[Complementary and alternative medicine in the German outpatient setting: extent, structure and reasons for provision]. / Komplementäre und alternative Heilverfahren im vertragsärztlichen Bereich: Ausmaß, Struktur und Gründe des ärztlichen Angebots.

BACKGROUND: Research on complementary and alternative medicine (CAM) has mainly focused on CAM utilisation by patients. Fewer studies have analysed extent and structure of CAM provision or the reasons why physicians offer CAM as a therapeutic option in the outpatient setting. METHODS: A standardised questionnaire was developed addressing reasons and patterns of CAM provision. The questionnaire was sent by post to 2,396 general practitioners and specialists in 9 selected German districts. 553 physicians participated in the survey (23%). RESULTS: 63% of the respondents (n=350) answered that they had provided some sort of CAM to their patients within a period of 12 months preceding the study. The most frequently provided methods were acupuncture/traditional Chinese medicine, herbal remedies and homeopathy. In the sample, 90% of the orthopaedists were CAM providers, the highest rate among the participating disciplines. Several reasons for offering CAM were identified: conviction of therapeutic effectiveness regarding the patient's situation (68%), aspects of therapeutic freedom (47%) or less harmful side effects than conventional therapies (34%). 6% provide CAM for monetary reasons. CONCLUSION: Findings suggest that the provision of CAM is widespread in the German outpatient setting. However, it has to be taken into account that a selection bias may apply which may lead to an overestimation of CAM provision. Doctors' reasons to offer CAM are manifold; therapeutic reasons seem to outweigh economic motives.

Impact of physician preferences for homeopathic or conventional medicines on patients with musculoskeletal disorders: results from the EPI3-MSD cohort.

OBJECTIVE: The objective of this study was to assess the effect of physician practicing preferences (PPP) in primary care for homeopathy (Ho), CAM (Complementary and alternative medicines) with conventional medicine (Mx) or exclusively conventional medicine (CM) on patients with musculoskeletal disorders (MSDs), with reference to clinical progression, drug consumption, side effects and loss of therapeutic opportunity. METHODS: The EPI3-MSD study was a nationwide observational cohort of a representative sample of general practitioners (GP) and their patients in France. Recruitment of GP was stratified by PPP, which was self-declared. Diagnoses and comorbidities were recorded by GP at inclusion. Patients completed a standardized telephone interview at inclusion, one, three and twelve months, including MSD-functional scales and medication consumption. RESULTS: 1153 MSD patients were included in the three PPP groups. Patients did not differ between groups except for chronicity of MSDs (>12 weeks), which was higher in the Ho group (62.1%) than in the CM (48.6%) and Mx groups (50.3%). The twelve-month development of specific functional scores was identical across the three groups after controlling for baseline score (p > 0.05). After adjusting for propensity scores, NSAID use over 12 months was almost half in the Ho group (OR, 0.54; 95%CI, 0.38-0.78) as compared to the CM group; no difference was found in the Mx group (OR, 0.81; 95% CI: 0.59-1.15). CONCLUSION: MSD patients seen by homeopathic physicians showed a similar clinical progression when less exposed to NSAID in comparison to patients seen in CM practice, with fewer NSAID-related adverse events and no loss of therapeutic opportunity.

Academic doctors' views of complementary and alternative medicine (CAM) and its role within the NHS: an exploratory qualitative study.

BACKGROUND: There has been a marked increase in the use of complementary and alternative medicine (CAM) in the UK population in recent years. Surveys of doctors' perspectives on CAM have identified a variety of views and potential information needs. While these are useful for describing the proportions of doctors who hold particular attitudes towards CAM, they are less helpful for understanding why. In addition, while the views of non-academic doctors have begun to be studied, the perspective and rationales of academic doctors remains under-researched. It seems important to investigate the views of those with a research-orientation, given the emphasis on the need for more scientific evidence in recent debates on CAM. METHODS: This exploratory study used qualitative methods to explore academic doctors' views of CAM and the rationales they provided for their views. A purposeful sampling strategy was used to identify doctors with a dual clinical and academic role in the Bristol area, with an anticipated variety of views on CAM. Semi-structured interviews were conducted with nine doctors. The data were analysed thematically, drawing on the Framework Approach. RESULTS: The doctors expressed a spectrum of views on CAM, falling into three broad groups: the 'enthusiasts', the 'sceptics' and the 'undecided'. Scepticism or uncertainty about the value of CAM was prominent, except among those practising a form of CAM. A variety of rationales underpinned their perspectives on CAM, a key recurring rationale being their perspective on the scientific evidence base. The main themes arising included: the role of doctors' professional experiences of conventional medicine and CAM in shaping their attitudes towards CAM, doctor-patient communication about CAM and patient disclosure, whether there is a need for training and education in CAM for doctors, a hierarchy of acceptability of CAM and the nature of evidence; and the role of CAM within the NHS. CONCLUSION: Despite the caution or scepticism towards CAM expressed by doctors in this study, more open doctor-patient communication about CAM may enable doctors' potential concerns about CAM to be addressed, or at least enhance their knowledge of what treatments or therapies their patients are using. Offering CAM to patients may serve to enhance patients' treatment choices and even increase doctors' fulfilment in their practice. However, given the recurring concerns about lack of scientific evidence expressed by the doctors in this study, perceptions of the evidence base may remain a significant barrier to greater integration of CAM within the NHS.

Integrative management of pediatric tonsillopharyngitis: An international survey.

This survey investigated the management of pediatric tonsillopharyngitis, with a focus on natural remedies. 138 pediatricians, general practitioners and ear-nose-throat (ENT) specialists in 7 countries were surveyed by a dedicated questionnaire. A rapid strept test (RST) to diagnose acute tonsillopharyngitis was routinely used by 56/138 participants (41%). The use of RST allowed 200 diagnosis/year compared with 125 diagnosis/year for clinicians who did not use this tool. Homeopathy remedies were prescribed as a supportive therapy by 62% of participants (85/138). Among different homeopathic remedies, SilAtro-5-90 was the most frequently prescribed (53/138, 38%). In the chronic setting, homeopathy was suggested as a supportive therapy by 82/138 participants (59%), phytotherapy by 39 (28%) and vitamins/nutritional supplementation by 51 (37%). The management of tonsillopharyngitis in pediatric patients still remains empiric. Natural remedies, and homeopathy in particular, are used in the management of URTIs. An integrative approach to these infections may help reduce excessive antibiotic prescription.

A comparison of the attitudes shown by general practitioners, hospital doctors and medical students towards alternative medicine.

The aim of this study was to compare and contrast the views of general practitioners (GPs), hospital doctors and medical students to alternative medicine. A questionnaire was sent to a random sample of 100 GPs and 100 hospital doctors in the South West Thames Regional Health Authority (SWTRHA). A convenience sample of 237 pre-clinical medical students at St George's Hospital Medical School was also given a questionnaire. Eighty-seven GPs and 81 hospital doctors replied. Five therapies were investigated: acupuncture; chiropractice; homeopathy; naturopathy; and osteopathy. All respondents were asked about their attitude towards and knowledge of these therapies. Doctors were asked how often they referred patients for such treatment and whether they practised it themselves. GPs and hospital doctors had similar levels of knowledge of the therapies. Medical students were the least informed but the most enthusiastic respondents. Seventy per cent of hospital doctors and 93% of GPs had, on at least one occasion, suggested a referral for alternative treatment. GPs were making these referrals more frequently and earlier. Twelve per cent of hospital doctors and 20% of GPs were practising alternative medicine. The majority of the respondents felt that alternative medicine should be available on the National Health Service (NHS) and that medical students should receive some tuition about alternative therapies. A considerable proportion of those doctors referring patients to alternative practitioners were ignorant of their official qualifications.

The value of complementary and alternative medicine in the treatment of climacteric symptoms: results of a survey among German gynecologists.

OBJECTIVES: The present study aims to detect the attitude and experience towards complementary and alternative medicine (CAM) in the treatment of climacteric disorders among gynecologists in Germany. STUDY DESIGN: A self-administered questionnaire, containing 15 questions, was sent to all gynecologists in private practice in Germany (n=9589). MAIN OUTCOME MEASURES: Gynecologists were asked about their experience with several forms of CAM. They were asked to rate different procedures as "effective", "sometimes effective" or "unimportant". RESULTS: The response rate was 33.7% (n=3227). We report on 2549 (26.6%) eligible questionnaires. Well-known therapies were black cohosh (Cimicifuga racemosa), chaste tree (Vitex agnus castus) and St. John's wort. More than 98% had had experiences with these therapies. Fewer experiences were stated with hormone-yoga (42.9%), acupuncture (29.1%) and homeopathy (21.6%). The most effective alternative therapy rated was an alteration of lifestyle with 54.4% (n=1325) stating it was effective and 35.7% (n=871) stating it was sometimes effective. Only 3.9% (n=96) prescribed no efficacy to a change of lifestyle. Other treatments rated as effective were St. John's wort (25.0%, n=606) and Black cohosh (21.1%, n=527). Agents regarded most ineffective were hormone-yoga (4.7%, n=109), acupuncture (10.3%, n=243) and homeopathy (10.6%, n=250). Female gynecologists were more likely to vote for a therapy to be effective compared to their male colleagues. CONCLUSIONS: German gynecologists seem to have made positive experiences with CAM when observing their patients, in general. An alteration of lifestyle is seen as the most effective alternative therapy in menopause. Due to their widespread use, possible side effect of natural agents should be excluded.

[Physicians attitudes towards complementary and alternative medicine in patients with cancer: preliminary report from pediatric and oncology centers]. / Postawy i opinie lekarzy leczacych pacjentow onkologicnyzh wobec medycyny alternatywnej i komolementarnej: doniesienie wstepne.

BACKGROUND: Opinions and attitudes of physicians concerning methods of complementary and alternative medicine (CAM) may have an influence on decisions of treatment and life of patients with cancer. Knowledge of oncologists regarding CAM methods is an important factor in professional and safe anti-cancer therapy. OBJECTIVE: Analysis of opinions and attitudes of physicians working in oncological wards concerning CAM methods. METHODS: A survey based on an anonymous questionnaire was performed among 52 physicians, including 28 women and 24 men from four oncological centres (paediatric and adult). RESULTS: All physicians had good knowledge on terminology and principles of CAM. 92% of responders knew the terminology of CAM; 75% of physicians understood the principles of methods of CAM. Knowledge on CAM methods and advising these methods to patients were strongly interrelated. 42.3% of doctors applied at least one of CAM methods to their patients. The most frequent methods, which were applied included herbal medicine, preparations of alternative medicine, acupuncture and homeopathy (59%, 36.4%, 18.2% and 13.6% of CAM users, respectively). CAM methods were more often applied to patients by doctors with longer professional experience. In opinion of 54% responders, CAM methods are ineffective in oncology, however 23% of physicians observe partially positive effect of CAM methods when used as a supportive therapy. 48/52 (92.3%) responders have not seen any efficacious activity of CAM methods in oncological patients. CONCLUSIONS: Awareness of oncologists concerning patients' interest in use of CAM methods is sufficient, however, high percentage of doctor's approval of use of CAM methods by patients undergoing anticancer therapy is disturbing. There is a need for research on safety and an educational programme for doctors on the inefficacy of CAM methods. The project requires further studies.

Empatía en médicos con experiencia en Medicina Alternativa. Universidad Nacional de Colombia ­ Bogotá 2012 ­ 2013 / Empathy in doctors with experience in Alternative Medicine. Universidad Nacional de Colombia - Bogotá 2012 - 2013

El presente estudio de carácter epidemiológico cuantitativo descriptivo correlacional tuvo como objetivo caracterizar el nivel de empatía de los médicos con experiencia en medicina alternativa en sus distintas áreas de énfasis (Homeopatía, Medicina Tradicional China y Acupuntura, Terapia Neural y Osteopatía) en el periodo comprendido entre Julio y Diciembre de 2012. Se realizó mediante el diligenciamiento de un instrumento de recolección de información basado en la Escala de Empatía Médica de Jefferson (JSPE) y la categorización y posterior correlación de los puntajes obtenidos con variables sociodemográficas propias de los sujetos, quienes voluntariamente decidieron participar en el mismo. El puntaje general de empatía encontrado en los médicos participantes fue en promedio de 124,81, con un rango de puntaje entre 94-140, una mediana de 127 y una DS de 9,93, observándose una mayor frecuencia de individuos de género femenino, pero sin mostrar una diferencia estadísticamente significativa con respecto a la población de género masculino. Al analizar los datos recolectados se evidencian niveles de empatía semejantes en médicos con formación en medicina alternativa y en quienes son especialistas médicos en áreas como psiquiatría, medicina familiar, medicina interna y pediatría, reportados en la literatura científica con puntajes favorables de empatía.