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: info@anhinternational.orgTel: 01306 646 600

STOP PRESS! ANH Nutritional practitioner conference7 Oct 2017; Sheepdrove Eco Conference, Ctr, Lambourn, Berkshire RG17 7UUBook via anhpractitionertools.eventzilla.net