Patients' preference for integrating homeopathy (PPIH) within the standard therapy settings in West Bengal, India: The part 1 (PPIH-1) study.

There is lack of studies assessing the preference of Indian patients for integration of homeopathy into standard therapy settings. The objectives of this study were to examine the knowledge, attitudes, and practice of homeopathy among Indian patients already availing homeopathy treatment and its integration into mainstream healthcare. A cross-sectional survey was conducted among adult patients attending the out-patients of the four government homeopathic hospitals in West Bengal, India. A self-administered 24-items questionnaire in local vernacular Bengali was developed and administered to the patients. A total of 1352 patients' responses were included in the current analysis. 40% patients thought that homeopathic medicines can be used along with standard therapy. 32.5% thought that homeopathic medicines might cause side effects, while only 13.3% believed that those might interact with other medications. Patients' knowledge ranged between 25.1 and 76.5% regarding regulations of practicing and safety of homeopathic medicine in India and abroad; while positive attitude towards the same ranged between 25.4 and 88.5%. 88.6% of the patients had favorable attitude toward integrated services. 68.2% of the patients used homeopathic medicines in any acute or chronic illness for themselves and 76.6% for their children. Preference for integrated services was significantly associated with better knowledge (P = 0.002), positive attitudes toward safety and regulations (P < 0.0001), and integration (P < 0.0001), but not with the level of practice (P = 0.515). A favorable attitude toward integrating homeopathy into conventional healthcare settings was obtained among the patients attending the homeopathic hospitals in West Bengal, India.

Knowledge, Attitude, and Practice Related to Diabetes Mellitus Among Diabetics and Nondiabetics Visiting Homeopathic Hospitals in West Bengal, India.

High prevalence of undiagnosed cases of diabetes mellitus and poor knowledge, awareness, and practice has increased premature death, costly complications, and financial burden. A cross-sectional survey was conducted in November 2014 on 273 diabetics and 355 nondiabetics in 3 government homeopathic hospitals in West Bengal, India. A self-administered questionnaire assessing knowledge, awareness, and practice related to diabetes was used. A total of 17.5% to 29.3% of the participants were aware of the normal blood sugar level. Lack of insulin, frequent urination, hypertension, and poor wound healing were identified most frequently as the cause, symptom, association, and complications. A total of 35.5% to 46.5% said that diabetes was preventable; 14.1% to 31.9% knew that diabetes was controllable rather than curable. Consumption of planned diet, avoiding sugar, and testing blood sugar were the most frequently identified components of healthy lifestyle, diabetic diet, and diagnostic domain. Diabetics had higher knowledge and awareness than nondiabetics (P < .0001); still the latter need to be made aware and knowledgeable to curtail the ever-increasing burden of diabetes.

Hering's Law Assessment Tool revisited: introducing a modified novel version--Patients' Response Assessment Tool after Homeopathic Treatment (PRATHoT) in chronic cases.

Hering's Law Assessment Tool emerged as a systematic outcome assessment tool following homeopathic intervention. The authors intend to modify it and develop a new tool-Patient Response Assessment Tool after Homeopathic Treatment (PRATHoT)-in chronic cases through Delphi technique for systematic categorization of probable outcomes following individualized homeopathic treatment in chronic cases. The PRATHoT was drafted after literature review and iterative Delphi rounds with multidisciplinary expert panel, setting Fleiss κ of 0.41 to 1.00 a priori as the desired level of multirater agreement. Following pilot testing, the tool was implemented on 37 patients suffering from knee osteoarthritis over 6 months. Logistic regression analysis confirmed that higher PRATHoT score was significantly associated with achieving pain visual analogue scale responses from the second follow-up visit onwards (B = 0.037-0.066; SE = 0.021-0.036; P = .003-.048). The tool appeared to have acceptable psychometric properties; hence, it may be considered as a promising tool, amendable for further development.

Patient activation measures in a government homeopathic hospital in India.

The American Patient Activation Measure-22 questionnaire (PAM-22) quantifies the knowledge, skills, and confidence essential to manage own health and health care. It is a central concept in chronic illness care models, but studied sparsely in homeopathic hospitals. PAM-22 was translated into Bengali and a cross-sectional study was undertaken in chronically ill 417 patients visiting the outpatient clinic of Mahesh Bhattacharyya Homeopathic Medical College and Hospital, India. Response rate was 90.41%. Data were analyzed using Rasch rating scale model with Winsteps. Activation score was 54.7 ± 8.04 or 62.13% of maximum score. PAM scores differed significantly by age, education, income, and health status (P < .05). The items had good data quality fit statistics and good range of difficulty. The construct unidimensionality was confirmed by good model fits for Rasch model and principal component analysis of residuals found no meaning structure. The questionnaire showed acceptable psychometrics. Patient activation was moderate and needs to be improved.

Evaluación de la satisfacción de los pacientes en un hospital homeopático gubernamental en Bengala Occidental, India / Assessment of patient satisfaction in a government homeopathic hospital in West Bengal, India

Introducción y objetivos: la determinación del grado de satisfacción de los pa¬cientes de un hospital homeopático puede producir un impacto sustancial en los esfuerzos para mejorar el estado de salud y la calidad de la atención proporcionada. En este trabajo, los investigadores evaluaron el grado de satisfacción de los pacientes después de recibir consulta médica, al igual que la validez y la confiabilidad del interrogatorio al que se sometieron. Métodos: estudio transversal con diseño observacional realizado en febre¬ro de 2013, con 390 voluntarios, en cinco unidades de consulta externa de la Facultad y Hospital de Medicina Homeopática Mahesh Bhattacharyya, perteneciente a la red pública de Bengala Occidental (Howrah, India). Fue auto-aplicado un breve cuestionario de satisfacción con consultas médicas, elaborado en Japón y traduci¬do al bengalí, con 12 ítems de respuesta múltiple en una escala tipo Likert de cinco puntos. El cuestionario generó cinco subescalas: satisfacción general, examen completo, cuidado completo de la persona, duración de la consulta y centralidad en el paciente. Las respuestas de cada ítem y sub-escala también incluían una escala visual analógica (EVA) de 100 mm. Resultados: el cuestionario se mostró válido y confiable. Su consistencia interna fue comprobada por valores entre 0.7 y 0.9 del coeficiente alfa de Cronbach (α), y la confiabilidad test-retest por el coeficiente kappa de Cohen (κ), cuyo valor fue superior a 0.7 en todos los ítems. La validez concurrente del coeficiente r de Pearson correspondiente al puntaje total del cuestionario y las EVA fue de 0.60, p<0.001; puntaje de cada escala 0.8 < r < 0.9, p<0.0001, y puntaje de cada ítem 0.8 < r < 0.9, p<0.0001.[...] En general, los pacientes reportaron alta satisfacción. Nuevos estudios son necesarios para adaptar el cuestionario utilizado en este trabajo a otros idiomas para uso global.

Discovering the degree of patient satisfaction in a homeopathic hospital setting may put substantial impact in improving health status and quality of care provided. In this study, the researchers evaluated the degree of patient satisfaction following medical encounters and re-examined the validity and reliability of the used questionnaires. An institutional, cross-sectional, observational study was carried out involving 390 participants in February, 2013 in five out-patient clinics of Mahesh Bhattacharyya Homeopathic Medical College and Hospital, Govt. of West Bengal, Howrah, India. A 12-item Japanese short-form self-administered consultation satisfaction questionnaire translated into Bengali with a five-point Likert scale was used. The questionnaire generated five subscales - overall satisfaction, complete examination, whole person care, examination time, and patient centeredness. Visual analogue scales (VASs) of 100 mm were provided with each single question item and each subscale. The questionnaire appeared reliable and valid. Internal consistency scores Cronbach’s alpha (α) were between 0.7-0.9 and test-retest reliability Cohen’s kappa (κ) was greater than 0.7 for each item. Concurrent validity Pearson’s r between total questionnaire and VASs was 0.60, p<0.001; each subscale scores 0.8 < r < 0.9, p<0.0001, and each question score 0.8 < r < 0.9, p<0.0001. Comparison of mean scores of five different subscales for five different outpatient clinics yielded F ratios between 4.3-9.8 (p< 0.05, df=4.95% CI) establishing discriminant validity. Overall, the patients’ satisfaction appeared to be high. Further works should be undertaken adapting the questionnaire globally in different languages.

Evaluación de la satisfacción de los pacientes en un hospital homeopático gubernamental en Bengala Occidental, India / Assessment of patient satisfaction in a government homeopathic hospital in West Bengal, India

Introducción y objetivos: la determinación del grado de satisfacción de los pa¬cientes de un hospital homeopático puede producir un impacto sustancial en los esfuerzos para mejorar el estado de salud y la calidad de la atención proporcionada. En este trabajo, los investigadores evaluaron el grado de satisfacción de los pacientes después de recibir consulta médica, al igual que la validez y la confiabilidad del interrogatorio al que se sometieron. Métodos: estudio transversal con diseño observacional realizado en febre¬ro de 2013, con 390 voluntarios, en cinco unidades de consulta externa de la Facultad y Hospital de Medicina Homeopática Mahesh Bhattacharyya, perteneciente a la red pública de Bengala Occidental (Howrah, India). Fue auto-aplicado un breve cuestionario de satisfacción con consultas médicas, elaborado en Japón y traduci¬do al bengalí, con 12 ítems de respuesta múltiple en una escala tipo Likert de cinco puntos. El cuestionario generó cinco subescalas: satisfacción general, examen completo, cuidado completo de la persona, duración de la consulta y centralidad en el paciente. Las respuestas de cada ítem y sub-escala también incluían una escala visual analógica (EVA) de 100 mm. Resultados: el cuestionario se mostró válido y confiable. Su consistencia interna fue comprobada por valores entre 0.7 y 0.9 del coeficiente alfa de Cronbach (α), y la confiabilidad test-retest por el coeficiente kappa de Cohen (κ), cuyo valor fue superior a 0.7 en todos los ítems. La validez concurrente del coeficiente r de Pearson correspondiente al puntaje total del cuestionario y las EVA fue de 0.60, p<0.001; puntaje de cada escala 0.8 < r < 0.9, p<0.0001, y puntaje de cada ítem 0.8 < r < 0.9, p<0.0001.[...] En general, los pacientes reportaron alta satisfacción. Nuevos estudios son necesarios para adaptar el cuestionario utilizado en este trabajo a otros idiomas para uso global. (AU)

Discovering the degree of patient satisfaction in a homeopathic hospital setting may put substantial impact in improving health status and quality of care provided. In this study, the researchers evaluated the degree of patient satisfaction following medical encounters and re-examined the validity and reliability of the used questionnaires. An institutional, cross-sectional, observational study was carried out involving 390 participants in February, 2013 in five out-patient clinics of Mahesh Bhattacharyya Homeopathic Medical College and Hospital, Govt. of West Bengal, Howrah, India. A 12-item Japanese short-form self-administered consultation satisfaction questionnaire translated into Bengali with a five-point Likert scale was used. The questionnaire generated five subscales - overall satisfaction, complete examination, whole person care, examination time, and patient centeredness. Visual analogue scales (VASs) of 100 mm were provided with each single question item and each subscale. The questionnaire appeared reliable and valid. Internal consistency scores Cronbach’s alpha (α) were between 0.7-0.9 and test-retest reliability Cohen’s kappa (κ) was greater than 0.7 for each item. Concurrent validity Pearson’s r between total questionnaire and VASs was 0.60, p<0.001; each subscale scores 0.8 < r < 0.9, p<0.0001, and each question score 0.8 < r < 0.9, p<0.0001. Comparison of mean scores of five different subscales for five different outpatient clinics yielded F ratios between 4.3-9.8 (p< 0.05, df=4.95% CI) establishing discriminant validity. Overall, the patients’ satisfaction appeared to be high. Further works should be undertaken adapting the questionnaire globally in different languages. (AU)

Medicine prescription practices of homeopathic undergraduate students in West Bengal, India.

OBJECTIVE: To our knowledge, prescription of homeopathic medicines by homeopathic undergraduate students has not been studied before though it may possess serious implications. We aimed to determine the practice and attitudes of prescription by homeopathic undergraduate students. METHODS: A cross-sectional study was carried out involving all the students from four government homeopathic schools of West Bengal, India. Ethical requirements were ensured and data were collected using self-administered questionnaires. Chi-square tests and logistic univariate regression analyses were performed to identify associations and differences. RESULTS: A total of 328 forms were completed. Of these, 264 (80.5%) homeopathic undergraduate students admitted of prescribing medicines independently and most (40.5%) said that they did this 2-3 times a year. The most common reasons for this were 'urgency of the problem' (35.2%), 'previous experience with same kind of illness' (31.8%), and 'the problem too trivial to go to a doctor' (25.8%). About 63.4% of the students thought that it was alright to independently diagnose an illness while 51.2% thought that it was alright for them to prescribe medicines to others. Common conditions encountered were fever, indigestion, and injury. Students who prescribed medicines were more likely to belong to Calcutta Homeopathic Medical College and Hospital (odds ratio = 5.8; 95% confidence interval 2.247-14.972). Prescription by students gradually increased with academic years of homeopathic schools. Many students thought it was alright for students to diagnose and treat illnesses. CONCLUSION: Prescription of medicines by homeopathic undergraduate students is quite rampant and corrective measures are warranted.

Medicine prescription practices of homeopathic undergraduate students in West Bengal, India / 中西医结合学报

To our knowledge, prescription of homeopathic medicines by homeopathic undergraduate students has not been studied before though it may possess serious implications. We aimed to determine the practice and attitudes of prescription by homeopathic undergraduate students.

A survey exploring research perception of homeopathic undergraduate students in West Bengal, India

Background: Prioritizing undergraduate research is emphasized to develop critical analytical skills and thinking, independent writing, future clinical practice, enhanced employability, and improved research productivity. Despite far reaching consequences, research perception of homeopathic undergraduate students has barely been investigated to date. Poor participation of homeopathic undergraduates in research is reflected by a single MEDLINE indexed publication with adequate students’ contribution in the last decade. We aimed to assess their knowledge and attitude towards research and to identify barriers towards successful conduct of research. Methods: Institutional cross-sectional survey was carried out during August-September, 2013 in the four Government undergraduate homeopathic schools in West Bengal, India involving 902 participants. A semi-structured questionnaire was developed for the purpose depending on earlier studies on medical undergraduates. 364 completed responses were analyzed in the end. Results: Study sample mostly spanned 18-25 years of age group (94%), belonged to urban families (44.8%), with no gender differences (almost 1:1) and no physicians in family (73.1%). Maximum complete responses were obtained from 3rd year students (61.5%) and students of Calcutta Homeopathic Medical College and Hospital (51.2%). In spite of willingness to participate and keeping a positive attitude towards research, current involvement, training, knowledge and awareness remained quite unsatisfactory. Lack of infrastructure was identified as the chief barrier towards research. Conclusion: Undergraduates had a positive attitude towards homeopathic research, but need a realistic understanding of the research process. Opportunities for research skill development are underdeveloped.

Introdução: Estimular a pesquisa no nível de graduação é considerado um recurso importante para o desenvolvimento da capacidade de análise e pensamento críticos, redação independente, prática clínica futura, melhorar as possibilidades de inserção no mercado de trabalho e a produtividade em pesquisa. Apesar dessas consequências de amplo alcance, a percepção sobre pesquisa de estudantes de graduação em homeopatia tem sido raramente investigada. A escassa participação em pesquisas de estudantes de graduação em homeopatia é evidenciado pelo achado de um único trabalho indexado em MedLine com expressiva participação de estudantes nos últimos 10 anos. O nosso objetivo consistiu em avaliar o conhecimento e atitude em relação à pesquisa e identificar as barreiras que impedem o sucesso na realização de pesquisas. Métodos: Um estudo transversal foi realizado entre agosto e setembro de 2013 nas quatro faculdades públicas de homeopatia na Bengala Ocidental, Índia, com um total de 902 participantes. Um questionário semiestruturado foi desenvolvido especificamente para este estudo baseado nos resultados de estudos anteriores realizados com estudantes de medicina. Um total de 364 questionários completos foi incluído na análise. Resultados: A maioria dos participantes tinha entre 18 e 25 anos de idade (94%), residia em áreas urbanas (44.8%) e não incluía médicos na família (73,1%). A amostra apresentou homogeneidade em relação ao sexo (quase 1:1). O maior número de questionários completos correspondeu a estudantes do 3o ano (61,5%) e da Faculdade e Hospital Homeopático de Calcutá (51,2%) [...] Conclusão: Os estudantes manifestaram atitude positiva em relação à pesquisa em homeopatia, porém precisam adquirir uma compreensão mais realista do processo de pesquisa. As oportunidades para desenvolvimento de competências de pesquisa são muito escassas.

A survey exploring research perception of homeopathic undergraduate students in West Bengal, India

Background: Prioritizing undergraduate research is emphasized to develop critical analytical skills and thinking, independent writing, future clinical practice, enhanced employability, and improved research productivity. Despite far reaching consequences, research perception of homeopathic undergraduate students has barely been investigated to date. Poor participation of homeopathic undergraduates in research is reflected by a single MEDLINE indexed publication with adequate students’ contribution in the last decade. We aimed to assess their knowledge and attitude towards research and to identify barriers towards successful conduct of research. Methods: Institutional cross-sectional survey was carried out during August-September, 2013 in the four Government undergraduate homeopathic schools in West Bengal, India involving 902 participants. A semi-structured questionnaire was developed for the purpose depending on earlier studies on medical undergraduates. 364 completed responses were analyzed in the end. Results: Study sample mostly spanned 18-25 years of age group (94%), belonged to urban families (44.8%), with no gender differences (almost 1:1) and no physicians in family (73.1%). Maximum complete responses were obtained from 3rd year students (61.5%) and students of Calcutta Homeopathic Medical College and Hospital (51.2%). In spite of willingness to participate and keeping a positive attitude towards research, current involvement, training, knowledge and awareness remained quite unsatisfactory. Lack of infrastructure was identified as the chief barrier towards research. Conclusion: Undergraduates had a positive attitude towards homeopathic research, but need a realistic understanding of the research process. Opportunities for research skill development are underdeveloped. (AU)

Introdução: Estimular a pesquisa no nível de graduação é considerado um recurso importante para o desenvolvimento da capacidade de análise e pensamento críticos, redação independente, prática clínica futura, melhorar as possibilidades de inserção no mercado de trabalho e a produtividade em pesquisa. Apesar dessas consequências de amplo alcance, a percepção sobre pesquisa de estudantes de graduação em homeopatia tem sido raramente investigada. A escassa participação em pesquisas de estudantes de graduação em homeopatia é evidenciado pelo achado de um único trabalho indexado em MedLine com expressiva participação de estudantes nos últimos 10 anos. O nosso objetivo consistiu em avaliar o conhecimento e atitude em relação à pesquisa e identificar as barreiras que impedem o sucesso na realização de pesquisas. Métodos: Um estudo transversal foi realizado entre agosto e setembro de 2013 nas quatro faculdades públicas de homeopatia na Bengala Ocidental, Índia, com um total de 902 participantes. Um questionário semiestruturado foi desenvolvido especificamente para este estudo baseado nos resultados de estudos anteriores realizados com estudantes de medicina. Um total de 364 questionários completos foi incluído na análise. Resultados: A maioria dos participantes tinha entre 18 e 25 anos de idade (94%), residia em áreas urbanas (44.8%) e não incluía médicos na família (73,1%). A amostra apresentou homogeneidade em relação ao sexo (quase 1:1). O maior número de questionários completos correspondeu a estudantes do 3o ano (61,5%) e da Faculdade e Hospital Homeopático de Calcutá (51,2%) [...] Conclusão: Os estudantes manifestaram atitude positiva em relação à pesquisa em homeopatia, porém precisam adquirir uma compreensão mais realista do processo de pesquisa. As oportunidades para desenvolvimento de competências de pesquisa são muito escassas. (AU)

A study on drug utilization and prescription habits of physicians in a government homeopathic hospital in West Bengal, India.

OBJECTIVE: Improper prescribing habits and inappropriate drug use lead to serious health and economic consequences. This study was undertaken to evaluate drug utilization services and prescription patterns of homeopathic doctors in a government homeopathic teaching hospital in India. METHODS: No standardized homeopathic drug use indicators are available. The researchers used indicators for health care setting (drug availability)-modified prescribing indicators and patient care indicators, based on World Health Organization's core drug use indicators. A cross-sectional, prospective, institutional, observational study of 2-month duration with record analysis was conducted on 600 patients visiting seven different outpatient departments (OPDs) for the first time at Mahesh Bhattacharyya Homeopathic Medical College and Hospital, Howrah, West Bengal, India, using the developed indicators. RESULTS: Overall availability of prescribed drugs was quite satisfactory (92.28%). Centesimal potencies accounted for the majority of prescriptions (74.76%). There was a poor record of diagnosis (39.17%) except in the OPDs of Gynecology and Obstetrics (68.48%, P < 0.01) and Dermatology (64.58%, P < 0.01). Records of investigational findings and ongoing therapies, if any, were also poor except OPDs of Gynecology and Obstetrics, and Pediatrics. Structure of prescriptions was maintained satisfactorily in all the OPDs. Though tendency of using 'individualized homeopathy' predominated, there also existed the use of 'polypharmacy'. Mean consultation time was 5.9 min. Labeling was extremely poor and is an area needing improvement. The prescriptions were highly legible. CONCLUSION: This was a preliminary study, conducted for the first time in homeopathy using newly developed indicators that yield meaningful results. Further studies are necessary in order to evaluate the different factors involved and to plan future interventions to improve the quality of care in healthcare settings.

A study on drug utilization and prescription habits of physicians in a government homeopathic hospital in West Bengal, India / 中西医结合学报

Improper prescribing habits and inappropriate drug use lead to serious health and economic consequences. This study was undertaken to evaluate drug utilization services and prescription patterns of homeopathic doctors in a government homeopathic teaching hospital in India.

A survey on perception of homoeopathic undergraduate students towards learning environment in an Indian scenario

Background and aims – This research was an attempt to understand the views of students of homoeopathic undergraduate schools in West Bengal, India and to identify areas of strength and weakness in the learning environment. Methodology – An institutional, cross-sectional, observational study was carried out involving 430 students in May, 2013 in two Government homoeopathic medical colleges in West Bengal, India. A seven-item close-ended questionnaire with four point Likert scale was used to determine students’ perceptions of the learning environment, intellectual climate and teacher-student relationship in homoeopathic schools. The questionnaire generated seven subscales – flexibility, student to student interaction, emotional climate, supportiveness, meaningful experience, organization, and breadth of interest. Results – 46.5% of students belonged to rural areas and Bengali was the mother tongue of 93.7% students. 39.5% preferred Bengali as the medium of instruction and group study was preferable to 77.9% students. 47.7% students were dissatisfied with the teaching process and 79.8% preferred the use of multimedia over conventional classroom teaching. Flexibility remained low (mean=1.9, SD=0.9); meaningful experience (theoretical teaching) score was high (mean=2.6, SD=0.9). Scores did not vary significantly (P>0.05) across the pre-clinical and clinical students, but few subscales produced significant differences individually among students of different years. Internal consistency scores of the scale remained questionable (Cronbach’s α 0.310-0.446); however, the scale showed acceptable test-retest reliability (Cohen’s κ 0.680-0.838). Conclusions – This study emphasized the areas requiring improvement in homoeopathic school environment based on students’ perspective. Changes in curriculum, faculty and infrastructure should be planned to improve students’ satisfaction.

Introdução e objetivo: Este estudo buscou entender a percepção de estudantes de faculdades homeopáticas em Bengala Ocidental, Índia, e identificar os pontos fortes e fracos do ambiente de aprendizagem. Métodos: Estudo transversal com desenho observacional realizado en maio de 2013 com 430 voluntários em duas faculdades públicas de medicina homeopática em Bengala Ocidental, Índia. Um questionário com 7 itens respondidos em uma escala tipo Likert de 4 pontos foi aplicada para determinar a percepção dos voluntários a respeito de seu ambiente de aprendizagem, clima intelectual e relação aluno-professor. O questionário gerou 7 sub-escalas –flexibilidade, interação entre Estudantes, clima emocional, suporte, experiência significativa, organização e amplitude de interesses. Cerca de 46,5% dos estudantes procedía de áreas rurais, a língua materna de 93,7% era bengalí, 39,5% preferia que se falasse bengalí nas aulas, 77,9% preferia trabalhar em grupo, 47,7% se manifestaram insatisfeitos com o modelo de ensino e 79,8% preferíam as técnicas multimídias comparadas às convencionais. A flexibilidade foi baixa (media= 1,9, desvio padrão DE = 0,9); a pontuação da experiência significativa (ensino teórico) foi elevada (média= 2,6, DE= 0,9). As pontuações não apresentaram diferenças significativas (p>0,05) entre os estudiantes em fase preclínica e clínica, porém, algumas sub-escalas individuais apresentaram diferenças significativas entre os estudantes dos diversos cursos. A consistência interna do questionário é duvidosea (coeficiente α de Cronbach: 0,310-0,446), porém, a confiabilidade do teste-reteste se mostrou aceitável ( de Cohen: 0,680-0,838). Conclusões: Este estudo assinala as áreas que devem ser melhoradas na aprendizagem da homeopatía desde a perspectiva dos estudantes. Mudanças nos programas de estudos, corpo docente e infraestructura são necessárias para melhoras a satisfação dos alunos.

Evaluation of patient satisfaction in a Government Homeopathic Hospital in West Bengal, India

Background and aims – Discovering the degree of patient satisfaction in a medical practice setting may put substantial impact in improving health status and quality of care provided. In this study, the researchers evaluated the degree of patient satisfaction following medical encounters and re-examined the validity and reliability of the used questionnaires. Methodology – An institutional, cross-sectional, observational study was carried out involving 390 participants in February, 2013 in five out-patient clinics of Mahesh Bhattacharyya Homeopathic Medical College and Hospital, Govt. of West Bengal, Howrah, India. A 12-item Japanese short-form self-administered consultation satisfaction questionnaire translated into Bengali with a 5-point Likert scale was used. The questionnaire generated 5 subscales – overall satisfaction, complete examination, whole person care, examination time, and patient centeredness. Visual analogue scales (VASs) of 100mm were provided with each single question item and each subscale. Results – The questionnaire appeared reliable and valid. Internal consistency scores Cronbach’s α were between 0.7-0.9 and test-retest reliability Cohen’s κ was greater than 0.7 for each item. Concurrent validity Pearson’s r between total questionnaire and VASs was 0.60, P < 0.001; each subscale scores 0.8 < r < 0.9, P < 0.0001, and each question score 0.8 < r < 0.9, P < 0.0001. Comparison of mean scores of five different subscales for five different outpatient clinics yielded F ratios between 4.3-9.8 (P < 0.05, df = 4, 95% CI) establishing discriminant validity. Conclusions – Overall, the patients’ satisfaction appeared to be high. Further works should be undertaken adapting the questionnaire globally in different languages.

Introdução e objetivos: A determinação do grau de satisfação dos pacientes de um hospital homeopático, pode producir impacto substancial nos esforços para melhorar o o estado de saúde e a qualidade da atenção proporcionada. Neste estudo, avaliamos o grau de satisfação dos pacientes, depois das consultas médicas, bem como a validade e confiabilidade do questionário utilizado. Métodos: Estudo transversal com desenho observacional realizado em fevereiro de 2013 com 390 voluntários em 5 ambulatórios da Facultade e Hospital de Medicina Homeopática Mahesh Bhattacharyya, pertencente a rede pública Bengala Ocidental, Howrah, India. Foi autoaplicado um breve questionário japonês de satisfação com as consultas médicas, traduzido para o bengalí, com 12 ítems respondidos em uma escala tipo Likert de 5 pontos. O questionario gerou 5 sub-escalas: satisfação global; exame completo; atenção do paciente como um todo; duração da consulta; foco no paciente. As respostas de cada ítem e sub-escala também incluíam uma escala visual analógica de 100 mm. Resultados: O questionário se mostrou válido e confiável. Sua consistência interna foi comprovada por valores entre 0,7 e 0,9 do coeficiente α de Cronbach, e a confiabilidade teste-reteste pelo coeficiente kappa de Cohen, cujo valor foi superior a 0,7 em todos os ítens. A validez concorrente do coeficiente r de Pearson correspondente a pontuação total do questionário a as EVAs foram de 0,60, p<0,001; pontuação de cada escala 0,8 < r < 0,9, p<0,0001, e pontuação de cada ítem 0,8 < r < 0,9, p<0,0001. A comparação das pontuações médias das 5 subescalas correspondentes aos 5 ambulatorios resultaram en valores de razão F de 4,3-9,8 (p<0,05, df = 4, intervalo de confiança de 95%), comprovando a validez discriminante do questionário. Em geral, os pacientes reportaram alta satisfação. Novos estudos são necessários para adaptar o questionário utilizado neste estudo a outros idiomas, para uso global.

Self-medication tendencies of patients visiting out-patient departments of Government homoeopathic medical colleges and hospitals in West Bengal, India

Self-medication is mostly prevalent in the low- and middle-income population segments of developing countries, thus reflecting the status of health services. Self-medication has frequently been held responsible for inducing drug resistance, higher cost of further treatment, and other complications. The World Health Organization (WHO) promotes self-medication in rural and remote areas to reduce the burden of health services. In this study, the researchers sought to establish the prevalence, consequences, and causes of self-medication. Methods: Multicenter, institution-based, cross-sectional study conducted with 456 participants in May, 2013 at the outpatient clinics of 2 Government homeopathic medical colleges in West Bengal, India. A pilot-tested structured questionnaire consisting of 12 self-administered questions in local vernacular Bengali was used; 8 were close-ended questions providing multiple answer options, while 4 were open-ended. Results: Overall, 12.7% of interviewees admitted to perform self-medication; 57.7% and 66.0% had appropriate knowledge of the medicines and dose regimens, respectively. Females (64.3%) predominated and self-medication was mostly found in age range 31-45 years old (32.5%). Conventional Western medicine (82.2%) was most preferred therapy, and fever (35.7%), hyperacidity (25.4%) and loose stool (24.3%) the most frequently reported complaints. The main causes for self-medication were feeling no need to consult doctor (32.5%), busy schedule (16.4%), family members advice (16.0%), over-the-counter (OTC) availability of medicines without prescription (12.5%), direct consumer pharmaceutical advertisement (12.1%), and high expenditure in private institutes (10.1%). The chi-square distribution of determinants across the two samples differed significantly. The tendency increased proportionately with literacy (Yates’ ÷2=175.731; p=0.000) and poverty (Yates’ ÷2=426.817; p=0.000).

A prevalência da automedicação é mais elevada nos segmentos populacionais de baixa e média renda nos países em desenvolvimento, como reflexo de nível de atenção pública. A automedicação é frequentemente considerada como causa de resistência a medicamentos, aumento do custo do tratamento e outras complicações. Os autores do presente estudo objetivaram investigar a prevalência, consequências e causas da automedicação. Métodos: estudo multicêntrico, institucional e transversal incluindo 456 indivíduos que consultaram em maio de 2013 os ambulatórios de 2 hospitais universitários homeopáticos públicos em Bengala Ocidental, Índia. Foi distribuído para auto-aplicação um questionário estruturado previamente validado num teste piloto. O questionário incluía com 8 perguntas fechadas, com múltiplas opções de resposta, e 4 abertas, na língua vernácula local. Resultados: Aproximadamente 12,7% dos entrevistados admitiram se utilizar de automedicação; 57,7% e 66,0% tinham conhecimento adequado sobre o medicamento utilizado e posologia, respectivamente. A amostra esteve composta predominantemente por mulheres (64,3%), e a faixa etária com maior frequência de automedicação foi a de 31-45 anos (32,5%). A medicina convencional foi indicada como a preferida (82,2%) e as queixas mais frequentes foram febre (35,7%), azia (25,4%) e diarreia (24,3%). As principais causas para a escolha de automedicação foram: sem necessidade de consultar um médico (32,5%), falta de tempo (16,4%), conselho de familiares (16.0%), existência de medicamentos de venda livre (12.5%), publicidade farmacêutica dirigida diretamente ao consumidor (12.1%) e alto custo de serviços de saúde privados (10,1%). O teste de qui quadrado identificou diferença significativa na distribuição dos determinantes entre os dois grupos. A tendência para uso de automedicação aumentou paralelamente ao nível de educação (Yates χ2=175,731; p=0.000) e à pobreza (Yates χ2=426.817; p=0,000).

Evaluation of patient satisfaction in a Government Homeopathic Hospital in West Bengal, India

Background and aims – Discovering the degree of patient satisfaction in a medical practice setting may put substantial impact in improving health status and quality of care provided. In this study, the researchers evaluated the degree of patient satisfaction following medical encounters and re-examined the validity and reliability of the used questionnaires. Methodology – An institutional, cross-sectional, observational study was carried out involving 390 participants in February, 2013 in five out-patient clinics of Mahesh Bhattacharyya Homeopathic Medical College and Hospital, Govt. of West Bengal, Howrah, India. A 12-item Japanese short-form self-administered consultation satisfaction questionnaire translated into Bengali with a 5-point Likert scale was used. The questionnaire generated 5 subscales – overall satisfaction, complete examination, whole person care, examination time, and patient centeredness. Visual analogue scales (VASs) of 100mm were provided with each single question item and each subscale. Results – The questionnaire appeared reliable and valid. Internal consistency scores Cronbach’s α were between 0.7-0.9 and test-retest reliability Cohen’s κ was greater than 0.7 for each item. Concurrent validity Pearson’s r between total questionnaire and VASs was 0.60, P < 0.001; each subscale scores 0.8 < r < 0.9, P < 0.0001, and each question score 0.8 < r < 0.9, P < 0.0001. Comparison of mean scores of five different subscales for five different outpatient clinics yielded F ratios between 4.3-9.8 (P < 0.05, df = 4, 95% CI) establishing discriminant validity. Conclusions – Overall, the patients’ satisfaction appeared to be high. Further works should be undertaken adapting the questionnaire globally in different languages. (AU)

Introdução e objetivos: A determinação do grau de satisfação dos pacientes de um hospital homeopático, pode producir impacto substancial nos esforços para melhorar o o estado de saúde e a qualidade da atenção proporcionada. Neste estudo, avaliamos o grau de satisfação dos pacientes, depois das consultas médicas, bem como a validade e confiabilidade do questionário utilizado. Métodos: Estudo transversal com desenho observacional realizado em fevereiro de 2013 com 390 voluntários em 5 ambulatórios da Facultade e Hospital de Medicina Homeopática Mahesh Bhattacharyya, pertencente a rede pública Bengala Ocidental, Howrah, India. Foi autoaplicado um breve questionário japonês de satisfação com as consultas médicas, traduzido para o bengalí, com 12 ítems respondidos em uma escala tipo Likert de 5 pontos. O questionario gerou 5 sub-escalas: satisfação global; exame completo; atenção do paciente como um todo; duração da consulta; foco no paciente. As respostas de cada ítem e sub-escala também incluíam uma escala visual analógica de 100 mm. Resultados: O questionário se mostrou válido e confiável. Sua consistência interna foi comprovada por valores entre 0,7 e 0,9 do coeficiente α de Cronbach, e a confiabilidade teste-reteste pelo coeficiente kappa de Cohen, cujo valor foi superior a 0,7 em todos os ítens. A validez concorrente do coeficiente r de Pearson correspondente a pontuação total do questionário a as EVAs foram de 0,60, p<0,001; pontuação de cada escala 0,8 < r < 0,9, p<0,0001, e pontuação de cada ítem 0,8 < r < 0,9, p<0,0001. A comparação das pontuações médias das 5 subescalas correspondentes aos 5 ambulatorios resultaram en valores de razão F de 4,3-9,8 (p<0,05, df = 4, intervalo de confiança de 95%), comprovando a validez discriminante do questionário. Em geral, os pacientes reportaram alta satisfação. Novos estudos são necessários para adaptar o questionário utilizado neste estudo a outros idiomas, para uso global. (AU)

A survey on perception of homoeopathic undergraduate students towards learning environment in an Indian scenario

Background and aims – This research was an attempt to understand the views of students of homoeopathic undergraduate schools in West Bengal, India and to identify areas of strength and weakness in the learning environment. Methodology – An institutional, cross-sectional, observational study was carried out involving 430 students in May, 2013 in two Government homoeopathic medical colleges in West Bengal, India. A seven-item close-ended questionnaire with four point Likert scale was used to determine students’ perceptions of the learning environment, intellectual climate and teacher-student relationship in homoeopathic schools. The questionnaire generated seven subscales – flexibility, student to student interaction, emotional climate, supportiveness, meaningful experience, organization, and breadth of interest. Results – 46.5% of students belonged to rural areas and Bengali was the mother tongue of 93.7% students. 39.5% preferred Bengali as the medium of instruction and group study was preferable to 77.9% students. 47.7% students were dissatisfied with the teaching process and 79.8% preferred the use of multimedia over conventional classroom teaching. Flexibility remained low (mean=1.9, SD=0.9); meaningful experience (theoretical teaching) score was high (mean=2.6, SD=0.9). Scores did not vary significantly (P>0.05) across the pre-clinical and clinical students, but few subscales produced significant differences individually among students of different years. Internal consistency scores of the scale remained questionable (Cronbach’s α 0.310-0.446); however, the scale showed acceptable test-retest reliability (Cohen’s κ 0.680-0.838). Conclusions – This study emphasized the areas requiring improvement in homoeopathic school environment based on students’ perspective. Changes in curriculum, faculty and infrastructure should be planned to improve students’ satisfaction. (AU)

Introdução e objetivo: Este estudo buscou entender a percepção de estudantes de faculdades homeopáticas em Bengala Ocidental, Índia, e identificar os pontos fortes e fracos do ambiente de aprendizagem. Métodos: Estudo transversal com desenho observacional realizado en maio de 2013 com 430 voluntários em duas faculdades públicas de medicina homeopática em Bengala Ocidental, Índia. Um questionário com 7 itens respondidos em uma escala tipo Likert de 4 pontos foi aplicada para determinar a percepção dos voluntários a respeito de seu ambiente de aprendizagem, clima intelectual e relação aluno-professor. O questionário gerou 7 sub-escalas –flexibilidade, interação entre Estudantes, clima emocional, suporte, experiência significativa, organização e amplitude de interesses. Cerca de 46,5% dos estudantes procedía de áreas rurais, a língua materna de 93,7% era bengalí, 39,5% preferia que se falasse bengalí nas aulas, 77,9% preferia trabalhar em grupo, 47,7% se manifestaram insatisfeitos com o modelo de ensino e 79,8% preferíam as técnicas multimídias comparadas às convencionais. A flexibilidade foi baixa (media= 1,9, desvio padrão DE = 0,9); a pontuação da experiência significativa (ensino teórico) foi elevada (média= 2,6, DE= 0,9). As pontuações não apresentaram diferenças significativas (p>0,05) entre os estudiantes em fase preclínica e clínica, porém, algumas sub-escalas individuais apresentaram diferenças significativas entre os estudantes dos diversos cursos. A consistência interna do questionário é duvidosea (coeficiente α de Cronbach: 0,310-0,446), porém, a confiabilidade do teste-reteste se mostrou aceitável ( de Cohen: 0,680-0,838). Conclusões: Este estudo assinala as áreas que devem ser melhoradas na aprendizagem da homeopatía desde a perspectiva dos estudantes. Mudanças nos programas de estudos, corpo docente e infraestructura são necessárias para melhoras a satisfação dos alunos. (AU)

Self-medication tendencies of patients visiting out-patient departments of Government homoeopathic medical colleges and hospitals in West Bengal, India

Self-medication is mostly prevalent in the low- and middle-income population segments of developing countries, thus reflecting the status of health services. Self-medication has frequently been held responsible for inducing drug resistance, higher cost of further treatment, and other complications. The World Health Organization (WHO) promotes self-medication in rural and remote areas to reduce the burden of health services. In this study, the researchers sought to establish the prevalence, consequences, and causes of self-medication. Methods: Multicenter, institution-based, cross-sectional study conducted with 456 participants in May, 2013 at the outpatient clinics of 2 Government homeopathic medical colleges in West Bengal, India. A pilot-tested structured questionnaire consisting of 12 self-administered questions in local vernacular Bengali was used; 8 were close-ended questions providing multiple answer options, while 4 were open-ended. Results: Overall, 12.7% of interviewees admitted to perform self-medication; 57.7% and 66.0% had appropriate knowledge of the medicines and dose regimens, respectively. Females (64.3%) predominated and self-medication was mostly found in age range 31-45 years old (32.5%). Conventional Western medicine (82.2%) was most preferred therapy, and fever (35.7%), hyperacidity (25.4%) and loose stool (24.3%) the most frequently reported complaints. The main causes for self-medication were feeling no need to consult doctor (32.5%), busy schedule (16.4%), family members advice (16.0%), over-the-counter (OTC) availability of medicines without prescription (12.5%), direct consumer pharmaceutical advertisement (12.1%), and high expenditure in private institutes (10.1%). The chi-square distribution of determinants across the two samples differed significantly. The tendency increased proportionately with literacy (Yates’ ÷2=175.731; p=0.000) and poverty (Yates’ ÷2=426.817; p=0.000). (AU)

A prevalência da automedicação é mais elevada nos segmentos populacionais de baixa e média renda nos países em desenvolvimento, como reflexo de nível de atenção pública. A automedicação é frequentemente considerada como causa de resistência a medicamentos, aumento do custo do tratamento e outras complicações. Os autores do presente estudo objetivaram investigar a prevalência, consequências e causas da automedicação. Métodos: estudo multicêntrico, institucional e transversal incluindo 456 indivíduos que consultaram em maio de 2013 os ambulatórios de 2 hospitais universitários homeopáticos públicos em Bengala Ocidental, Índia. Foi distribuído para auto-aplicação um questionário estruturado previamente validado num teste piloto. O questionário incluía com 8 perguntas fechadas, com múltiplas opções de resposta, e 4 abertas, na língua vernácula local. Resultados: Aproximadamente 12,7% dos entrevistados admitiram se utilizar de automedicação; 57,7% e 66,0% tinham conhecimento adequado sobre o medicamento utilizado e posologia, respectivamente. A amostra esteve composta predominantemente por mulheres (64,3%), e a faixa etária com maior frequência de automedicação foi a de 31-45 anos (32,5%). A medicina convencional foi indicada como a preferida (82,2%) e as queixas mais frequentes foram febre (35,7%), azia (25,4%) e diarreia (24,3%). As principais causas para a escolha de automedicação foram: sem necessidade de consultar um médico (32,5%), falta de tempo (16,4%), conselho de familiares (16.0%), existência de medicamentos de venda livre (12.5%), publicidade farmacêutica dirigida diretamente ao consumidor (12.1%) e alto custo de serviços de saúde privados (10,1%). O teste de qui quadrado identificou diferença significativa na distribuição dos determinantes entre os dois grupos. A tendência para uso de automedicação aumentou paralelamente ao nível de educação (Yates χ2=175,731; p=0.000) e à pobreza (Yates χ2=426.817; p=0,000). (AU)