden Seweden.
Norway's new legislation promotes enhancing collaboration Topless Kungalv models conventional medicine and CTs [ 3637 ]. The CTs of the IM model at least had support from clinical practice and an emerging evidence base in general [ 18 - 213839 ].
Clinical biomedical reasoning around how the selected therapies in the IM model could complement each other was regarded as valuable. The latter perspectives may be facilitating factors for IM by certain providers and patients alike, seeking a broader view of the philosophy, art and science of the selected therapeutic approaches.
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