Primary health care case management through the lens of complexity: an exploratory study of naturopathic practice using complexity science principles

Abstract

Background Advances in systems science creates an opportunity to bring a complexity perspective to health care practices and research. While medical knowledge has greatly progressed using a reductionist and mechanistic philosophy, this approach may be limited in its capacity to manage chronic and complex illness. With its holistic foundation, naturopathy is a primary health profession with a purported alignment with a complexity perspective. As such this pilot study aimed to investigate the application of complexity science principles, strategies, and tools to primary health care using naturopathy as a case study. Methods A network mapping and analysis of the naturopathic case management process was conducted. Mind maps were created by naturopathic practitioners to reflect their clinical conceptualisation of a common paper clinical case. These mind maps were inputed into Gephi, a network mapping, exploration, and analysis software. Various layouts of the data were produced, and these were analysed using exploratory data analysis and computational network analysis. Results Seven naturopathic practitioners participated in the study. In the combined network mapping, 133 unique elements and 399 links were identified. Obesity, the presenting issue in the case, was centrally located. Along with obesity, other keystone elements included: systemic inflammation, dysbiosis, diet, the liver, and mood. Each element was connected on average to 3.05 other elements, with a degree variation between one and 36. Six communities within the dataset were identified, comprising: the nervous system and mood, gastroinstetinal and dietary factors, systemic inflammation and obesity, the endocrine system and metabolism. Conclusions This pilot study demonstrates that it is feasible to apply a complexity science perspective to investigating primary health care case management. This supports a shift to viewing the human organism as a complex adaptive system within primary health care settings, with implications for health care practices that are more cognisant with the treatment of chronic and complex conditions and research opportunities to capture the complex clinical reasoning processes of practitioners.

A Review of Technological Forecasting from the Perspective of Complex Systems

“…Firstly, based on the context and agent identified above, the full context-agent and single context-agent co-occurrence matrices were constructed. Secondly, the relationship was visualized with Gephi [ 23 ] software, which provides information not only about the network structure but also about the relationships of the network nodes. Finally, the research status and future research trends of the TF field are analyzed and explored.…”

Protocol for a scoping review of traditional medicine research methods, methodologies, frameworks and strategies

“…Scholars seeking research approaches that align with TM therapeutic systems are furthermore adopting research approaches designed to evaluate complex interventions. Examples include, complexity science ( 47 , 48 ) (which is the interdisciplinarity study of complex adaptive systems ( 49 )) and systems science approaches ( 50 ), such as network pharmacology ( 51 , 52 ) that have “shifted the paradigm from a “one-target, one-drug” mode to a network-target, multiple-component-therapeutics’ mode” ( 52 ). Likewise, TM-focused social scientists have demonstrated the importance of addressing paradigmatic considerations within TM policy processes ( 53 , 54 ).…”