Motivations of patients seeking supportive care for cancer from physicians prescribing homeopathic or conventional medicines: results of an observational cross-sectional study.

BACKGROUND & AIMS: The motivations of patients who consult a homeopathic (GP-Ho) or conventional (GP-CM) general practitioner for supportive care during cancer treatment have not been widely studied. We investigated the reasons why cancer patients consult a GP-Ho versus a GP-CM for supportive care and the GPs' motivations for their prescriptions. METHODS: This observational survey was carried out in France between October 2008 and October 2011. GPs across France were randomly selected and asked to recruit four cancer patients each. At inclusion, the sociodemographic and clinical (including psychological) characteristics and medical history of the patients were recorded by the GPs and the patients noted their quality of life (QoL) and anxiety/depression using the Quality of Life Questionnaire-C30 (QLQ-C30) and Hospital Anxiety and Depression Scale (HADS) self-questionnaires. The main motivations of the patients regarding the type of GP consultation and the main reasons for the GPs' prescriptions were recorded. RESULTS: Six hundred and forty four patients were included in the analysis: 399 consulted a GP-CM (n = 112) and 245 a GP-Ho (n = 73). Patients consulting a GP-Ho were more often female [OR = 1.93; 95%CI: 1.11-3.35; p = 0.02], employed in a professional capacity [OR = 6.57; 95%CI: 1.96-21.99; p = 0.002], have a shorter time since cancer diagnosis [OR = 2.19; 95%CI: 1.24-3.87; p = 0.007], have received targeted anticancer therapy [OR = 3.70; 95%CI: 1.67-8.18; p = 0.001] and have a high QLQ-C30 score for constipation [OR = 1.01; 95%CI: 1.00-1.02; p = 0.001]. Patients mainly consulted a GP-Ho to receive overall care (73.5% vs. 64.9%; p = 0.024) and medicines to prevent anticancer treatment-related side-effects (63.7% vs. 41.4%; p < 0.0001). In contrast, patients consulted a GP-CM to receive psychological care (50.1% vs. 40.8%; p = 0.021) and more information regarding the oncologists' strategic decisions (p < 0.0001). There was a significantly greater prescription of psychotropic drugs by GP-CM (53.7% vs. 22.4%, p < 0.0001). CONCLUSIONS: Patients consulting a GP-Ho or GP-CM had different motivations for seeking supportive care. There was a significantly greater prescription of psychotropic drugs by GP-CM.

Complementary and alternative medicine (CAM) in obstetrics and gynaecology: a survey of office-based obstetricians and gynaecologists regarding attitudes towards CAM, its provision and cooperation with other CAM providers in the state of Hesse, Germany.

PURPOSE: Whereas we have some information on complementary medicine in the field of oncology, little is known about complementary medicine in the field of obstetrics and gynaecology especially outside of hospitals. METHODS: All office-based obstetricians and gynaecologists in the state of Hesse, Germany, were contacted and asked to fill in an assessment form regarding cooperation in the field of complementary and alternative medicine (CAM), as well as the perceived efficacy of various CAM methods for a number of pathological conditions in the field of obstetrics and gynaecology. RESULTS: It was found that more than half of Hessian office-based obstetricians and gynaecologists had existing cooperation regarding CAM, especially with colleagues, but also midwives, pharmacists, physiotherapists, and health practitioners. The probability of cooperation was significantly inversely associated with age. It was found that the probability for advising CAM differed between various health problems. The following CAM methods were considered reasonable for the treatment of different conditions: phytotherapy for climacteric complaints and premenstrual syndrome; homoeopathy for puerperal problems; acupuncture and traditional Chinese medicine for complaints during pregnancy; and dietary supplements for the side effects of cancer therapy. CONCLUSIONS: The analysis shows that there is much cooperation in the field of CAM. Comparison between physicians' perceived efficacy of CAM methods and objective findings shows that there is a need for the provision of valid information in the field.

Homeopathy has clinical benefits in rheumatoid arthritis patients that are attributable to the consultation process but not the homeopathic remedy: a randomized controlled clinical trial.

OBJECTIVES: To assess whether any benefits from adjunctive homeopathic intervention in patients with RA are due to the homeopathic consultation, homeopathic remedies or both. METHODS: Exploratory double-blind, randomized placebo-controlled trial conducted from January 2008 to July 2008, in patients with active stable RA receiving conventional therapy. Eighty-three participants from three secondary care UK outpatient clinics were randomized to 24 weeks of treatment with either homeopathic consultation (further randomized to individualized homeopathy, complex homeopathy or placebo) or non-homeopathic consultation (further randomized to complex homeopathy or placebo). Co-primary outcomes: ACR 20% improvement (ACR20) criteria and patient monthly global assessment (GA). SECONDARY OUTCOMES: 28-joint DAS (DAS-28), tender and swollen joint count, disease severity, pain, weekly patient and physician GA and pain, and inflammatory markers. RESULTS: Fifty-six completed treatment phase. No significant differences were observed for either primary outcome. There was no clear effect due to remedy type. Receiving a homeopathic consultation significantly improved DAS-28 [mean difference 0.623; 95% CI 0.1860, 1.060; P = 0.005; effect size (ES) 0.70], swollen joint count (mean difference 3.04; 95% CI 1.055, 5.030; P = 0.003; ES 0.83), current pain (mean difference 9.12; 95% CI 0.521, 17.718; P = 0.038; ES 0.48), weekly pain (mean difference 6.017; 95% CI 0.140, 11.894; P = 0.045; ES 0.30), weekly patient GA (mean difference 6.260; 95% CI 0.411, 12.169; P = 0.036; ES 0.31) and negative mood (mean difference - 4.497; 95% CI -8.071, -0.923; P = 0.015; ES 0.90). CONCLUSION: Homeopathic consultations but not homeopathic remedies are associated with clinically relevant benefits for patients with active but relatively stable RA. TRIAL REGISTRATION: Current controlled trials, http://www.controlled-trials.com/, ISRCTN09712705.

Pharmacists' actions when patients use complementary and alternative medicine with medications: A look at Texas-Mexico border cities.

OBJECTIVES: To determine how often pharmacists inquire about patients' complementary and alternative medicine (CAM) use, actions taken in response to patients' CAM use, and demographic or professional characteristics that predict differences in pharmacists' actions. METHODS: A survey was mailed to 400 randomly selected community pharmacists who resided in Texas-Mexico border cities. RESULTS: Most (63.8%) pharmacists had encountered patients who were using CAM. They documented CAM use in 9.8% of cases and monitored for drug-related problems in 39.4%. Among users, pharmacists sometimes to usually (3.4 ± 1.4 [mean ± SD]) took actions such as referring patients to their physicians. Pharmacists were not particularly comfortable (3.2 ± 1.0) with responding to CAM inquiries but believed patients needed adequate CAM knowledge. Pharmacists rarely to sometimes (2.6 ± 1.2) asked patients about their CAM use. Inquiry about CAM use was greater when information could be documented in profiles (F = 4.29, P = 0.02) and when pharmacists had additional training in CAM (t = -2.59, P = 0.01). Also, in pharmacies that stocked herbal or homeopathic products, pharmacists were more likely to recommend other CAM therapies appropriate for patients' conditions (t = -3.27, P < 0.01). CONCLUSION: Pharmacists were not very proactive in inquiring about CAM use, and their actions (e.g., referral to physician) were somewhat passive. More routine inquiry and documentation are needed. Pharmacists should routinely ask about and document CAM use by patients in order to optimize drug therapy outcomes.

The frequency of dietary references in homeopathic consultations.

A retrospective quantitative study on dietary references found in medical records of 2753 patients attending consultations from 10/1/1994 to 5/31/2007 was conducted. The symptoms found in the rubrics relating to food and drink aggravation and amelioration, aversion and craving of homeopathic repertories reflect diets at different places and times and do not correspond fully, to contemporary gastronomy. Desires for sweet and spicy foods were statistically more frequent, revealing the prevailing taste for such food among the studied population. Food cravings should be carefully analyzed before considering them as indications for choosing homeopathic therapy, they are less significant than aversions, aggravations and ameliorations.

Consultation with health care professionals and influenza immunization among women in contact with young children.

OBJECTIVE: Primary health providers serve an important role in providing and promoting annual influenza immunization to high-risk groups and their close contacts. The purpose of this analysis was to determine whether consultation with a medical professional increases the likelihood of receiving a flu shot among women who have given birth in the past five years and to determine whether this association differs by type of medical professional. METHODS: Data were obtained from the Canadian Community Health Survey (2005), Cycle 3.1. Logistic regression was used to examine the association between receiving a flu shot in the past 12 months and consulting with family doctors, specialists, nurses, chiropractors, or homeopaths/naturopaths. RESULTS: Among the 6,925 women included in our sample, 1,847 (28.4%) reported receiving a flu shot in the past 12 months. After adjustment for socio-demographic characteristics and province of residence, women who received flu shots in the past 12 months were significantly more likely to consult with a family doctor (AOR 1.56, 95% CI 1.34-1.83) and significantly less likely to consult with a chiropractor (AOR 0.76, 95% CI 0.64-0.90) or a homeopath/naturopath (AOR 0.72, 95% CI 0.54-0.97) over the same time period. CONCLUSION: Consultation with family doctors was found to have the strongest association with annual flu shots among women in contact with young children, whereas consultation with alternative care providers was found to have an independent inverse association. Given the influenza-associated health risks for young children, medical professionals should promote immunization at the time of consultation for household contacts of young children, including pregnant women.

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).

The use of alternative medicine by children.

OBJECTIVE: Alternative medicine (AM) is of growing interest to the general public. Although several studies have been published concerning its use in adults, the use by children is less well known. The purpose of this study is to determine the frequency with which alternative medicine is employed in a pediatric population that also uses conventional medicine. A second goal is to investigate the sociodemographic factors that influence the choice of these forms of therapy. METHODS: Parents of children consulting the general outpatient clinic of a university hospital completed a self-administered questionnaire asking about previous use of AM for themselves or their children. RESULTS: Based on 1911 completed questionnaires, 208 children (11%) previously consulted one or more AM practitioners. Chiropractic, homeopathy, naturopathy, and acupuncture together accounted for 84% of use. Children who used AM differed significantly from those who only used conventional medicine in that they were older than the nonusers, their mothers were better educated, and their parents also tended to use AM. CONCLUSION: The findings indicate that AM is an aspect of child health care that no longer can be ignored. Being aware of these practices will enable physicians to discuss alternative therapies with parents in order to ensure the continuity of essential conventional treatments.

Use of complementary and alternative medicine in Israel: 2000 vs. 1993.

BACKGROUND: Complementary and alternative medical care has gained increasing popularity in western societies in recent years. OBJECTIVES: To provide a cross-sectional and temporal (2000 vs. 1993) analysis of the use of complementary and alternative medicine in Israel. METHODS: The subjects studied represented the Israeli Jewish urban population aged 45-75 years. Full sit-down interviews were conducted with 2,003 respondents in 1993 and 2,505 respondents in 2000. RESULTS: For 1993, 6% of the population reported on consultations with CAM providers during the previous year. For 2000, that proportion increased to 10%. Being a woman, having higher education, enjoying better economic status, being younger, living in a big city, and being dissatisfied with specialists' care were all positively related to the use of non-conventional medicine, particularly in 2000. In both years, more than 50% of the consultations were with acupuncturists and homeopaths. However, chiropractors have doubled their market shares, and lower back pain became the leading problem for which care was sought. The main reason for consulting CAM was a reluctance to use too many drugs or to undergo an invasive procedure. However, a significant proportion of the users continue to use conventional medicine concurrently. Seventy-five percent in 2000 and 60% in 1993 reported that the treatment helped. CONCLUSIONS: Between 1993 and 2000, CAM in Israel changed from an infant industry into a mainstream medical commodity, reflected in both prevalence and different patterns of consumption.

Referrals for alternative therapies.

BACKGROUND: The purpose of this study was to examine how allopathic physicians participate in the decision to refer patients for alternative therapies. METHODS: A pretested, self-administered, structured questionnaire was distributed simultaneously to all area physicians at community locations in Washington State, New Mexico, and southern Israel. The primary outcome measures were monthly and yearly rates of referral to alternative therapies. RESULTS: More than 60% of all physicians made referrals to alternative providers at least once in the preceding year and 38% in the preceding month. Referrals were generally based on patient requests, synergy between the alternative therapy and the patients' cultural beliefs, failure of conventional treatment, and the belief that patients have "nonorganic" or "psychological" disease. There was no relationship between the rate of referral and the referring physician's level of knowledge about, beliefs about the effectiveness of, or familiarity with alternative therapies. CONCLUSIONS: Primary care physicians are more likely than other medical specialists to be knowledgeable about, personally subscribe to, and refer patients for alternative therapies. Physicians who use alternative techniques for themselves and their families or who adopt complementary therapies into their practices have higher rates of referrals. Referral rates and patterns were similar between sites despite considerable cross-cultural and health system differences. Given the high rate of referral and the absence of an apparent internal logic for such recommendations, guidelines and physician education may be advisable.

Alternative medicine and the medical profession: views of medical students and general practitioners.

A survey was undertaken to explore the attitudes and practices of general practitioners and medical students in the United Arab Emirates with regards to forms of therapy not generally accepted by conventional medicine, including herbal medicine, acupuncture, homeopathy, spiritual therapy and osteopathy/chiropractic. The study found that alternative medicine is in common use to complement conventional medicine by a section of educated people within the health care system. Our observations lead us to appreciate its role in community health care and indicate a need to design culturally appropriate medical curricula which incorporate information about alternative medicine.

[Users of homeopathy in Norway]. / Brukere av homøopati i Norge.

BACKGROUND: 37% of the Norwegian population have been to a homeopath. This article describes user complaints and characteristics and compares this with previous users and patients in general practice. MATERIAL AND METHODS: We conducted a survey of 1097 patients visiting 80 Norwegian homeopaths in 1998 and compared them with a similar survey in 1985 (1072 consultations) and a 1989 survey of patients in general practice (90,458 consultations). RESULTS: One in four of patients seeing a homeopath in 1998 were children below ten years of age compared to one in ten in the 1985 study and one in eleven in the general practice study. Children saw homeopaths most often because of respiratory and skin complaints. One half of the 1998 patients had used prescription drugs provided by a medical doctor the last month for the same complaint that they presented to the homeopath. The reasons for seeing a homeopath are similar to those found in medical general practice, expect for circulatory complaints. INTERPRETATION: There has been a substantial increase in the proportion of children among users of homeopaths. Homeopathy is most often used complementary to services given by general practitioners for the same complaints.

Medical online consultation service in CAM at the University Hospital Zurich.

BACKGROUND: The University Hospital Zurich offers medical online consultation services in individual health concerns. We examined the need for users' information in the field of CAM. For this purpose, the content of the questions, the users' profiles, and the online responses of the physicians were analyzed. METHODS: The retrospective study analyzed 154 (1.3%) out of 11,827 questions and responses, selected by a literature-based keyword list between 2006 and 2007. They were evaluated by means of an inductive category system described by Mayring using a professional text analysis program (MAXQDA). Frequencies and mean values of the categories were statistically determined. RESULTS: Users (aged 39.2 ± 16, females 61%) asked questions, which were in 73% allocated to herbal medicine, 7% to homeopathy, and 2% to acupuncture. The questions referred to medical fields, such as gynecology (18%), dermatology (13%), psychiatry (11%), and oncology (8%). One third of the responses provided detailed information about herbal treatment options. CONCLUSIONS: The email-based online consultation service was used as a source of medical information in order to get more professional consultation in the field of CAM. Future scientific evaluation should investigate if online consultation services which are embedded in an environment of highly qualified health professionals may contribute to a better health literacy and empowerment of the patients.

Complementary medicine and general practice in an urban setting: a decade on.

AIM: To conduct a follow-up survey ascertaining changes in usage, referral rate, beliefs and attitudes towards complementary and alternative medicine (CAM) during the last decade. BACKGROUND: In many countries, CAM use is reported to be substantial and increasing. METHODS: A questionnaire was posted to all GPs registered with the Liverpool Primary Care Trust. Respondents were asked whether they treat, refer, endorse or discuss eight common CAM therapies and about their views on National Health Service (NHS) funding, effectiveness, CAM training needs and theoretical validity of each therapy. Comparisons were made between these results and those collected in 1999. FINDINGS: The response rate was low (32%) compared with the 1999 survey (52%). The main findings were similar to the most popular therapies still being acupuncture, hypnotherapy and chiropractic and the least being aromatherapy, reflexology and medical herbalism. GPs felt most comfortable with acupuncture, with greater belief in its theoretical validity, a greater desire for training and a greater support for acupuncture to receive NHS funding than for the other CAM therapies under question. Opinions about homeopathy had become less supportive. Overall, GPs were less likely to endorse CAMs than previously shown (38% versus 19%).

Além das curvas de crescimento: investigando o atendimento pediátrico e as práticas de puericultura na formação em residências médicas / Beyond growth curves: investigating service pediatric care and childcare practices in training in medical residencies

Este Trabalho de Conclusão de Curso (TCC) investiga a prática da puericultura e o atendimento pediátrico por residentes, com foco no aprendizado, confiança e atualizações dos profissionais, proporcionados pelos programas de residência médica. Os resultados revelam que a atualização é crucial para garantir a qualidade do atendimento, considerando as constantes evoluções na área pediátrica. Aspectos como crescimento, desenvolvimento neuropsicomotor, vacinação, diário alimentar e dinâmica familiar são fundamentais na consulta de puericultura e a conscientização sobre a importância da vacinação também é relevante. Promover programas de residência médica com formação teórica sólida e baseada em evidências científicas é essencial para o desenvolvimento de profissionais preparados para uma prática pediátrica de excelência, beneficiando diretamente a saúde das crianças e adolescentes atendidos. Palavras-chave: Medicina baseada em evidências. Puericultura. Hospitais de Ensino. Pediatria. Residência médica.

Homeopathy enables rheumatoid arthritis patients to cope with their chronic ill health: a qualitative study of patient's perceptions of the homeopathic consultation.

OBJECTIVE: The role of the consultation in mediating improved clinical outcomes has been demonstrated in both conventional and complementary medicine but to date no depth study has explored how complementary medical consultations achieve such benefits. This study explored rheumatoid arthritis (RA) patients' perceptions of the homeopathic consultation including any perceived benefit. METHODS: Qualitative study nested within a placebo-controlled multi-centre trial assessing adjunctive homeopathic intervention for RA. In-depth face to face interviews (with 16 participants) were analysed using interpretative phenomenological analysis. RESULTS: RA participants perceived homeopathic consultations helped them cope better through either enabling improved physical health, wellbeing and/or illness management. Four themes associated with improved coping were: receiving emotional support; exploring the illness; exploring self; and gaining advice. Exploring the wider narrative of their illness, enabled participants to address their individual needs and for some, this process of increased awareness changed their perception resulting in the perceived benefits. CONCLUSION: Homeopathic consultations enable RA patient to cope better. PRACTICE IMPLICATIONS: Homeopathic consultations may provide an additional resource for RA patients. Identifying and employing the "active ingredients" that confer benefit may be appropriate for other clinicians to maximise patient benefits from consultations.