Use of Complementary and Alternative Medicine in Patients with Primary Immunodeficiency: a Multicentric Analysis of 101 Patients.

The term complementary and alternative medicine (CAM) describes a broad spectrum of health care practices that are not an integral part of the conventional health care system. Many patients worldwide use CAM on their own initiative, often in combination with their conventional medical therapy. CAM use is attractive especially to patients with primary immunodeficiency, since they suffer from frequent infections and autoimmunity. Those are frequently addressed by CAM providers. The aim of this multicentric study was to collect information on the use of CAM by these patients and to define characteristics that are associated with the use of CAM. A total of 101 patients with primary immunodeficiencies at German hospitals were surveyed on their CAM use (further 14 patients rejected to participate). Multiple psychological tests (MARS-D, WHO-5, PHQ9, EFQ) were conducted to investigate variations among personality traits associated with CAM use. Additionally, clinical and sociodemographic patient data was collected. A total of 72% of patients used CAM to treat their primary immunodeficiency. The three most frequently used methods were physical exercise or fitness training (65%), dietary supplements (58%), and homeopathy (49%). Most patients did not discuss CAM use with their doctors, mostly because they felt that there was no time for it. CAM plays an important role for patients with primary immunodeficiency in a high-resource health care setting such as Germany. In clinical practice, doctors should create a platform to discuss needs that go beyond conventional therapy.

Differences in use of complementary and alternative medicine between children and adolescents with cancer in Germany: a population based survey.

BACKGROUND: Use of complementary and alternative medicine (CAM) in children with cancer is common and probably increasing. However, data concerning differences between children and adolescents focusing on prevalence, reasons for use/non-use, costs, adverse effects, and socio-demographic factors are lacking. PROCEDURE: A population-based survey over a 1 year period with 497 participants was conducted. RESULTS: Of the 457 respondents (92%) 322 were children and 135 adolescents (>16 years of age) with malignancies. 31% reported CAM use from the time when being diagnosed, compared to an overall lifetime prevalence rate of 41% before cancer diagnosis. Among CAM users the most prevalent therapies were homeopathy, massage, anthroposophic medicine, acupuncture, and Bach flowers. The main reasons for use were to reduce therapy-related side effects, to strengthen the immune system, to achieve physical stabilization and to increase healing chances. Socio-demographic factors associated with CAM use were higher parental education and higher family income. A majority of CAM users (97%) would recommend CAM use. Most users (78%) informed a physician about CAM use. Side effects were rarely reported (5%), minor and self-limiting. CONCLUSIONS: The high prevalence rates seem to represent the parental or patients needs for additional treatment perceived as successful and devoid of side-effects. Clinical care and the physician-patient relation would profit from an enhanced understanding of CAM and a greater candidness towards the parental needs. Safety and efficacy - especially of CAM with high prevalence rates - should be studied in rigorous basic and clinical research.

What is the out-of-pocket expenditure on medicines in India? An empirical assessment using a novel methodology.

The share of expenditure on medicines as part of the total out-of-pocket (OOP) expenditure on healthcare services has been reported to be much higher in India than in other countries. This study was conducted to ascertain the extent of this share of medicine expenditure using a novel methodology. OOP expenditure data were collected through exit interviews with 5252 out-patient department patients in three states of India. Follow-up interviews were conducted after Days 1 and 15 of the baseline to identify any additional expenditure incurred. In addition, medicine prescription data were collected from the patients through prescription audits. Self-reported expenditure on medicines was compared with the amount imputed using local market prices based on prescription data. The results were also compared with the mean expenditure on medicines per spell of ailment among non-hospitalized cases from the National Sample Survey (NSS) 75th round for the corresponding states and districts, which is based on household survey methodology. The share of medicines in OOP expenditure did not change significantly for organized private hospitals using the patient-reported vs imputation-based methods (30.74-29.61%). Large reductions were observed for single-doctor clinics, especially in the case of 'Ayurvedic' (64.51-36.51%) and homeopathic (57.53-42.74%) practitioners. After adjustment for socio-demographic factors and types of ailments, we found that household data collection as per NSS methodology leads to an increase of 25% and 26% in the reported share of medicines for public- and private-sector out-patient consultations respectively, as compared with facility-based exit interviews with the imputation of expenditure for medicines as per actual quantity and price data. The nature of healthcare transactions at single-doctor clinics in rural India leads to an over-reporting of expenditure on medicines by patients. While household surveys are valid to provide total expenditure, these are less likely to correctly estimate the share of medicine expenditure.

Patients whose GP knows complementary medicine tend to have lower costs and live longer.

BACKGROUND: Health economists have largely ignored complementary and alternative medicine (CAM) as an area of research, although both clinical experiences and several empirical studies suggest cost-effectiveness of CAM. OBJECTIVE: To explore the cost-effectiveness of CAM compared with conventional medicine. METHODS: A dataset from a Dutch health insurer was used containing quarterly information on healthcare costs (care by general practitioner (GP), hospital care, pharmaceutical care, and paramedic care), dates of birth and death, gender and 6-digit postcode of all approximately 150,000 insurees, for the years 2006-2009. Data from 1913 conventional GPs were compared with data from 79 GPs with additional CAM training in acupuncture (25), homeopathy (28), and anthroposophic medicine (26). RESULTS: Patients whose GP has additional CAM training have 0-30% lower healthcare costs and mortality rates, depending on age groups and type of CAM. The lower costs result from fewer hospital stays and fewer prescription drugs. DISCUSSION: Since the differences are obtained while controlling for confounders including neighborhood specific fixed effects at a highly detailed level, the lower costs and longer lives are unlikely to be related to differences in socioeconomic status. Possible explanations include selection (e.g. people with a low taste for medical interventions might be more likely to choose CAM) and better practices (e.g. less overtreatment, more focus on preventive and curative health promotion) by GPs with knowledge of complementary medicine. More controlled studies (replication studies, research based on more comprehensive data, cost-effectiveness studies on CAM for specific diagnostic categories) are indicated.

Complementary and alternative medicine use in patients with fractures.

Complementary and alternative medicine (CAM) encompasses dietary supplements, herbs, homeopathic medicines, and other modalities. In light of prevalent CAM use, patient interest, increasing CAM expenditures, and possible interactions with traditional treatments or healing we identified the following in patients with fractures: prevalence of CAM use, the amount of money patients are spending on CAMs, and the number of patients who disclose CAM use to their orthopaedic surgeon and the reasons for withholding disclosure. Factors associated with CAM use were evaluated. Of the 322 patients with fractures surveyed, 35% were using CAMs. Of the patients using CAMs, 50% spent more than $25 per month. Fifty-five percent of the patients using CAMs had not discussed their CAM use with their orthopaedic surgeon citing "it was not an important issue to discuss." Factors associated with CAM use included level of education (odds ratio, 2.5; 95% confidence interval, 1.4-4.7) and psychiatric disorders (odds ratio, 2.5; 95% confidence interval, 1.3-5.0). To avoid possible interactions with traditional treatments and to identify side effects, surgeons should ask patients with fractures about CAM use in an unbiased fashion, as most patients will not voluntarily disclose their use.

Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up national survey.

CONTEXT: A prior national survey documented the high prevalence and costs of alternative medicine use in the United States in 1990. OBJECTIVE: To document trends in alternative medicine use in the United States between 1990 and 1997. DESIGN: Nationally representative random household telephone surveys using comparable key questions were conducted in 1991 and 1997 measuring utilization in 1990 and 1997, respectively. PARTICIPANTS: A total of 1539 adults in 1991 and 2055 in 1997. MAIN OUTCOMES MEASURES: Prevalence, estimated costs, and disclosure of alternative therapies to physicians. RESULTS: Use of at least 1 of 16 alternative therapies during the previous year increased from 33.8% in 1990 to 42.1% in 1997 (P < or = .001). The therapies increasing the most included herbal medicine, massage, megavitamins, self-help groups, folk remedies, energy healing, and homeopathy. The probability of users visiting an alternative medicine practitioner increased from 36.3% to 46.3% (P = .002). In both surveys alternative therapies were used most frequently for chronic conditions, including back problems, anxiety, depression, and headaches. There was no significant change in disclosure rates between the 2 survey years; 39.8% of alternative therapies were disclosed to physicians in 1990 vs 38.5% in 1997. The percentage of users paying entirely out-of-pocket for services provided by alternative medicine practitioners did not change significantly between 1990 (64.0%) and 1997 (58.3%) (P=.36). Extrapolations to the US population suggest a 47.3% increase in total visits to alternative medicine practitioners, from 427 million in 1990 to 629 million in 1997, thereby exceeding total visits to all US primary care physicians. An estimated 15 million adults in 1997 took prescription medications concurrently with herbal remedies and/or high-dose vitamins (18.4% of all prescription users). Estimated expenditures for alternative medicine professional services increased 45.2% between 1990 and 1997 and were conservatively estimated at $21.2 billion in 1997, with at least $12.2 billion paid out-of-pocket. This exceeds the 1997 out-of-pocket expenditures for all US hospitalizations. Total 1997 out-of-pocket expenditures relating to alternative therapies were conservatively estimated at $27.0 billion, which is comparable with the projected 1997 out-of-pocket expenditures for all US physician services. CONCLUSIONS: Alternative medicine use and expenditures increased substantially between 1990 and 1997, attributable primarily to an increase in the proportion of the population seeking alternative therapies, rather than increased visits per patient.

Medicamentos subutilizados en el ámbito comunitario, área salud coronado, Costa Rica / Medicines subused in the communitarian scope, area coronado health, Costa Rica

En este estudio de prevalencia de medicamentos, los objetivos fueron identificar los determinantes que promueven la subutilización de medicamentos, los usos alternativos de los medicamentos no utilizados, la gestión de los residuos, desechos y disposición final de los medicamentos en el ámbito comunitario. Se aplicó una encuesta y fueron inventariados los medicamentos en una comunidad urbano rural representativa. Se visitaron 440 viviendas, donde se determinaron tres categorías de medicamentos subutilizados: vencidos (9 por ciento); los que no se sabe cuándo se vencen (17 por ciento) y los que no estaban vencidos; pero estaban sin uso (26 por ciento). Se asoció la subutilización de medicamentos con la edad, el estado civil, el nivel educativo, dificultades para el uso y manejo de los medicamentos, el consumo incompleto y las alternativas de tratamiento: medicina natural y homeopatía. La razón principal encontrada para la acumulación de medicamentos en el hogar fue como reserva en caso de emergencia: los desechos no se clasifican y los medicamentos subutilizados terminan en el basurero. Se evidenció la necesidad de una política nacional para la promoción, uso racional y manejo de los medicamentos, sin que esto implique un abuso de los servicios de salud, el diseño de una propuesta de recuperación de medicamentos domiciliarios no utilizados, el manejo de los residuos y su disposición final, un mayor control de las fechas de caducidad de los medicamentos, así como el fomento de la atención farmacéutica, y la educación para la salud en los diferentes escenarios sociales.

The cost and effectiveness of homoeopathy

The results of a pilot study suggest that doctors practising homeopathic medicine issue fewer prescriptions and at a lower cost than their colleagues. Despite the severe limitations of the study the implications of these figures justify fuller and more rigorous enquiry. The limitations of this study and requirements for future cost effectiveness of studies are discussed

La técnica anestésica en cirugía cardiovascular y el "fast-track" / The anesthetic technique for cardiovascular surgery and the \"fast-track\"

En la búsqueda de una técnica de anestesia para cirugía de revascularización apropiada para lograr extubación precoz, veloz recuperación de los pacientes y un alta rápida del hospital, disminuyendo de esta manera los costos ("fast track"), se ha diseñado una técnica barata, sencilla y que permite alcanzar esos objetivos. MATERIAL Y METODOS. Se seleccionaron 30 pacientes electivos divididos al azar en tres grupos iguales en los que se estudiaron las variables hemodinámicas de los efectos de la introducción en el circuito anestésico de uno de 3 agentes inhalatorios (halothano, enflurano e isoflurano) antes y después de circulación extracorpórea. Todos los pacientes tenían buena función ventricular, o ligeramente deteriorada (FEò0.4). Se premedicaron con lorazepam; la inducción se hizo con sulfentanilo (4 µg.kg1) y pancuronio (0.15 mg.kg.1); el mantenimiento se efectuó con los anestésicos inhalatorios y dosis repetidas de sufentanilo según necesidad. Se obtuvo excelente estabilidad hemodinámica. RESULTADOS. Ninguno de los inhalatorios fue más elegible que el otro. Antes de CEC los inhalatorios provocaron disminución de PA, IC, I/L, RVS y frec, probablemente por disminución del VO2. Después de CEC no impidieron la recuperación de los efectos de la misma, permitiendo que disminuyeran la frec y el IC, sin cambios en la PA y aumento de la RVS; el I/L se mantuvo bajo. Todos los pacientes se pudieron extubar dentro de las 4 a 6 horas de llegados a la Sala de Recuperación.