From parallel practice to integrative health care: a conceptual framework

Seven different models of team-oriented health care practice are illustrated in this paper: parallel, consultative, collaborative, coordinated, multidisciplinary, interdisciplinary and integrative. Each of these models occupies a position along the proposed continuum from the non-integrative to fully integrative approach they take to patient care. The framework is developed around four key components of integrative health care practice: philosophy/values; structure, process and outcomes.This framework can be used by patients and health care practitioners to determine what styles of practice meet their needs and by policy makers, healthcare managers and researchers to document the evolution of team practices over time. This framework may also facilitate exploration of the relationship between different practice models and health outcomes.The stimulus for this paper was a recent international workshop [1] designed to clarify and define the concept of integrative health care as it applies to the combination of complementary/alternative medicine (CAM) and conventional health care. A literature review conducted for a pre-workshop background paper highlighted the diversity of thinking about integrative health care and identified that existing definitions tend to be idealistic in nature, view integrative health care as a finite outcome and as a predetermined outcome [2]. The workshop participants, however, described their own attempts at integrating CAM and conventional medicine as a developmental process along a continuum, anchored by their goal of fully integrated health care. Although the idea that a continuum of team-oriented health care practice models exists is not new, [3-5] participants suggested that if further developed, it might provide an important framework for differentiating the concept of integrative health care from other models of team-oriented health care practice. The primary objective of this paper is to develop a conceptual framework for describing, c