Complementary Therapies & Public-Health Indicators Lecture

Complementary and Alternative Medicine (CAM)

CAM = Complementary and/or Alternative Medicine
- Complementary → used with conventional care.
- Alternative → used instead of conventional care.
Biofeedback
- Machine monitors physiologic data (e.g., muscle tension, skin temp, brain waves).
- Goal: teach pt. to modify body responses → ↓ pain, ↓ inflammation, ↑ circulation.
TENS (Trans-cutaneous Electrical Nerve Stimulation)
- Electrodes deliver small current to muscle/nerve.
- Expected effects: analgesia, muscle relaxation, autonomic “biofeedback” that jump-starts recovery.
Reiki
- Practitioner channels/“transfers” energy through hands (light or no-touch).
- Sensations reported: warmth, tingling, relaxation.
Other routinely mentioned therapies
- Music, aroma, pet, massage, therapeutic touch, reflexology, acupuncture.
- All aim to create “a break” from medical procedures and decrease stress/anxiety.

Assess
- Ask: Which CAM? Complementary vs. alternative? Dosage/frequency? Source/licensure?
- Review concurrent meds, diets, cultural or spiritual relevance.
Analyze
- Safe? Evidence-based? Could it be causing current symptoms? Any med–herb or diet–drug interactions?
- Common NCLEX highlights:
- \text{Ginkgo biloba}, \text{Ginseng}, etc. with anticoagulants.
- Grapefruit juice interactions (CYP-450 inhibitor).
Intervene / Educate
- Licensed practitioners only (esp. acupuncture).
- Proper technique, dosing, potential side-effects.
- Emphasize integration, not replacement, unless HCP approves.
Evaluate & Document
- Effectiveness, adverse effects, pt. satisfaction, need for referral.

Federal initiative of the Office of Disease Prevention & Health Promotion (ODPHP); first launched 1979.
Updated every 10 yrs; identifies what is killing or harming the U.S. population most.
Website provides data dashboards, baselines, targets, and progress status.

Core measurable objectives (CMOs) → 359 with baseline + target + evidence-based interventions.
Research objectives → monitored, no specific targets yet.
Leading Health Indicators (LHIs)
- Sub-set of CMOs, marked with a star ★.
- Represent highest-priority, high-impact, preventable drivers of morbidity/mortality.

RUA assignment: choose a POPULATION × LHI combo (must show ★) and analyze social determinants (SDOH).
Track whether each objective is: “Target met/exceeded,” “Improving,” “Little/no change,” or “Worsening.”

Root drivers: childhood trauma, IPV, financial stress, marital issues.
Evidence-based strategies
- Education (DARE, school curricula, trauma-informed care).
- OTC naloxone (Narcan) distribution programs.
- Accessible, evidence-based treatment (MAT, counseling).
- Routine, non-judgmental screening in all health-care encounters.

Risks: ↑ TB, eye dz, \text{DM2}, autoimmune disorders, rheumatoid arthritis, systemic vascular damage.
Interventions: nicotine patches/gum, pharmacotherapy (bupropion, varenicline), counseling, public policy (age limits, taxation).

Definitions
- Food insecurity → inconsistent access to enough nutritious food.
- Food desert → geographic area with scarce affordable, healthy options.
SDOH links: poverty, medical debt, low education, poor transit.
Programs & resources
- SNAP (food stamps), WIC (women/infants/children), Meals on Wheels, produce-rescue co-ops.
- Nutrition education → MyPlate (post-food-pyramid visual guide).
- Community gardens, mobile markets.

Goal: increase quality, reduce cost.
Bundled payments = one payment for a full episode of care.
Reimbursement tied to:
- Readmission rates
- Hospital-acquired infections/pressure injuries
- Patient satisfaction surveys (quietness, explanations, white-board use, etc.).

Reduce incidental overtime (clock-in/clock-out vigilance).
Supply stewardship: bring only what is needed into rooms/OR → ↓ waste, ↓ landfill, ↓ cost.
Shift non-emergent care to urgent-care/PCP/outpatient PT before surgical referral.

Honor cultural CAM preferences while ensuring safety & evidence.
Ensure CAM providers are licensed; avoid “back-alley” services.
Educate without judgment; build trust to elicit full disclosure (legal, illegal substances).
Systems approach: social programs (SNAP, Narcan access) complement bedside nursing.