Naturopaths in Ontario, Canada: geographic patterns in intermediately-sized metropolitan areas and integration implications

Stephen P. Meyer

doi:10.1515/jcim-2015-0092

Article

Naturopaths in Ontario, Canada: geographic patterns in intermediately-sized metropolitan areas and integration implications

Stephen P. Meyer

Published/Copyright: February 14, 2017

Published by

Become an author with De Gruyter Brill

Submit Manuscript Author Information Explore this Subject

From the journal Journal of Complementary and Integrative Medicine Volume 14 Issue 1

Abstract

Evaluating conventional medicine (CM) and complementary and alternative medicine (CAM) with respect to integration opportunities (such as patient referrals and professional knowledge sharing) and possible geographic implications is novel. This research utilizes nearest neighbour and local spatial autocorrelation statistical analyses and surveys directed towards Doctors of Naturopathic Medicine (NDs) and their patients to better understand the geographic patterns of NDs and potential integration qualities. While the statistical tests reveal that the offices of NDs and Doctors of Medicine (MDs) display clustered patterns in intermediately-sized census metropolitan areas in Ontario and that the majority of NDs are near MDs, proximity is not manifesting in discernible integration tendencies between NDs and MDs. The NDs polled were strongly in favour of greater integration with the CM sector (as were their patients) to: achieve better patient health outcomes and to gain efficiencies within the health care system. Yet, both surveys also indicate that the barriers to integration are substantial and, generally speaking, centre on the perception that many MDs lack respect for, and/or knowledge about, naturopathic approaches. It is speculated that as students in conventional medical schools are increasingly exposed to CAM approaches, perhaps more MDs in the future will be receptive to greater integration with CAM. Should this occur, then it is also possible that geographic proximity may be a catalyst for deeper CAM-CM integration; as it has been for CAM–CAM relationships.

Keywords: complementary and alternative medicine (CAM); geographic information systems (GIS); health care integration; naturopaths; spatial analysis

Acknowledgments

The author would like to thank Anita Kieswetter, BSc, ND; Sarah Goulding, BSc, ND; John Bender, BSc, ND; Allan Price, BSc, ND; and Peter Jebreen, BSc, MA, ND for allowing questionnaires to be filled out in their office space. I would also like to thank all of the personnel at Nickel Ridge Health Centre, Pure Wellness, Health Coach and Waterloo Naturopathic Clinic for their help with the patient-centred questionnaires and NDs throughout Ontario who participated in the survey.

Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: Jawhar Laamech was supported in his PhD thesis project by grants of excellence from Moroccan Ministry of Education and Scientific Research.
Employment or leadership: None declared.
Honorarium: None declared.
Competing: interests The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

References

1. Willms L, Pierre-Hansen N. Blending in: is integrative medicine the future of family medicine? Can Fam Physician 2008;54:1085–1087.Search in Google Scholar

2. Hunter J, Leeder S. Patient questionnaires for use in the integrative primary care setting – a systematic literature review. Eur J Integr Med 2013;5:194–216.10.1016/j.eujim.2013.02.002Search in Google Scholar

3. Sundberg T, Hok J, Finer D, Arman M, Swartz J, Falkenberg T. Evidence-informed integrative care systems – the way forward. Eur J Integr Med 2014;6:12–20.10.1016/j.eujim.2013.09.005Search in Google Scholar

4. Pelletier KR, Herman PM, Metz RD, Nelson CF. Health and medical economics applied to integrative medicine. Explore 2010;6:86–99.10.1016/j.explore.2009.12.009Search in Google Scholar PubMed

5. McEwen S. Social work in health care when conventional meets complementary: nonspecific back pain and massage therapy. Health Soc Work 2015;40:19–25.10.1093/hsw/hlu041Search in Google Scholar PubMed

6. Welch P, Thomas C, Bingley A. Working at the coalface: using action research to study ‘integrative medicine’ in the NHS. Eur J Integr Med 2013;5:75–82.10.1016/j.eujim.2012.08.004Search in Google Scholar

7. Owens K. Boundary objects in complementary and alternative medicine: acupuncture vs. Christian science. Soc Sci Med 2015;128:18–24.10.1016/j.socscimed.2014.12.020Search in Google Scholar PubMed

8. Bellavite P. Homeopathy and integrative medicine: keeping an open mind. J Med Person 2015;13:1–6.10.1007/s12682-014-0198-xSearch in Google Scholar PubMed PubMed Central

9. Ben-Arye E, Frenkel M, Klein A, Scharf M. Attitudes toward integration of complementary and alternative medicine in primary care: perspectives of patients, physicians and complementary practitioners. Patient Educ Couns 2008;70:395–402.10.1016/j.pec.2007.11.019Search in Google Scholar PubMed

10. Sharf BF, Martin PG, Cosgriff-Hernández KK, Moore J. Trailblazing healthcare: institutionalizing and integrating complementary medicine. Patient Educ Couns 2012;89:434–438.10.1016/j.pec.2012.03.006Search in Google Scholar PubMed

11. Canadian Association of Naturopathic Doctors. Naturopathic Medicine in Canada 2010;Available at: https://www.cand.ca/fileadmin/cand/CP_program_and_publications/NMC_2010.pdf.Search in Google Scholar

12. Meyer SP. The spatial pattern of complementary and alternative medical offices across Ontario and within intermediate-sized metropolitan areas. Urban Geogr 2008;29:662–682.10.2747/0272-3638.29.7.662Search in Google Scholar

13. Verheij RA, De Bakker DH, Groenewgen PP. Is there a geography of alternative medical treatment in The Netherlands? Health Place 1999;5:83–97.10.1016/S1353-8292(98)00043-4Search in Google Scholar

14. Williams AM. The diffusion of alternative health care: a Canadian case study of chiropractic and naturopathic practices. Can Geogr 2000;44:152–166.10.1111/j.1541-0064.2000.tb00699.xSearch in Google Scholar

15. Smith M, Carber L. Chiropractic health care in health professional shortage areas in the United States. Am J Public Health 2002;92:2001–2009.10.2105/AJPH.92.12.2001Search in Google Scholar PubMed PubMed Central

16. Albert DP, Butar FB. Distribution, concentration and health care implications of naturopathic physicians in the United States. Complement Health Pract Rev 2004;9:103–117.10.1177/1076167503252944Search in Google Scholar

17. Arcury TA, Gesler WM, Preisser JS, Sherman J, Spencer J, Perin J. The effect of geography and spatial behavior on health care utilization among residents of a rural region. Health Serv Res 2005;40:135–155.10.1111/j.1475-6773.2005.00346.xSearch in Google Scholar PubMed PubMed Central

18. Waalen JK. Practice patterns of 692 Ontario chiropractors (2000–2001. J Can Chiropr Assoc 2005;49:21–31.Search in Google Scholar

19. Albert D. New York and Colorado as critical states in the diffusion of state licensing of naturopathic physicians. Complement Health Pract Rev 2009;14:59–69.10.1177/1533210109337002Search in Google Scholar

20. Bormann JE. Predictors of complementary/alternative medicine use and intensity of use among men with HIV infection from two geographic areas in the United States. J Assoc Nurses AIDS Care 2009;20:468–480.10.1016/j.jana.2009.03.008Search in Google Scholar PubMed

21. Hollenberg D, Lytle M, Walji R, Cooley K. Addressing provider shortage in underserviced areas: the role of traditional, complementary and alternative medicine (TCAM) providers in Canadian rural healthcare. Eur J Integr Med 2013;5:15–26.10.1016/j.eujim.2012.08.008Search in Google Scholar

22. Wardle J, Adams J, Magalhaes RJ, Sibbritt D. Distribution of complementary and alternative medicine (CAM) providers in rural New South Wales, Australia: a step towards explaining high CAM use in rural health? Aust J Rural Health 2011;19:197–204.10.1111/j.1440-1584.2011.01200.xSearch in Google Scholar PubMed

23. Meyer SP. A geographic assessment of ‘total’ health care supply in Ontario: complementary and alternative medicine and conventional medicine. Can Geogr 2010;54:104–122.10.1111/j.1541-0064.2009.00285.xSearch in Google Scholar

24. Meyer SP. A spatial analysis of acupuncture practitioners in Ontario, Canada: assessing regional and intra-metropolitan trends. Saad M, editors. Acupuncture: concepts and physiology. Rijeka: InTech, 2011:189–206.Search in Google Scholar

25. Meyer SP. Comparing spatial accessibility to conventional medicine and complementary and alternative medicine in Ontario, Canada. Health Place 2012;18:305–314.10.1016/j.healthplace.2011.10.005Search in Google Scholar PubMed

26. Meyer SP. Place-specific explanations for the geographic patterns of complementary and alternative practitioners: contrasting chiropractic, massage, holistic, acupuncture, naturopathic and homeopathic operations in Ontario. Int J Bus Soc Sci 2012;3:24–39.Search in Google Scholar

27. Meyer SP. Evaluating the geography and the visibility tendencies of acupuncture treatment locations in metropolitan Toronto. Chen LL, Cheng TO, editors. Acupuncture in modern medicine. Rijeka: InTech, 2013:371–389.Search in Google Scholar

28. Slocum-Gori S, Howard AF, Balneaves LG, Kazanjian A. Investigating the perceived feasibility of integrative medicine in a conventional oncology setting: yoga therapy as a treatment for breast cancer survivors. Integr Cancer Ther 2012;12:103–112.10.1177/1534735412443851Search in Google Scholar PubMed PubMed Central

29. Hollenberg DB, Tsasis P, Kelley N. CAM in Canadian hospitals: the new frontier? J Complement Integr Med 2011;8:1–20.10.2202/1553-3840.1466Search in Google Scholar PubMed

30. Garner MJ, Birmingham M, Aker P, Moher D, Balon J, Keenan D. Developing integrative healthcare delivery: adding a chiropractor to the team. Explore 2008;4:18–24.10.1016/j.explore.2007.10.003Search in Google Scholar PubMed

31. Kakai H. A community of healing: psychosocial functions of integrative medicine perceived by oncology patients/survivors, healthcare professionals, and CAM providers. Explore 2013;9:365–371.10.1016/j.explore.2013.08.002Search in Google Scholar PubMed

32. Cohen E, Cambron J, Shiel R. Measuring the development of integrative care communication patterns and cross-disciplinary knowledge at a university clinic: a baseline cross-sectional study. J Manipulative Physiol Ther 2009;32:758–764.10.1016/j.jmpt.2009.10.008Search in Google Scholar PubMed

33. Van Hyfte G, Kozak LE, Lepore M. A survey of the use of complementary and alternative medicine in Illinois hospice and palliative care organizations. Am J Hosp Palliat Me 2014;3:553–561.10.1177/1049909113500378Search in Google Scholar PubMed

34. Wolever RQ, Caldwell KL, Wakefield JP, Little KJ, Gresko J, Shaw A. Integrative health coaching: an organizational case study. Explore 2011;7:30–36.10.1016/j.explore.2010.10.003Search in Google Scholar PubMed

35. Lebensohn P, Dodds S, Brooks AJ, Cook P, Guerrera M, Sierpina V. Increasing resident recruitment into family medicine: effect of a unique curriculum in integrative medicine. Explore 2014;10:187–192.10.1016/j.explore.2014.02.001Search in Google Scholar PubMed

36. Pierantozzi AM, Steel A, Seleem M. Integrating complementary and alternative medicine into medical intern teaching: preliminary findings from an Australian hospital. Complement Ther Clin Pract 2013;19:237–242.10.1016/j.ctcp.2013.06.002Search in Google Scholar PubMed

37. Wilkinson JM, Stevens MJ. Use of complementary and alternative medical therapies (CAM) by patients attending a regional comprehensive cancer centre. J Complement Integr Med 2014;11:139–145.10.1515/jcim-2013-0048Search in Google Scholar PubMed

38. Shuval JT, Mizrachi N. Changing boundaries: modes of coexistence of alternative and biomedicine. Qual Health Res 2004;14:675–690.10.1177/1049732304263726Search in Google Scholar PubMed

39. Ben-Arye E, Hamadeh AM, Schiff E, Jamous RM, Dagash J, Jamous RM. Compared perspectives of Arab patients in Palestine and Israel on the role of complementary medicine in cancer care. J Pain Symptom Manage 2015;49:878–884.10.1016/j.jpainsymman.2014.10.006Search in Google Scholar PubMed

40. Keshet Y. Dual embedded agency: physicians implement integrative medicine in health care organizations. Health 2013;17:605–621.10.1177/1363459312472084Search in Google Scholar PubMed

41. Wardle JL, Sibbritt DW, Adams J. Referral to massage therapy in primary health care: a survey of medical general practitioners in rural and regional New South Wales, Australia. J Manipulative Physiol Ther 2013;36:595–603.10.1016/j.jmpt.2013.09.003Search in Google Scholar PubMed

42. Wardle JL, Sibbritt DW, Adams J. The interface with naturopathy in rural primary health care: a survey of referral practices of general practitioners in rural and regional New South Wales, Australia. BMC Complement Altern Med 2014;14:238–246.10.1186/1472-6882-14-238Search in Google Scholar PubMed PubMed Central

43. Lee RT, Hlubocky FJ, Hu JJ, Stafford RS, Daugherty CK. An international pilot study of oncology physician’s opinions and practices on complementary and alternative medicine (CAM. Integr Cancer Ther 2008;7:70–75.10.1177/1534735408319059Search in Google Scholar PubMed

44. InfoCanada. Canadian business directory. Mississauga: InfoCanada, 2014.Search in Google Scholar

45. Statistics Canada. Boundary files, reference guide, first edition, 2011 census. Statistics Canada cat no 92-160-G. Available at: http://www12.statcan.gc.ca/census-recensement/2011/geo/index-eng.cfm.Search in Google Scholar

46. Statistics Canada. Road network file, 2011 census. Statistics Canada cat no 92-500-X. Available at: http://www12.statcan.gc.ca/census-recensement/2011/geo/index-eng.cfm.Search in Google Scholar

47. Ebdon D. Statistics in geography, 2nd ed. Cambridge: Basil Blackwell, 1987:232.Search in Google Scholar

48. ESRI. ArcGIS version 10.1. Redlands: Environmental Systems Research Institute, 2012.Search in Google Scholar

49. Meyer SP, Kieswetter A. Naturopathic doctor offices in Ontario, Canada: the relevance of visible locations and patient proximity. Cherniack EP, Holmes T, editors. Alternative medicine: perceptions, uses and benefits and clinical implications. New York: Nova, 2016:51–75.Search in Google Scholar

50. Jepson NRR, Ritchie K. Methods of synthesizing qualitative research studies for health technology assessment. Int J Technol Assess Health Care 2011;27:384–390.10.1017/S0266462311000389Search in Google Scholar PubMed

51. Sandelowski M, Barroso J. The travesty of choosing after positive prenatal diagnosis. J Obstet Gynecol Neonatal Nurs 2005;34:307–318.10.1177/0884217505276291Search in Google Scholar PubMed

52. Williams AL. Perspectives on spirituality at the end of life: a meta-summary. Palliat Support Care 2006;4:407–417.10.1017/S1478951506060500Search in Google Scholar

53. Statistics Canada. Geosuite: 2011 census. Statistics Canada cat no 92-150-XBB. Available at: http://www12.statcan.gc.ca/census-recensement/2011/geo/ref/geosuite-eng.cfm.Search in Google Scholar

54. Sargeant J, Loney E, Murphy G. Effective interprofessional teams: contact is not enough to build a team. J Contin Educ Health Prof 2008;28:228–234.10.1002/chp.189Search in Google Scholar PubMed

55. Oandasan IF, Gotlib-Conn L, Lingard L, Karim A, Jakubovicz D, Whitehead C. The impact of space and time on interprofessional teamwork in Canadian primary health care settings: implications for health care reform. Prim Health Care Res Dev 2009;19:151–162.10.1017/S1463423609001091Search in Google Scholar

Received: 2015-10-14

Accepted: 2016-9-8

Published Online: 2017-2-14

You are currently not able to access this content.

Articles in the same Issue

https://doi.org/10.1515/jcim-2015-0092

Keywords for this article

complementary and alternative medicine (CAM); geographic information systems (GIS); health care integration; naturopaths; spatial analysis