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Special Article
January 28, 2002

Integrative Medicine and Systemic Outcomes Research: Issues in the Emergence of a New Model for Primary Health Care

Author Affiliations

From the Program in Integrative Medicine, Departments of Medicine (Drs Bell, Caspi, Schwartz, Grant, Gaudet, Rychener, Maizes, and Weil), Psychiatry (Drs Bell and Schwartz), Psychology (Drs Bell, Caspi, and Schwartz), Neurology (Dr Schwartz), Family & Community Medicine (Drs Bell and Weil), Obstetrics and Gynecology (Dr Gaudet), and Pharmacy Practice (Dr Grant), The University of Arizona Colleges of Medicine and Pharmacy, and the Southern Arizona Veterans Affairs Health Care System (Dr Bell), Tucson. Dr Gaudet is now with Duke University Center for Integrative Medicine, Durham, NC.

Arch Intern Med. 2002;162(2):133-140. doi:10.1001/archinte.162.2.133

Clinicians and researchers are increasingly using the term integrative medicine to refer to the merging of complementary and alternative medicine (CAM) with conventional biomedicine. However, combination medicine (CAM added to conventional) is not integrative. Integrative medicine represents a higher-order system of systems of care that emphasizes wellness and healing of the entire person (bio-psycho-socio-spiritual dimensions) as primary goals, drawing on both conventional and CAM approaches in the context of a supportive and effective physician-patient relationship. Using the context of integrative medicine, this article outlines the relevance of complex systems theory as an approach to health outcomes research. In this view, health is an emergent property of the person as a complex living system. Within this conceptualization, the whole may exhibit properties that its separate parts do not possess. Thus, unlike biomedical research that typically examines parts of health care and parts of the individual, one at a time, but not the complete system, integrative outcomes research advocates the study of the whole. The whole system includes the patient-provider relationship, multiple conventional and CAM treatments, and the philosophical context of care as the intervention. The systemic outcomes encompass the simultaneous, interactive changes within the whole person.