Diagnoses and visit length in complementary and mainstream medicine.

BACKGROUND: The demand for complementary medicine (CM) is growing worldwide and so is the supply. So far, there is not much insight in the activities in Dutch CM practices nor in how these activities differ from mainstream general practice. Comparisons on diagnoses and visit length can offer an impression of how Dutch CM practices operate. METHODS: Three groups of regularly trained physicians specialized in CM participated in this study: 16 homeopathic physicians, 13 physician acupuncturists and 11 naturopathy physicians. Every CM physician was asked to include a maximum of 75 new patients within a period of six months. For each patient an inclusion registration form had to be completed and the activities during a maximum of five repeat visits were subsequently registered. Registrations included patient characteristics, diagnoses and visit length. These data could be compared with similar data from general practitioners (GPs) participating in the second Dutch national study in general practice (DNSGP-2). Differences between CM practices and between CM and mainstream GP data were tested using multilevel regression analysis. RESULTS: The CM physicians registered activities in a total of 5919 visits in 1839 patients. In all types of CM practices general problems (as coded in the ICPC) were diagnosed more often than in mainstream general practice, especially fatigue, allergic reactions and infections. Psychological problems and problems with the nervous system were also diagnosed more frequently. In addition, each type of CM physician encountered specific health problems: in acupuncture problems with the musculoskeletal system prevailed, in homeopathy skin problems and in naturopathy gastrointestinal problems. Comparisons in visit length revealed that CM physicians spent at least twice as much time with patients compared to mainstream GPs. CONCLUSIONS: CM physicians differed from mainstream GPs in diagnoses, partly related to general and partly to specific diagnoses. Between CM practices differences were found on specific domains of complaints. Visit length was much longer in CM practices compared to mainstream GP visits, and such ample time may be one of the attractive features of CM for patients.

Homeopathy in the public health system: a seven-year observational study at Lucca Hospital (Italy).

OBJECTIVE: To evaluate the response to homeopathic treatment in a public homeopathic clinic of all patients attending between September 1998 until December 2005, and to analyze homeopathic practice. METHODS AND SETTING: Longitudinal observational study in a homeopathic clinic based in a public hospital in Lucca, Italy. Data relating to patient details, clinical diagnosis, remedy prescribed, potency of dosage, prescription strategy and identification of the case as acute-chronic-recurrent were analyzed. Clinical response was assessed by the Glasgow Homeopathic Hospital Outcome Score. RESULTS: Overall 74% of patients reported at least moderate improvement. Outcomes were better with longer treatment duration and younger age of patients. Respiratory, followed by dermatological and gastrointestinal pathologies responded best, psychological problems relatively poorly. CONCLUSIONS: Homeopathic therapy is associated with improvement in a range of chronic and recurring pathologies. Certain characteristics of patient and pathology influence the outcome.

[Prevalence of psychiatric disorders in French general practice using the patient health questionnaire: comparison with GP case-recognition and psychotropic medication prescription]. / Prévalence des troubles psychiatriques en médecine générale selon le patient health questionnaire: adéquation avec la détection par le médecin et le traitement prescrit.

INTRODUCTION: Psychiatric disorders, mainly depression and anxiety, are frequently encountered in primary care and are a major cause of distress and disability. Nearly half of cases go unnoticed and among those that are recognised, many do not receive adequate treatment. In France, there is limited research concerning the prevalence, detection and management of these conditions in primary care. OBJECTIVES: To estimate the prevalence of psychiatric disorders, overall and for the main psychiatric diagnostic categories, encountered in primary care; to describe general practitioners' (GPs') case identification rate; to examine psychotropic medication prescription according to diagnosis, in a regionally representative sample of GP attenders. METHODS: GP practicing standard general practice in an urban area of the city of Montpellier and a nearby semi-rural region were recruited to participate. The response rate was 32.8% (n=41). Five additional GP almost exclusively offering homeopathy and acupuncture were recruited nonrandomly for convenience purposes. In each GP surgery, consecutive patients entering the waiting room were invited by a research assistant to participate until 25 patients per GP were recruited. Each participant completed self-report questionnaires in the waiting time, including the patient health questionnaire (PHQ), which yields provisional DSM-IV diagnoses. The GP completed a brief questionnaire during the consultation, giving his/her rating of the severity of any psychiatric disorder present and action taken. RESULTS: The patient response rate was 89.8%. In all, 14.9% of patients reached DSM-IV criteria for major depression or anxiety disorder on the PHQ (9.1% for major depression, 7.5% for panic disorder; 6% for other anxiety disorders). For the subthreshold categories, 7.4% met criteria for other depressive disorders, 11.8% for somatoform disorders and 10.9% for probable alcohol abuse or dependence. 66.3% of patients with DSM-IV diagnoses of major depression or anxiety disorder were identified by the GP as having a psychiatric disorder. The identification rate was 51% for all depressive disorders, anxiety and somatoform disorders. Of patients receiving a prescription for anxiolytic or antidepressant medication on the survey day, 80% were classified as cases of psychiatric disorder by the GP. Only 48.8% met criteria for major depression or anxiety disorder on the PHQ. CONCLUSION: This study highlights the frequency of psychiatric disorders in a regional study of French general practice. Overall, prevalence rates were similar to those found elsewhere, except for probable alcohol abuse and dependence, which was considerably higher than in the USA PHQ validation study. As in other countries, GP identified roughly half of psychiatric cases. Furthermore, half of patients treated by anxiolytic or antidepressant medication did not meet the diagnostic criteria on the survey day for which these medications have mainly shown their efficacy. This confirms the French paradox of one of the highest psychotropic medication consumption rates in Europe despite many cases of depression remaining untreated. The PHQ could be a rapid and acceptable diagnostic aid tool for French general practice but first needs to be validated against the diagnosis of mental health professionals in this setting.

The pathway followed by psychotic patients to a tertiary health center in a developing country: a comparison with patients with epilepsy.

The objective of this study was to describe and compare the pathways followed by Malay patients with psychoses (schizophrenia and schizophreniform disorder) and Malay patients with epilepsy to a tertiary health center in the northeastern area of peninsular Malaysia. There were 60 patients in each group. The most popular pathway for both groups was first contact with traditional or alternative healers. Consultation with Malay traditional healers (bomohs) and/or homeopathic practitioners (44.2%) was significantly higher for psychotic patients (61.7%) than for patients with epilepsy (26.7%) (chi(2)(2)=15.609, P<0.001). Direct access (24.2%) was the second most popular pathway and almost equally followed by both groups of patients. The third and last pathway was initial contact with private general practitioners and government doctors, respectively. Patients with epilepsy dominated the last two pathways. The treatment delay (TD) was significantly longer in epileptic than psychotic patients regardless of their visit to a bomoh and/or homeopathic practitioner (P<0001) or not (p<0.01). The socioeconomic status of psychotic patients also was significantly better than people with epilepsy (chi(2)=9.957, chi(2)(4), p=0.041).

Use of complementary and alternative medicine in Germany - a survey of patients with inflammatory bowel disease.

BACKGROUND: Previous studies have suggested an increasing use of complementary and alternative medicine (CAM) in patients with inflammatory bowel disease (IBD). The aim of our study was to evaluate the use of CAM in German patients with IBD. METHODS: A questionnaire was offered to IBD patients participating in patient workshops which were organized by a self-help association, the German Crohn's and Colitis Association. The self-administered questionnaire included demographic and disease-related data as well as items analysing the extent of CAM use and satisfaction with CAM treatment. Seven commonly used CAM methods were predetermined on the questionnaire. RESULTS: 413 questionnaires were completed and included in the analysis (n = 153 male, n = 260 female; n = 246 Crohn's disease, n = 164 ulcerative colitis). 52 % of the patients reported CAM use in the present or past. In detail, homeopathy (55%), probiotics (43%), classical naturopathy (38%), Boswellia serrata extracts (36%) and acupuncture/Traditional Chinese Medicine (TCM) (33%) were the most frequently used CAM methods. Patients using probiotics, acupuncture and Boswellia serrata extracts (incense) reported more positive therapeutic effects than others. Within the statistical analysis no significant predictors for CAM use were found. 77% of the patients felt insufficiently informed about CAM. CONCLUSION: The use of CAM in IBD patients is very common in Germany, although a large proportion of patients felt that information about CAM is not sufficient. However, to provide an evidence-based approach more research in this field is desperately needed. Therefore, physicians should increasingly inform IBD patients about benefits and limitations of CAM treatment.

Auditing outcomes and costs of integrated complementary medicine provision--the importance of length of follow up.

A retrospective audit was carried out on 58 patients with chronic health problems who were referred by 22 general practitioners (GPs) for acupuncture, aromatherapy, homeopathy, massage and osteopathy, or a combination. Costs of GP consultations, prescriptions, secondary care referrals, and diagnostic tests from records of 33 of these patients were compared pre (24 months), during (mean 4.3 months) and post (mean 5.7 months) complementary medicine (CM) treatment. Patient centred outcome data included the Measure Yourself Medical Outcome Profile (MYMOP) and content analysis of patient and practitioner comments. Costs of GP consultations/patient/month were significantly higher during (20.10 pounds, p<0.001) and post (17.53 pounds, p<0.01) CM treatment compared with pre-treatment costs (11.27 pounds). Total prescription costs were not significantly higher during and post-treatment than pre-treatment. Prescription costs for referred conditions were lower during (2.26 pounds) and higher post-treatment (3.75 pounds) compared with costs pre-treatment (3.24 pounds). Pre- and post-treatment MYMOP scores indicated significant improvements in health and well-being. Longer follow up, is required in order to demonstrate significant cost savings related to CM provision. Cost comparisons with conventional medicine should consider quantitative and qualitative data to capture the wider benefits experienced by patients.

Patients' choice of asthma and allergy treatments.

BACKGROUND AND OBJECTIVES: Only a few studies have focused on a comparison between general practitioner (GP) patients' and classical homeopath (CH) patients' reasons for choosing, continuing or termination of their treatment by GPs or CHs, respectively. The existing studies are mostly based on quantitative methods and dealing with patients' reasons for choosing complementary and alternative medicine (CAM). The objective of this paper is to develop concepts to understand and compare Danish GP patients' and CH patients' initial choice of, continuing choice of, and termination of treatments for asthma and allergy. DESIGN: Data originate from an explorative study based on semistructured interviews with 18 GP patients and CH patients having asthma and allergy. The selection of the patients to the interviews was based on a questionnaire study including 88 respondents (response rate 58 patients). RESULTS: In understanding the patients' initial choice and continuing choice of treatment and termination of treatment, the concepts push-from, pull, press-into, stop, and stay factors are used. These factors are connected to the patients' experiences with conventional treatment, patients' attitudes toward and personal experiences with alternative treatment, and the patients' understanding of their asthma and allergy. The results of the study indicate that patients before seeking CHs had experienced inappropriate health care within the conventional health care system. The results of the study also indicate that if the CH patients experience inappropriate health care within homeopathic treatment, they terminate the treatment. CONCLUSIONS: The study indicates the importance of health providers' insight into GP patients' and CH patients' different reflections on adverse events, the patients' different understandings of asthma and allergy, and the different learning processes that GP patients and CH patients might be involved in while living with asthma and allergy. These are important issues for understanding patients' initial and, continuing choice of and termination of GP treatment and CH treatment, respectively.

The integration of complementary therapies in Australian general practice: results of a national survey.

METHODS: Australian general practitioners' (GPs) attitudes toward and use of a range of complementary therapies (CTs) were determined through a self-administered postal survey sent to a random sample of 2000 Australian GPs. The survey canvassed GPs' opinions as to the harmfulness and effectiveness of CTs; current levels of training and interest in further training; personal use of, and use in practice of, CTs; referrals to CT; practitioners; appropriateness for GPs to practice and for government regulation; perceived patient demand and the need for undergraduate education. RESULTS: The response rate was 33.2%. Based on GPs' responses, complementary therapies could be classified into: nonmedicinal and nonmanipulative therapies, such as acupuncture, massage, meditation, yoga, and hypnosis, that were seen to be highly effective and safe; medicinal and manipulative therapies, including chiropractic, Chinese herbal medicine, osteopathy, herbal medicine, vitamin and mineral therapy, naturopathy, and homeopathy, which more GPs considered potentially harmful than potentially effective; and esoteric therapies, such as spiritual healing, aromatherapy, and reflexology, which were seen to be relatively safe yet also relatively ineffective. The risks of CTs were seen to mainly arise from incorrect, inadequate, or delayed diagnoses and interactions between complementary medications and pharmaceuticals, rather than the specific risks of the therapies themselves. CONCLUSIONS: Nonmedicinal therapies along with chiropractic are widely accepted in Australia and can be considered mainstream. GPs are open to training in complementary therapies, and better communication between patients and GPs about use of CTs is required to minimize the risk of adverse events. There is also a need to prioritize and provide funding for further research into the potential adverse events from these therapies and other therapies currently lacking an evidence base.

Developing and evaluating complementary therapy services: Part 1. Establishing service provision through the use of evidence and consensus development.

The integration of complementary therapies within the British National Health Service (NHS) in the context of limited evidence of effectiveness has been much debated, as has the need for the provision of health services to be more evidence-based. In June 1994, a project was launched within a South-East London NHS Hospital Trust to introduce complementary therapy (acupuncture, homeopathy, and osteopathy), in the context of an evaluation program. This followed approximately 4 years of working toward raising the profile of complementary therapies within the hospital through study days, workshops, and providing a massage and osteopathic service for staff. A survey of local general practitioners highlighted areas of complementary therapy provision and interest in referring patients to a hospital-based service. A steering group was established to draw together a proposal for funding the service. Evidence for the effectiveness of acupuncture, homeopathy, and osteopathy was presented at a multidisciplinary seminar. A consensus development process, using a modified Delphi technique to establish referral indicators followed this. This study provides a useful model of service development in the absence of good quality evidence for the effectiveness of clinical interventions.

Spirituality and choice of health care practitioner.

BACKGROUND: Patients who include a complementary and alternative medicine (CAM) practitioner in their health care represent a small percentage of the population identified as CAM users. Their choice may be motivated by intangible personality or worldview characteristics. OBJECTIVE: A prospective study was designed to determine if a patient's choice of conventional or alternative health care practitioner was related to total score on an instrument for scaling psychospiritual characteristics. DESIGN: A sequential convenience sample of patients attending five different health care practices in New England. SETTING: A family practitioner (FP) who uses CAM. (1) A FP clearly not identified with CAM. (3) A chiropractor. (4) A naturopath, and (5) A homeopath. OUTCOME MEASURES: Total scores on the Spiritual Involvement and Beliefs Scale (SIBS), plus item scores of five separate questions and two factors. RESULTS: With 210 respondents, SIBS scores in Practice 2 were significantly lower than in practice 1 (p = 0.004), 3 (p = 0.001), 4 (p = 0.018), and 5 (p = 0.02). This pattern remained over the five question scores and two factors. CONCLUSION: Patients who chose a physician associated with CAM, or an alternative practitioner (chiropractor, naturopath, or homeopath) for their direct health care scored higher on a psychospiritual testing instrument (SIBS) than those who chose a conventional physician.

[Opinions and practices of family physicians regarding measles-mumps-rubella vaccination]. / Opinions et pratiques des médecins généralistes face à la vaccination rougeole-oreillons-rubéole.

BACKGROUND: Measles-mumps-rubella immunization rates among young children depend on the awareness and responsibility of parents and physicians. In order to improve immunization programmes, it is important to enhance our knowledge about attitudes of physicians in regard to MMR immunization. A random sample of 1013 general practitioners was interviewed by telephone in December 1994, with the collaboration of the BVA Institute. The large majority of French physicians (86%) have a favourable opinion about MMR immunization that they systematically propose to each child aged 12-24 months. However, barriers remain among some physicans. Favourable opinion about MMR immunization to infants was less frequent among physicians aged 41-50 years, homeopaths, those practicing in Southern France, those asking for higher payment to patients, those who are treating a small proportion of patients receiving public medical aid, those not convinced about the role of physicians in health education, those who experienced side-effects of immunization and those who are not personnally immunized against hepatitis B. Eradication of measles, mumps and rubella in France will be only achieved through a stronger and well-argumented information of physicians supported by health professional organizations.

[Determinants for choice of medical management in the Bas-Rhin]. / Les déterminants du choix de la prise en charge médicale dans le Bas-Rhin.

UNLABELLED: It has already been established that the social origin and the demographic factors have an influence, among other things, on medical practice. What about it in the Bas-Rhin? Our survey's objective consists of emphasising on what motivates the choice of the type of medicine. METHOD: Phone survey on a representative sample of 1010 persons aged between 25 and over 64, residing in the Bas-Rhin. RESULTS: Participation has been of 66.3%. Among participants, there are 49.1% of men and 50.9% of women. 9 among 10 participants state that they have a family doctor. More women claim they are more likely to see a homeopathic doctor and/or a professional of alternative medicine. 8 among 10 persons have their blood pressure checked. 50.9% of participants have a blood analysis made in order to determine their cholesterol level. Building on these medical practices, several groups have been created. 54.1% of participants belong to the same group, having in common the facts of having a family doctor, having their blood pressure checked, and never seeing a professional of alternative medicine. The female participants are properly followed up on the gynecological point of view. Only 29 among 500 women have never had a cervical smear done. The carrying out of a mammography raises with age. When fearing a potential cancer, the first step taken by 56.2% of participants consists of seeing a generalist doctor, whereas 65.9% would prefer going to the hospital to perform further tests. As far as treatment is concerned, 76.8% of them would rather go to a specialised department, even if it is located far from their home. Special attention is to be paid to the fidelity of the population of the Bas-Rhin toward their family doctor. He represents the main link of information between the patient and the prevention policies that have been implemented over the last years.

Health correlates and mode of administration of hormones--are there any differences between parenteral and oral estrogen preparations?

OBJECTIVES: To investigate use-associated differences between parental and oral hormone therapy (HT) users in reference to HT non-users regarding self-rated general health status, quality of life, health service utilization, and selected chronic diseases. METHODS: All cases of last-week medicine use were recorded among 2248 women aged 40-79 who participated in the German Health Interview and Examination Survey 1997-1999. 89 current parenteral HT users and 322 oral HT users were identified. Health correlates were compared between the two groups in reference to HT non-users. RESULTS: Oral HT users had a poorer current health status as well as an impaired health status compared to the year before, were less satisfied with their health and life in general, and showed a lower quality of life regarding 'body pain' and 'vitality' in comparison with hormone non-users (all p<.05). Parenteral HT users showed no significant difference compared with HT non-users and oral HT users, respectively, in these health correlates except for a less satisfaction with health found in comparison with HT non-users (p=.002). Prevalences of cerebral-cardiovascular diseases were not different among women using parenteral or oral HT use. Parenteral HT users visited the offices of general practitioner and gynecologists more frequently than oral HT users as well as hormone non-users (all p<.05). CONCLUSIONS: Oral HT use is associated with a negative assessment for health well-being whereas parenteral HT use shows largely a neutral effect. Further designated studies could clarify whether the mode of hormone administration consistently affects health-related quality of life and whether the mode of hormone treatment influences the choice of outpatient facilities for surveillance of therapy.

Expectations and effectiveness of medical treatment and classical homeopathic treatment for patients with hypersensitivity illnesses--one year prospective study.

OBJECTIVE: To describe and compare characteristics of adult patients who received treatment for hypersensitivity illnesses by general practitioners (GPs) and classical homeopaths (CHs) over a period of 1 year and examine the statistical predictors of self-reported treatment outcomes. MATERIAL AND METHODS: We conducted a survey on 151 Danish adult patients with hypersensitivity illnesses, who chose treatment from one of 13 GPs or one of 10 CHs who participated in the project. The treatments were given as individual packages in the naturalistic clinical setting. Patients completed questionnaires at start of treatment, after 6 months and a year after start of treatment. Response rates for the first, second and third questionnaire were respectively 68%, 98%, 95% for the GP patients and 82%, 98%, 94% for the CH patients. RESULTS: Patients seeking CH treatment in this study are significantly different in gender and education from patients seeking GP treatment. We did not find significant differences in terms of occupational training, occupation, sickness absence due to hypersensitivity illnesses, diseases other than hypersensitivity illnesses, symptoms severity due to hypersensitivity illnesses before treatment and expectation of the ability of the treatment to alleviate symptoms. Eighty-eight percent of GP and 21% of CH patients were continuing treatment after 1 year. Regression analysis showed that the only significant independent variables to explain the probability of obtaining very positive effect or cure for GPs and CHs were that the patients were in 'maintenance treatment', and had high expectation before treatment of the ability of the treatment to relieve their symptoms. CONCLUSION: In this study self-reported very positive effect of GP treatment and very positive effect and cure of CH treatment are associated with the patients' high expectation of the treatment and continuation of maintenance treatment.

An exploratory retrospective study of people suffering from hypersensitivity illnesses who attend medical or classical homeopathic treatment.

The objective of this study is to describe patients who had treatment for hypersensitivity illnesses by general practitioners (GPs) or classical homeopaths (CHs) and the patients' self-reported effectiveness of the treatment received. The data stems from an exploratory retrospective study amongst 88 Danish patients (response rate 58%) suffering from hypersensitivity illnesses, who chose treatment from one of six GPs or one of 10 CHs who participated in the project. The patients themselves selected their treatment. The GPs or the CHs considered that the patient's treatment was complete or that the patient was in a situation of current 'maintenance treatment'. The patients' primary reason for consulting the GP or the CH was that they were suffering from hypersensitivity illnesses. No significant difference was found between the two groups of patients in relation to age, education and duration of hypersensitivity symptoms. The CH patients were more likely to be employed in teaching, research, health care or the social sector compared to GP patients. The two groups of patients were similar in respect of their health at the start of the treatment, 57% of the patients who consulted a CH experienced an improvement of their state of health compared to 24% of the GP patients. Both groups of patients experienced an improvement of their psychological health after treatment. Logistic regression analysis showed that the GP or CH was the only significant effect variable. The results are based on the patients' retrospective, self-reported effectiveness of the treatments.

Homoeopathic and herbal prescribing in general practice in Scotland.

AIMS: To investigate the current levels of homoeopathic and herbal prescribing in Scottish general practice. METHODS: Prescribing of homoeopathic and herbal remedies in primary care was assessed in 1891 669 patients for the year 2003-2004, using computerized prescribing data retrieved from 323 general practices in Scotland. RESULTS: Forty-nine percent of practices prescribed homoeopathic and 32% herbal remedies. A total of 193 homoeopathic and 17 herbal remedies were prescribed, with 5% of practices accounting for 46% of patients and 50% of remedies. Four thousand one hundred and sixty patients (2.2/1000 registered patients) were prescribed at least one homoeopathic remedy during the study period, with the highest prevalence to children under 12 months of age (9.5/1000 children of that age). Children under the age of 16 made up 16% of the population prescribed homoeopathic remedies (2.2/1000 registered patients of that age). Three hundred and sixty-one patients (0.2/1000 registered patients) were prescribed at least one herbal remedy during the study period, 44 of whom were children < 16 years old. Patients prescribed a homoeopathic or herbal remedy were also prescribed a median of four and five conventional medicines, respectively. Of patients prescribed an oral herbal remedy, 4% were also concomitantly prescribed a conventional medicine with which a drug-herb interaction has been documented. CONCLUSIONS: Our study reports that a substantial number of Scottish general practitioners prescribe homoeopathic and herbal remedies, with an approximate doubling in the number of children prescribed homoeopathic remedies. The level of homoeopathic and herbal prescribing raises questions about homoeopathic/herbal provision in the National Health Service and should prompt critical review.

Responses to homeopathic treatment in National Health Service general practice.

OBJECTIVE: To assess homeopathic consultations in NHS general practice over a 12-month study period; to analyse the conditions treated homeopathically and assess the responses to homeopathy prescribed in a standard 10 min GP consultation. METHODS: Data on each homeopathic consultation over 12 months were recorded: including patient details; condition/diagnosis; response score; prescribed medicine; prescribing strategy; medical specialty category. Clinical response was scored using a modified version of the Glasgow Homeopathic Hospital Outcome Scale. RESULTS: Over the 12-month study period, a total of 5,331 consultations were conducted within the general practice; 489 (9%) of these consultations were homeopathic. A wide variety of conditions were treated homeopathically, 78% of patients had a positive clinical response, 19% no response, 3% negative response. Analysis of the prescribing strategies demonstrated that 73% of the homeopathic prescriptions were issued using the 'problem-based' strategy. The remainder were 'patient-based' (19%), 'context-based' (4%) and 'combined' (4%) strategies. CONCLUSIONS: This study illustrates the varied and successful application of homeopathy within the general practice setting. Response scores reveal the beneficial effects of homeopathic treatment. This study supports the use of homeopathy within NHS general practice, delivered in a 10 min consultation.

Paediatric homoeopathy in general practice: where, when and why?

AIMS: To investigate the extent of homoeopathic prescribing in primary care for childhood diseases and assess GP attitudes towards the use of homoeopathy in children. METHODS: Homoeopathic prescribing in primary care was assessed in 167 865 children aged 0-16 years for the year 1999-2000. Computerized prescribing data were retrieved from 161 representative general practices in Scotland. Medical attitudes towards homoeopathic prescribing to children were also assessed via a questionnaire survey. RESULTS: During the year 1999-2000 22% (36) of general practices prescribed homoeopathic medicines to 190 (1.1/1000 registered) children. The majority of such prescriptions were issued to children under 1 year of age (8.0/1000 registered children). The most frequently prescribed medicines were for common self-limiting infantile conditions such as colic, cuts and bruises, and teething. A total of 259 completed questionnaires were returned by GPs, giving a response rate of 75%. GPs who frequently prescribed homoeopathic medicines to children (more than 1 per month) were more likely to claim an interest in homoeopathy, have had a formal training and keep up to date in the discipline, and refer on to a homoeopath (P < 0.001 for all variables) than those GPs who prescribed less than once a month or never. The majority of GPs who prescribed homoeopathic medicines did so when conventional treatments had apparently failed (76%), while 94% also perceived homoeopathy to be safe. Frequent prescribers reported a more positive attitude towards homoeopathic medicines than those who prescribed less frequently. Non-prescribers reported a lack of proven efficacy and lack of training as the main reasons for not prescribing homoeopathic medicines (55% and 79%, respectively). However non-prescribers from within homoeopathic prescribing practices reported a more favourable attitude in general towards homoeopathy and less resistance towards prescribing in the future than non-prescribers from practices where none of the partners practiced homoeopathy. CONCLUSIONS: In primary care paediatric prescribing of homoeopathic medicines most commonly occurs for self-limiting conditions in infants less than 1 year of age. Although the current level of homoeopathic prescribing is low, the widespread use in the community suggests that at least some knowledge of the main indications for homoeopathy and the preparations used would be of benefit to registered medical practitioners.