ORIGINAL ARTICLE Comparison of integrative medicine centers in the USA and Germany: a mixed method study EunJin Lim 1 & Janette L. Vardy 1,2 & ByeongSang Oh 3 & Haryana M. Dhillon 4,5 Received: 11 October 2016 /Accepted: 16 January 2017 # Springer-Verlag Berlin Heidelberg 2017 Abstract Purpose Integrative medicine (IM) has received increasing attention since the 1990s, but few studies have explored the key factors of the IM model in health care. This study aimed to describe the IM model in leading centers operating in the USA and Germany. Methods A 28-item structured survey and semi-structured in- terviews were conducted in six centers providing integrative medicine in the USA and Germany, and were analyzed using a convergent mixed-method approach. Results The elements in common across all six centers were the following: (1) involvement of general physicians (GP) in delivering complementary and alternative medicine (CAM) services; (2) requirement for GP or medical referral or recom- mendation to CAM services; (3) involvement of an integrative physician (IP) as a Bgatekeeper^; (4) focus on research, education, and clinical practice; and (5) ongoing academic activities. The key elements differentiating the two countries were the following: (1) level of requirements for GP referral to CAM services; (2) differences in IM service delivery, includ- ing treatment modalities used; (3) accessibility of CAM ser- vices to patients; (4) interaction between team members and patients; (5) perception of CAM/IM; and (6) perception of patient-centered care. Themes underpinning these elements are the following: cultural aspects in conceptualizing IM health care; communication within IM programs; and resource availability for delivering IM services, which impacts patient engagement and team collaboration in the IM framework. Conclusions Delivering IM health care requires a model of care that encourages interaction between all stakeholders. Developing a comprehensive conceptual framework to sup- port IM practice is required to facilitate efficient and safe patient care. Keywords Integrative medicine . Model of care . Complementary and alternative medicine (CAM) . Healthcare systems Introduction An increase in the number of patients seeking complementary and alternative medicine (CAM) treatments has driven CAM regulation, particularly professional licensing and health in- surance coverage, within the health-care system [1]. The in- corporation of CAM into a country’s health-care scheme dif- fers depending on cultural, political, social, and historical con- texts. The concept of integrative medicine (IM), incorporating the coordination of conventional medicine and CAM services, first emerged in the USA in 1996 at the University of Arizona [2]. Its origins lay in the social post-modernist movement of Electronic supplementary material The online version of this article (doi:10.1007/s00520-017-3590-2) contains supplementary material, which is available to authorized users. * Haryana M. Dhillon Haryana.dhillon@sydney.edu.au 1 Concord Clinical School, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia 2 Concord Cancer Centre, Concord Repatriation General Hospital, Concord, Sydney, NSW, Australia 3 Northern Clinical School, The University of Sydney, St. Leonard’s, Sydney, NSW, Australia 4 CeMPED, School of Psychology, Faculty of Science, The University of Sydney, Sydney 2006, NSW, Australia 5 Center for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney Medical School, The University of Sydney, Level 6-North, Chris O’Brien Lifehouse (C39Z), Sydney, NSW 2006, Australia Support Care Cancer DOI 10.1007/s00520-017-3590-2