Outcomes research in integrative health care clinics: What are the barriers?

Background Integrative health care (IHC) is an interdisciplinary blending of conventional medicine and complementary and alternative medicine with the purpose of enhancing patients’ health. Various models of IHC clinics have been developed and several studies have aimed to evaluate the outcomes of these approaches. However, outcomes assessment in IHC clinics is challenging. The type of outcome measures used to date tend to be disease oriented and do not capture the patient's lived experience, consider self-identified health goals of patients or fully reflect the IHC philosophy of care. The diversity of measures used in IHC outcomes research makes comparisons across studies difficult. To address these issues, a package of patient-centered outcome measures was designed that reflected the holistic and individualized nature of IHC care. We aimed to test the appropriateness and applicability of this package within IHC clinic settings. However, major challenges arose in conducting this study which prompted the team to hypothesize that a lack of research orientation within the clinics was a fundamental barrier impeding the conduct of outcomes research. This issue was significant enough that the team felt it warranted further investigation. A second phase of the study was developed to explore the barriers in conducting outcomes research in IHC clinics and identify strategies for implementation of successful in-house outcomes research programs. Methods Given the exploratory nature of the proposed question, a qualitative descriptive research design was followed. Twenty-five in-depth, semi-structured interviews were conducted with key participants from 19 IHC clinics across Canada. Basic content analysis was used to identify key themes from the transcribed interviews. Results Barriers identified by participants fell into four main categories: organizational culture, organizational resources, organizational environment, and logistical challenges. Strategies for successful implementation of outcomes research activities emerging from participant interviews were: (1) embedding research values within the organizational mandate, (2) creation of a viable research infrastructure, and (3) integrating research activities and clinical workload into a seamless flow. Conclusion Assessing and enhancing the research culture within IHC clinics is an important consideration and initial step which needs to be taken for the implementation of productive and cost-effective research programs.