Integrative Health and Wellbeing Thrives at New York-Presbyterian

INDIVIDUALIZED HOLISTIC EVIDENCE-BASED medicine will be accessible to more patients in New York beginning in June 2018, when the 2-year-old Integrative Health and Wellbeing program expands from its original site, 12 blocks from New York-Presbyterian/Weill Cornell Medical Center, to a larger and more accommodating setting across the street from the center.

“Over the [past] 2 years, we have been intimately involved in the design process to create a truly healing environment,” program co-director Chiti Parikh, MD, said in an announcement about the expansion. “Special attention has been given to include more natural and environmentally friendly elements that will help patients [retreat] from the busy streets of New York City into a tranquil sanctuary.”

The program was proposed by Parikh and her co-director, Alka Gupta, MD, as a collaboration between New York-Presbyterian and Weill Cornell Medicine to provide patient care centered on prevention, lifestyle medicine, wellness, and more comprehensive care for chronic disease and symptom management.

In addition to providing resources, guidance, and activities to achieve a healthier lifestyle, reduce stress, and improve resilience, the program tailors its interventions for particular patient populations, which may lessen their requirement for and improve their response to medication and medical interventions.

The emphasis for cardiology patients, for example, is on prevention and slowing disease progression by optimizing nutrition and instituting stress-relief measures. Assistance also is provided to oncology patients receiving a new diagnosis and to help relieve the adverse effects (AEs) from chemotherapy and radiation therapy. Patients with gastroenterology conditions, such as irritable bowel syndrome (IBS), autoimmune diseases, and chronic pain have also benefited.

PROPOSING HOSPITALIZATION REDUCTION

“We know [that], most likely, more than 80% of coronary artery disease is probably preventable and that we can identify those risk factors ahead of time,” Gupta told MD Magazine®. “We try to counsel patients on risks as early as possible, in a variety of ways. We collaborate with the cardiology division here, and many patients seek us out earlier in the process, and we may then be able to prevent patients from requiring that [counseling] down the road.” Parikh and Gupta, both certified in internal medicine, proposed the program after attending an integrative health conference that described improved patient outcomes when conventional outpatient service centers incorporated interventions such as meditation, breathing, acupuncture, and yoga—techniques often otherwise dismissed by many in medicine.

“We put together a business plan of the concept we had for what an integrative health program would look like,” Parikh told MD Magazine®. “It was fortunate that the hospital leadership was looking for such a program around the same time.”

Parikh recounted their experience with sharing the idea of the program across provider specialties, noting that in its first year, much of their time was spent on outreach to physicians and providers at the institution. “[We wanted to] learn what they thought of integrative medicine, their idea of the modalities we should be offering, the needs of their patient population, and how we could help make this a more robust program and really excel at patient care,” she said.

COMPREHENSIVE PROGRAM

“I think it is important to think about integrative health as more of an ‘approach’ than a separate field,” Gupta added. “It is really more of an approach and a mindset that, really, all providers should have, rather than a specific area of concentration.” In addition to co-founders/directors Parikh and Gupta, who are dual certified in integrative medicine and internal medicine, the program staff includes an integrative nutritionist, an integrative nurse who is also a certified yoga instructor and mind-body instructor, a practitioner certified in acupuncture and Oriental medicine, and a massage therapist who is also a certified instructor in Pilates and yoga.

An initial patient visit typically involves a 45- to 60-minute evaluation by Parikh or Gupta, including a physical examination, review of medical records, and orders for additional testing, if indicated. Lifestyle management is discussed, as well as behavioral modification and, if needed, adjunctive therapies such as acupuncture, massage therapy, nutrition counseling, yoga instruction, mindfulness coaching, and meditation instruction.

The nutritionist then considers any barriers to healthy eating and develops a plan to address them. Recommendations have included mindful eating rather than rushing through a meal; avoiding too much salt, fat, and calories in a meal; and staying away from foods that trigger symptoms, such as discomfort due to IBS or migraine.

Acupuncture sessions can last 90 minutes and are repeated for a cumulative effect. The procedure is included in recent clinical guidelines from the American College of Physicians for treatment of lower back pain and has been applied in a variety of circumstances, including reduction of AEs from chemotherapy.

Mind-body techniques principally focus on stress reduction through slower breathing, lowering blood pressure and heart rate, achieving feelings of calmness and relaxation, learning better coping skills, and enhancing resilience.

ASSIMILATING INTEGRATIVE HEALTH

Pilates sessions are offered to improve core muscle strength, stability, posture, balance, and flexibility. These are modified for conditions such as osteoporosis and during recovery from surgery or other invasive procedures. Massage therapies, including deep tissue massage and foot reflexology, are not limited to musculoskeletal complaints; they can be used to treat a variety of conditions, such as fibromyalgia and stress. Parikh and Gupta pointed out that the services are provided to patients both at the program location and throughout the medical center.

“About half of our referrals are within the institution, and we are also establishing more concrete collaborations,” Parikh explained. “For instance, we have some other providers, like the mind-body therapist and the massage therapist, who actually go into the oncology infusion center and provide services at bedside.”

Gupta emphasized the importance of the program being available to support all patients of the medical center. “We chose to have a broader approach to this [rather] than just working on oncology and pain management—which tend to be our bigger patient referral sources,” she said. “We wanted to make sure we offered the most services possible and improved access for our patients in a way that is financially sustainable.”

Parikh agreed. “I think that practicing medicine in New York City is a whole different ball game,” she said. “If [we] create a sustainable, acceptable program for a New York City population...hopefully, a lot of institutions can learn from what we’ve done and really meet the needs in their own delivery systems.”

The overall mission of the program and of the medical center is to provide education, research, and clinical care, Gupta noted, so the program targets providers, as well as patients, in fulfilling that mission. She is hopeful that the program will be able to offer a continuing medical education lecture series in the future.

“When we talk about education, it is not just education of patients—although that’s very, very important— but it is also educating other providers,” Gupta said. “We currently have a few students rotating through our center, but starting in June, once we move into our new building, we’ll have more capacity for students and residents.”