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Balens 2017 CPD EventBuilding Healthcare Networks
in your Local Community
Robert Verkerk PhDFounder & Executive Director, Alliance for
Natural Health International
Rob Verkerk BSc MSc DIC PhD FACN
Alliance for Natural Health International
www.anhinternational.org
ANHInternational
@anhcampaign@VerkerkRob
*
Building healthcare networks in your local community -Hawthorn Health Initiative
Who’s the flat earther?
CAM practitioner?
Skeptic?
Status of evidence
Conclusive evidencetherapy works (cause and effect demonstrated)
Conclusive evidencetherapy does not work (cause and effect not demonstrated)?
Crisis = time of opportunity & change
Negative Positive
Change ahoy…
Three Horizons
International Futures Forumwww.internationalfuturesforum.com
BAU – is it working?
Individual Community
The challenge…
EVIDENCE!
But what do we want to inform:
• Evidence-based Medicine?• Evidence based practice (EBP)?• Practice based evidence (PBE)?• Effective healthcare?• Effective for specific health problems?• Improved outcomes compared with standard treatment?
The EBM hierarchy
Six biases against patient and carers in EBM
RCT vs TRW
RCT• Single/double-blind• Randomised + control• Mean effects• Eliminates P-T and
social relationships • Eliminates Hawthorne
effect• Outliers ignored• Biases (Greenhalgh et
al, 2015)= MEASUREMENT OF EFFICACY OF THERAPEUTIC INTERVENTION
TRW• Self-selected
population• No control population• P-T effect• Hawthorne Effect • Self-care incl
diet/lifestyle, physical activity, restoration
• Includes concomitant treatments
• Patient experienceDIFFICULT TO MEASURE= SYSTEM OF HEALTHCARE
What are we most interested in?
Adapted from slide presented by Edzard Ernst at CAMexpo 2007
Patient experience
Specific therapeutic effect vs total effect?
What determines outcomes?
Time with practitioner
Time without practitioner
Average vs best practitioner effect
Health status: multi-factorial
How much influence does a CAM intervention have, compared with choices made as part of our self-care routines?
HHI: Getting started
1 2
HAWTHORN HEALTH INITIATIVEForum Event 2017
HAWTHORN HEALTH INITIATIVEForum Event 2017
New Website ~ Community & Membership, Research & Resources, News & Viewswww.HawthornHI.org
Research ~ Pilot Questionnaire for Therapists
“Not everything that can be counted counts, and not everything that counts can be counted..” - Albert Einstein…
Pilot Questionnaire was sent to approximately 300 CPD Attendees – Reponses received from 48. Questionnaire will be revised and sent to Balens Client Base.
HAWTHORN HEALTH INITIATIVEForum Event 2017
14 Massage & Aromatherapy (All forms) 2 Craniosacral Therapy
14 Other therapist / Practitioner 2 Hopi Ear Candles
11 Healing (all forms), Meditation & Mindfulness 2 Kinesiology
11 Manipulative Therapy inc. Osteopathy & Chiropractic 2 Shiatsu
9 Reiki 2 Talking Therapies
7 Acupuncture & Dry Needling 2 Teaching & Supervision
7 Nutrition Therapy 2 Traditional Chinese Medicine
7 Reflexology 2 Yoga & Pilates
6 Neuro Linguistic Programming 1 Bowen Technique
5 Herbal / Flower Medicine 1 Emotional Freedom Technique
4 Acupressure 1 Foot Health Practice
3 Homeopathy 1 EMDR / Iridology
3 Hypnotherapy 1 Music & Sound Therapies
2 Conventional Medicine and Dental 1 Sports Therapy, Personal Training & Fitness
What are your main areas of practise? (please tick main areas apply up to a maximum of 5)
HAWTHORN HEALTH INITIATIVEForum Event 2017
0 10 20 30
A desire to make a…
Aligns with your…
Dissatisfaction with…
Interest in health &…
Natural healthcare…
Why did you decide to become a healthcare practitioner
HAWTHORN HEALTH INITIATIVEForum Event 2017
0
10
20
30
0-15 16-25 25-37.5 37.5–40 Over 50
How many hours a week on average do you normally practise?
HAWTHORN HEALTH INITIATIVEForum Event 2017
0
10
20
30
0–5 6-10 11–20 21–30 40+
How many treatment sessions on average do you do in a week?
HAWTHORN HEALTH INITIATIVEForum Event 2017
86%
8% 4%2%
How many new clients do you typically see in a week?
0–3
4–8
9–15
HAWTHORN HEALTH INITIATIVEForum Event 2017
43%
2%17%
38%
If you have been practising more than three years, are you aware of a change in the number if clients who are approaching you?
No - Remains thesame
Prefer not toanswer
Yes - Decreasing
Yes - Increasing
HAWTHORN HEALTH INITIATIVEForum Event 2017
45
20
14 9
20
1 6
1
Where do your clients normally hear of you from? (multiple answers could be picked)
Recommendation from current or past client /friends and familyRecommendation from other practitioners
Your Organisation or Association
Lecturing / presentations
HAWTHORN HEALTH INITIATIVEForum Event 2017
Recommended by family / friends 38Recommended / referred by their doctor 10They have a chronic illness that is not responding well to conventional medicine 29To complement their conventional medical treatments 21Dissatisfaction with conventional medicine / doctors 26They are taking a greater responsibility for their own personal health needs 26They are following natural lifestyle choices in their healthcare 21They are following the latest health and fitness trends 1They have seen marketing / adverts for a specific treatment 2They have read about a specific treatment, you or your therapy 16
They are responding to the greater public awareness generally of the benefits of natural healthcare9
Social media 5Attended a talk or a lecture 7
Which of the following best describes why you believe your clients choose you?
HAWTHORN HEALTH INITIATIVEForum Event 2017
45
0
10
20
30
40
50 Recommendationfrom current or pastclient / friends andfamily
Recommendationfrom otherpractitioners
Your Organisation orAssociation
142 2
169
Where do your clients normally hear of you from (multiple answers were allowed)
HAWTHORN HEALTH INITIATIVEForum Event 2017
6%
75%
19%
How often do you refer your clients to natural healthcare practitioners / fitness professionals?
Never
SometimesOften
HAWTHORN HEALTH INITIATIVEForum Event 2017
4%
83%
13%
How often do you refer your clients to conventional medical practitioners?
Never
Sometimes
HAWTHORN HEALTH INITIATIVEForum Event 2017
HAWTHORN HEALTH INITIATIVEForum Event 2017
4%17%
46%
33%
How often do you give general lifestyle advice?
Never
Occasionally
Throughout thetherapeutic process
With every client
31%
69%
Would you be interested in a website specifically for Natural Health Professionals that is a hub for sharing, including info on business and research into Natural Medicine, networking opportunities and events?
No
Yes
HAWTHORN HEALTH INITIATIVEForum Event 2017
No23%
Yes49%
Unsure28%
Would you be open to involving your clients in a research project to gain greater understanding into the benefits of visiting a Health & Wellbeing practitioner?
No
Yes
Unsure
HAWTHORN HEALTH INITIATIVEForum Event 2017
HAWTHORN HEALTH INITIATIVEForum Event 2017
Client/patient health tracking and big data research
Data collection and ownership
Data processes
• Quantifiable self data
• Qualified self data
• (Multi-channel data)
• Healthcare choice data
• Data aggregation
• Pattern recognitionMotivationSelf-improvementResearch
Quantifiable self- general trends
1st level of meaning: gratuitous movement data
2nd level of meaning: motivates self-improvement
3rd level of meaning: motivates better decisions about health at point of choice/decision
Collaboration for pilot development
Collecting big [health] data:what do we need?
Patient-centred, patient-owned (non-profit, cooperative structure)
Should be empowering, motivating and increase engagement
Quick and simple
Broad scope
Should not require specialist, high-cost equipment
Multiple systems of electronic data capture
Baseline and ongoing assessments
Characterisation of healthcare system
Cross-cultural / (multiple languages)
International scientific/medical advisory panel
Adaptation of existing/proven systems
Individual’s‘Healthcare
System’
• Practitioner-mediated interventions
• Practitioner-guided self-care
• Other self-care
Proposed ‘big [health] data’ collection system
Baseline assessment
Follow-up/Ongoing assessmentsCharacterisation
of system
Handling bias
Sampling(self-selected)
Data(response)
The Hawthorn project
3 key data channels
• ABOUT ME- Weight, height, waist, hip, chest- Optional: BIA/body comp
• MY HEALTH- Self-reported health status- SF-12 (Physical and Mental Health Composite Scores, PCS & MCS)
• MY HEALTHCARE - About your healthcare professionals- Reasons for visiting a healthcare provider- Attitudes to different types of healthcare- Individual empowerment- Mono- vs multi-therapeutic treatments- Experience- Value for money
About Me
• Coding for anonymity• Algorithm links vital stats to
epidemiological data sets to determine ‘metabolic risk’ category
• 8 body shapes• 4 metabolic risk categories
Body shapes/metabolic risk categories
My health
SF-12
• General health status
• Current physical health
• Physical health over last 4 weeks
• Emotional health/feeling over last 4 weeks
• Physical pain over last 4 weeks
COMPOSITE SCORE = HEALTH STATUS = RESILIENCE
Tracking screens (dev version)
Data ownership/privacy
Establishing big data capture for research and health transformation [1]
Agreement on approaches across a broad range of modalities
Cooperation with patients/clients
Collaboration with international researchers/institutions
Collaboration with associations and practitioners
Pre-trial/pilot: Proof-of-concept
Establish health data cooperative(s)
Funding required for large-scale roll-out
Establishing big data capture for research and health transformation [2]
Electronic data capture e.g. MIDATA, Filemaker (re Dr Peter Davies)
Analysis and communication of findings – via scientific collaborators/multi-institutions (e.g. UK, NL, USA, Autralia, China?)
Key Opinion Leaders (medical/scientific/political)
Celebrity endorsement
Project should sit firmly within LOHAS (Lifestyles of Health and Sustainability) framework
Do we need new terminology? e.g. NALSH, Hawthorn…???
Beta-testing
• UK
• Netherlands
• USA
• Australia
1000 fully compliant subjects (minimum) over 12 months
Supportingapproaches
Open forum/discussion between practitioners and associations
Campaigns / advocacy
The power of story: testimonials
PR
Professionalisation
Engagement with the mainstream www.healthtalk.orgDatabase of Individual Patient Experienceswww.dipexinternational.org
Let’s just do it!
@anhcampaignANHInternational
Email: [email protected]: 01306 646 600
STOP PRESS! ANH Nutritional practitioner conference7 Oct 2017; Sheepdrove Eco Conference, Ctr, Lambourn, Berkshire RG17 7UUBook via anhpractitionertools.eventzilla.net