Naturopathic Primary Care

 

Naturopathic physicians (ND) are an increasingly integral part of the primary care workforce in several US states, including Oregon and Washington [1-3]. Research shows that naturopathic physicians are effective at treating some of the most common conditions seen by primary care providers, including cardiovascular disease [4], mental health [5,6], diabetes [7], urinary tract infection [8], and back pain [9]. Furthermore, complementary and integrative health is popular in the Pacific Northwest but is mostly self-administered rather than delivered by trained professionals [10].

NDs are trained in holistic primary care through a standardized four-year graduate curriculum similar to conventional physicians (MD/DO). Naturopathic medicine is characterized by its emphasis on the Whole Person and its “therapeutic order,” an approach to patient care that aims to maximize benefit while reducing side effects and secondary harm. Naturopathic medicine prioritizes non-drug methods such as lifestyle, stress management, diet, and natural substances, but also includes medication, minor surgery, and referrals for specialty care when needed.

 

Naturopathic medical students learn evidence-based medicine and critical appraisal of the scientific evidence for conventional and non-conventional treatment modalities [11,12]. Teaching clinic networks attached to the naturopathic schools in Oregon and Washington provide primary and complementary care to Medicaid recipients and the uninsured with a high level of patient satisfaction [13].

References:

[1] Bellas A, Lafferty WE, Lind B, Tyree PT. Frequency, predictors, and expenditures for pediatric insurance claims for complementary and alternative medical professionals in Washington State. Arch Pediatr Adolesc Med. 2005 Apr;159(4):367-72. doi: 10.1001/archpedi.159.4.367.

[2] Lafferty WE, Tyree PT, Bellas AS, Watts CA, Lind BK, Sherman KJ, Cherkin DC, Grembowski DE. Insurance coverage and subsequent utilization of complementary and alternative medicine providers. Am J Manag Care. 2006 Jul;12(7):397-404. 

[3] Bradley R, Walter B. Opioid Prescribing Patterns by Naturopathic Physicians in Oregon. Pain Med. 2019 Feb 1;20(2):414-415. doi: 10.1093/pm/pny235.

[4] Seely D, Szczurko O, Cooley K, Fritz H, Aberdour S, Herrington C, Herman P, Rouchotas P, Lescheid D, Bradley R, Gignac T, Bernhardt B, Zhou Q, Guyatt G. Naturopathic medicine for the prevention of cardiovascular disease: a randomized clinical trial. Canadian Medical Association Journal. 2013; 185(9): E409-16. doi: 10.1503/cmaj.120567.

[5] Breed C, Bereznay C. Treatment of Depression and Anxiety by Naturopathic Physicians: An Observational Study of Naturopathic Medicine. Journal of Alternative and Complementary Medicine. 2017; 23(5): 348-354. doi: 10.1089/acm.2016.0232.

[6] Cooley K, Szczurko O, Perri D, et al. Naturopathic care for anxiety: a randomized controlled trial ISRCTN78958974. PLoS One. 2009; 4(8): e6628. Published 2009 Aug 31. doi:10.1371/journal.pone.0006628.

[7] Bradley R, Sherman KJ, Catz S, Calabrese C, Oberg EB, Jordan L, Grothaus L, Cherkin D. Adjunctive naturopathic care for type 2 diabetes: patient-reported and clinical outcomes after one year. BMC Complementary and Alternative Medicine. 2012; 12: 44. doi: 10.1186/1472-6882-12-44.

[8] Garofalo L, Zwickey H, Bradley R, Hanes D. Naturopathic Management of Urinary Tract Infections: A Retrospective Chart Review. J Altern Complement Med. 2021 Aug 23. doi: 10.1089/acm.2021.0163.

[9] Szczurko O, Cooley K, Busse JW, et al. Naturopathic care for chronic low back pain: A randomized trial. PLoS One. 2007; 2(9). doi:10.1371/journal.pone.0000919.

[10] Wardle J, Lui CW, Adams J. Complementary and alternative medicine in rural communities: current research and future directions. J Rural Health. 2012 Jan;28(1):101-12. doi: 10.1111/j.1748-0361.2010.00348.x.

[11] Zwickey H, Schiffke H, Fleishman S, et al. Teaching Evidence-Based Medicine at Complementary and Alternative Medicine Institutions. Journal of Complementary and Alternative Medicine. 2014; 00(0): 1-7. doi: 10.1089/acm.2014.0087.

[12] Council on Naturopathic Medical Accreditation. Handbook of Accreditation for Naturopathic Medicine Programs. Great Barrington, MA; January 2017. Available at https://cnme.org/wpcontent/uploads/2017/09/2017_cnme_handbook_of_ accreditation.pdf. Accessed November 19, 2019.

[13] Washington Health Alliance. Your Voice Matters: Patient Experience with Primary Care Providers in the Puget Sound Region. 2004. Available at https://wahealthalliance.org/wp-content/uploads/2014/02/WHA-Patient-Experience-2014.pdf. Accessed on September 24, 2019.