Working at the coalface: Using action research to study 'integrative medicine' in the NHS

Aim of the study: This research considered the clinical and organisational issues for integrative medicine from the multiple viewpoints of its primary stakeholders: GPs, Clinics, Patients and the CAM therapist, studying the interface between complementary and orthodox practitioners working together. Methodology: Two National Health Service (NHS) primary care clinics were recruited and remedial massage therapy was made available to patients referred by their GPs. Action research methods then provided opportunities to study the working relationships through reflexive, inter-professional problem solving in clinic situations. Data collection included questionnaires, recorded interviews and meetings, case notes, field notes, reflexive journals, pictures, emails and letters. Results: The reflexive cycles of action research identified practical problems and collaborative solutions within the clinic. Data highlighted aspects of IM relationships, for example clinical decision-making, organisational effects, inter-professional dynamics, and patient input. Whilst outcomes included improved patient satisfaction and enhanced GP-patient relationships, cycles of learning also suggested overarching barriers, particularly noting the mainly unstructured, 'ad hoc' relationships between CAM and orthodox professionals, and the lack of opportunities for meaningful inter-professional dialogue. Discussion and conclusions: This research contributes an experiential perspective to the field of integrative medicine through action research, a collaborative and participative approach to investigate the complexities of best practice. Data indicate that CAM providers need to upgrade their dialogue with NHS practitioners and policy-makers and to negotiate structures that support IM within the NHS. Without the underpinning of more 'structure' and 'dialogue', working models of IM can be unstable and lacking in accountability. (C) 2012 Elsevier GmbH. All rights reserved.