Patient satisfaction with primary care: an observational study comparing anthroposophic and conventional care.

BACKGROUND: This study is part of a cross-sectional evaluation of complementary medicine providers in primary care in Switzerland. It compares patient satisfaction with anthroposophic medicine (AM) and conventional medicine (CON). METHODS: We collected baseline data on structural characteristics of the physicians and their practices and health status and demographics of the patients. Four weeks later patients assessed their satisfaction with the received treatment (five items, four point rating scale) and evaluated the praxis care (validated 23-item questionnaire, five point rating scale). 1946 adult patients of 71 CON and 32 AM primary care physicians participated. RESULTS: 1. Baseline characteristics: AM patients were more likely female (75.6% vs. 59.0%, p < 0.001) and had higher education (38.6% vs. 24.7%, p < 0.001). They suffered more often from chronic illnesses (52.8% vs. 46.2%, p = 0.015) and cancer (7.4% vs. 1.1%). AM consultations lasted on average 23,3 minutes (CON: 16,8 minutes, p < 0.001). 2. Satisfaction: More AM patients expressed a general treatment satisfaction (56.1% vs. 43.4%, p < 0.001) and saw their expectations completely fulfilled at follow-up (38.7% vs. 32.6%, p < 0.001). AM patients reported significantly fewer adverse side effects (9.3% vs. 15.4%, p = 0.003), and more other positive effects from treatment (31.7% vs. 17.1%, p < 0.001). Europep: AM patients appreciated that their physicians listened to them (80.0% vs. 67.1%, p < 0.001), spent more time (76.5% vs. 61.7%, p < 0.001), had more interest in their personal situation (74.6% vs. 60.3%, p < 0.001), involved them more in decisions about their medical care (67.8% vs. 58.4%, p = 0.022), and made it easy to tell the physician about their problems (71.6% vs. 62.9%, p = 0.023). AM patients gave significantly better rating as to information and support (in 3 of 4 items p [less than or equal to] 0.044) and for thoroughness (70.4% vs. 56.5%, p < 0.001). CONCLUSION: AM patients were significantly more satisfied and rated their physicians as valuable partners in the treatment. This suggests that subject to certain limitations, AM therapy may be beneficial in primary care. To confirm this, more detailed qualitative studies would be necessary.

Patient satisfaction and side effects in primary care: an observational study comparing homeopathy and conventional medicine.

BACKGROUND: This study is part of a nationwide evaluation of complementary medicine in Switzerland (Programme Evaluation of Complementary Medicine PEK) and was funded by the Swiss Federal Office of Public Health. The main objective of this study is to investigate patient satisfaction and perception of side effects in homeopathy compared with conventional care in a primary care setting. METHODS: We examined data from two cross-sectional studies conducted in 2002-2003. The first study was a physician questionnaire assessing structural characteristics of practices. The second study was conducted on four given days during a 12-month period in 2002/2003 using a physician and patient questionnaire at consultation and a patient questionnaire mailed to the patient one month later (including Europep questionnaire).The participating physicians were all trained and licensed in conventional medicine. An additional qualification was required for medical doctors providing homeopathy (membership in the Swiss association of homeopathic physicians SVHA). RESULTS: A total of 6778 adult patients received the questionnaire and 3126 responded (46.1%). Statistically significant differences were found with respect to health status (higher percentage of chronic and severe conditions in the homeopathic group), perception of side effects (higher percentage of reported side effects in the conventional group) and patient satisfaction (higher percentage of satisfied patients in the homeopathic group). CONCLUSION: Overall patient satisfaction was significantly higher in homeopathic than in conventional care. Homeopathic treatments were perceived as a low-risk therapy with two to three times fewer side effects than conventional care.

Complementary medicine courses in Swiss medical schools: actual status and students' experience.

BACKGROUND: In line with growing public popularity of complementary and alternative medicine (CAM), courses in CAM have been implemented in Medical Schools internationally, but as yet in an uncoordinated and heterogeneous way. In Switzerland, comprehensive data about CAM education at Medical Faculties are lacking. OBJECTIVES: To survey courses at Swiss Medical Schools, document medical students' attitude toward and knowledge of CAM and their experience of CAM courses at medical schools. The aim was to determine the relationship between the presence/absence of CAM courses at each medical school and students' attitude toward, knowledge of, and motivation to learn about CAM. METHODS: Data about current courses in CAM were collected from the websites of the five Swiss Medical Schools and from an online questionnaire addressed to the CAM teachers (n = 13). All Swiss senior medical students (n = 640) were surveyed by an anonymous online questionnaire. RESULTS: There are two chairs for CAM in Bern and Zürich, CAM familiarisation courses are provided by external teachers in Basel and Lausanne, and there was no CAM education in Geneva. 38.3% of the senior medical students replied to the survey. 80.0% of the students who visited CAM courses stated that they have improved their knowledge of CAM. There was no relationship between the presence of CAM education and a significant elevation of the self-assessed knowledge of CAM of the students. CAM education has no significant influence on students' opinions about CAM, nor does it significantly motivate them to deepen their study of CAM. Form, frequency and content of CAM courses are similarly as heterogeneous as in other countries. CONCLUSIONS: There is no coordination or standard for CAM courses in Swiss Medical Schools. Our results suggest an overall positive attitude toward and positive personal experiences with CAM of Swiss medical students', but a relationship between the absence or presence of CAM courses and students attitudes and knowledge could not be found. A coordinated policy towards the integration of CAM in medical curricula is strongly recommended.

Complementary medicine: equity issues in evaluation and policy-making.

The increasing use and practice of complementary and alternative medicine (CAM) all over the world raises important ethical issues for health care providers, researchers and policy-makers. This article addresses the equity issues arising in the context of an evaluation of five complementary therapies provided by general practitioners: homeopathy, anthroposophic medicine, traditional Chinese medicine, neural therapy and phytotherapy. The evaluation was commissioned by the Swiss government in order to provide scientific data to make a policy decision about including these disciplines in basic insurance coverage, if provided by physicians. Both the research process and the related health policy raise a number of equity issues that are explored and further discussed on the basis of Daniels' and Sabin's criteria for fair decision-making as defined in their 'accountability for reasonableness' approach. Combining the lessons learnt from the case study with current approaches to fairness in decision-making and priority-setting, propositions are made in order to increase awareness for transparency and fairness in CAM-related evaluations and policy.

Medical pluralism: global perspectives on equity issues.

Over the last decades, awareness has increased about the phenomenon of medical pluralism and the importance to integrate biomedicine and other forms of health care. The broad variety of healing cultures existing alongside biomedicine is called complementary or alternative medicine (CAM) in industrialized countries and traditional medicine (TM) in developing countries. Considerable debate has arisen about ethical problems related to the growing use of CAM in industrialized countries. This article focuses on equity issues and aims to consider them from a global perspective of medical pluralism. Several dimensions of equity are explored and their interrelatedness discussed: access to care, research (paradigm and founding) and recognition. This so-called 'equity circle' is then related to Iris Marion Young's justice theory and particularly to the concepts of cultural imperialism, powerlessness and marginalisation.

Exploring different dimensions of holism: considerations in the context of an evaluation of complementary medicine in primary care.

Holism is often associated with both complementary medicine and primary care. In the context of the Swiss Programme for the Evaluation of Complementary Medicine (PEK), the concept of holism emerged from data on physician's philosophy of care and motivation for patients' choice of physician. Yet, as PEK primarily aimed to quantify differences between conventional and complementary medicine, qualitative aspects of the study were neglected and data not fully explored. The main objective of this article is to explore the concept, variations and dimensions of holism by exploring and reflecting on PEK results implicitly and explicitly related to holism.

Physicians' philosophy of care: a comparison of complementary and conventional medicine.

BACKGROUND: This project is part of an evaluation of complementary and alternative medicine (CAM) aimed at providing a scientific basis for the Swiss Government to include 5 CAM methods in basic health coverage: anthroposophic medicine, homeopathy, neural therapy, phytotherapy and Traditional Chinese Medicine (TCM). OBJECTIVES: The objective was to explore the philosophy of care (convictions and values, priorities in medical activity, motivation for CAM, criteria for the practice of CAM, limits of the used methods) of conventional and CAM general practitioners (GPs) and to determine differences between both groups. MATERIALS AND METHODS: This study was a cross-sectional survey of a representative sample of 623 GPs who provide complementary or conventional primary care. A mailed questionnaire with open-ended questions focusing on the philosophy of care was used for data collection. An appropriate methodology using a combination of quantitative and qualitative approaches was developed. RESULTS: Significant differences between both groups include philosophy of care (holistic versus positivistic approaches), motivation for CAM (intrinsic versus extrinsic) and priorities in medical activity. Both groups seem to be aware of limitations of the therapeutic methods used. The study reveals that conventional physicians are also using complementary medicine. DISCUSSION: Our study provides a wealth of data documenting several aspects of physicians' philosophy of care as well as differences and similarities between conventional and complementary care. Implications of the study with regard to quality of care as well as ethical and health policy issues should be investigated further.

Complementary and conventional medicine in Switzerland: comparing characteristics of general practitioners.

OBJECTIVES: Do structural characteristics of general practitioners (GPs) who practice complementary medicine (CAM) differ from those GPs who do not? Assessed characteristics included experience and professional integration of general practitioners (GPs), workload, medical activities, and personal and technical resources of practices. The investigated CAM disciplines were anthroposophic medicine, homoeopathy, traditional Chinese medicine, neural therapy and herbal medicine. MATERIAL AND METHODS: We designed a cross-sectional study with convenience and stratified samples of GPs providing conventional (COM) and/or complementary primary care in Switzerland. The samples were taken from the database of the Swiss medical association (FMH) and from CAM societies. Data were collected using a postal questionnaire. RESULTS: Of the 650 practitioners who were included in the study, 191 were COM, 167 noncertified CAM and 292 certified CAM physicians. The proportion of females was higher in the population of CAM physicians. Gender-adjusted age did not differ between CAM and COM physicians. Nearly twice as many CAM physicians work part-time. Differences were also seen for the majority of structural characteristics such as qualification of physicians, type of practice, type of staff, and presence of technical equipment. CONCLUSION: The study results show that structural characteristics of primary health care do differ between CAM and COM practitioners. We assumed that the activities of GPs are defined essentially by analyzed structures. The results are to be considered for evaluations in primary health care, particularly when quality of health care is assessed.

Health status and health care utilisation of patients in complementary and conventional primary care in Switzerland--an observational study.

BACKGROUND: The study is part of a nationwide evaluation of complementary and alternative medicine (CAM) in primary care in Switzerland. OBJECTIVES: Patient health status with respect to demographic attributes such as gender, age, and health care utilisation pattern was studied and compared with conventional primary care. METHODS: The study was performed as a cross-sectional survey including 11932 adult patients seeking complementary or conventional primary care. Patients were asked to document their self-perceived health status by completing a questionnaire in the waiting room. Physicians were performing conventional medicine and/or various forms of complementary primary care such as homeopathy, anthroposophic medicine, neural therapy, herbal medicine, or traditional Chinese medicine. Additional information on patient demographics and yearly consultation rates for participating physicians was obtained from the data pool of all Swiss health insurers. These data were used to confirm the survey results. RESULTS: We observed considerable and significant differences in demographic attributes of patients seeking complementary and conventional care. Patients seeking complementary care documented longer lasting and more severe main health problems than patients in conventional care. The number of previous physician visits differed between patient groups, which indicates higher consumption of medical resources by CAM patients. CONCLUSIONS: The study supports the hypothesis of differences in socio-demographic and behavioural attributes of patients seeking conventional medicine or CAM in primary care. The study provides empirical evidence that CAM users are requiring more physician-based medical services in primary care than users of conventional medicine.