Florica Marian

Patient satisfaction with primary care: an observational study comparing anthroposophic and conventional care

BackgroundThis study is part of a cross-sectional evaluation of complementary medicine providers in primary care in Switzerland. It compares patient satisfaction with anthroposophic medicine (AM) and conventional medicine (CON).MethodsWe collected baseline data on structural characteristics of the physicians and their practices and health status and demographics of the patients. Four weeks later patients assessed their satisfaction with the received treatment (five items, four point rating scale) and evaluated the praxis care (validated 23-item questionnaire, five point rating scale). 1946 adult patients of 71 CON and 32 AM primary care physicians participated.Results1. Baseline characteristics: AM patients were more likely female (75.6% vs. 59.0%, p < 0.001) and had higher education (38.6% vs. 24.7%, p < 0.001). They suffered more often from chronic illnesses (52.8% vs. 46.2%, p = 0.015) and cancer (7.4% vs. 1.1%). AM consultations lasted on average 23,3 minutes (CON: 16,8 minutes, p < 0.001).2. Satisfaction: More AM patients expressed a general treatment satisfaction (56.1% vs. 43.4%, p < 0.001) and saw their expectations completely fulfilled at follow-up (38.7% vs. 32.6%, p < 0.001). AM patients reported significantly fewer adverse side effects (9.3% vs. 15.4%, p = 0.003), and more other positive effects from treatment (31.7% vs. 17.1%, p < 0.001).Europep: AM patients appreciated that their physicians listened to them (80.0% vs. 67.1%, p < 0.001), spent more time (76.5% vs. 61.7%, p < 0.001), had more interest in their personal situation (74.6% vs. 60.3%, p < 0.001), involved them more in decisions about their medical care (67.8% vs. 58.4%, p = 0.022), and made it easy to tell the physician about their problems (71.6% vs. 62.9%, p = 0.023). AM patients gave significantly better rating as to information and support (in 3 of 4 items p [less than or equal to] 0.044) and for thoroughness (70.4% vs. 56.5%, p < 0.001).ConclusionAM patients were significantly more satisfied and rated their physicians as valuable partners in the treatment. This suggests that subject to certain limitations, AM therapy may be beneficial in primary care. To confirm this, more detailed qualitative studies would be necessary.

Patient satisfaction and side effects in primary care: An observational study comparing homeopathy and conventional medicine

BackgroundThis study is part of a nationwide evaluation of complementary medicine in Switzerland (Programme Evaluation of Complementary Medicine PEK) and was funded by the Swiss Federal Office of Public Health. The main objective of this study is to investigate patient satisfaction and perception of side effects in homeopathy compared with conventional care in a primary care setting.MethodsWe examined data from two cross-sectional studies conducted in 2002–2003. The first study was a physician questionnaire assessing structural characteristics of practices. The second study was conducted on four given days during a 12-month period in 2002/2003 using a physician and patient questionnaire at consultation and a patient questionnaire mailed to the patient one month later (including Europep questionnaire).The participating physicians were all trained and licensed in conventional medicine. An additional qualification was required for medical doctors providing homeopathy (membership in the Swiss association of homeopathic physicians SVHA).ResultsA total of 6778 adult patients received the questionnaire and 3126 responded (46.1%). Statistically significant differences were found with respect to health status (higher percentage of chronic and severe conditions in the homeopathic group), perception of side effects (higher percentage of reported side effects in the conventional group) and patient satisfaction (higher percentage of satisfied patients in the homeopathic group).ConclusionOverall patient satisfaction was significantly higher in homeopathic than in conventional care. Homeopathic treatments were perceived as a low-risk therapy with two to three times fewer side effects than conventional care

Physicians’ Philosophy of Care: A Comparison of Complementary and Conventional Medicine

Background: This project is part of an evaluation of complementary and alternative medicine (CAM) aimed at providing a scientific basis for the Swiss Government to include 5 CAM methods in basic health coverage: anthroposophic medicine, homeopathy, neural therapy, phytotherapy and Traditional Chinese Medicine (TCM). Objectives: The objective was to explore the philosophy of care (convictions and values, priorities in medical activity, motivation for CAM, criteria for the practice of CAM, limits of the used methods) of conventional and CAM general practitioners (GPs) and to determine differences between both groups. Materials and Methods: This study was a cross-sectional survey of a representative sample of 623 GPs who provide complementary or conventional primary care. A mailed questionnaire with open-ended questions focusing on the philosophy of care was used for data collection. An appropriate methodology using a combination of quantitative and qualitative approaches was developed. Results: Significant differences between both groups include philosophy of care (holistic versus positivistic approaches), motivation for CAM (intrinsic versus extrinsic) and priorities in medical activity. Both groups seem to be aware of limitations of the therapeutic methods used. The study reveals that conventional physicians are also using complementary medicine. Discussion: Our study provides a wealth of data documenting several aspects of physicians’ philosophy of care as well as differences and similarities between conventional and complementary care. Implications of the study with regard to quality of care as well as ethical and health policy issues should be investigated further.

Complementary and Conventional Medicine in Switzerland: Comparing Characteristics of General Practitioners

Objectives: Do structural characteristics of general practitioners (GPs) who practice complementary medicine (CAM) differ from those GPs who do not? Assessed characteristics included experience and professional integration of general practitioners (GPs), workload, medical activities, and personal and technical resources of practices. The investigated CAM disciplines were anthroposophic medicine, homoeopathy, traditional Chinese medicine, neural therapy and herbal medicine. Material and Methods: We designed a cross-sectional study with convenience and stratified samples of GPs providing conventional (COM) and/or complementary primary care in Switzerland. The samples were taken from the database of the Swiss medical association (FMH) and from CAM societies. Data were collected using a postal questionnaire. Results: Of the 650 practitioners who were included in the study, 191 were COM, 167 noncertified CAM and 292 certified CAM physicians. The proportion of females was higher in the population of CAM physicians. Gender-adjusted age did not differ between CAM and COM physicians. Nearly twice as many CAM physicians work part-time. Differences were also seen for the majority of structural characteristics such as qualification of physicians, type of practice, type of staff, and presence of technical equipment. Conclusion: The study results show that structural characteristics of primary health care do differ between CAM and COM practitioners. We assumed that the activities of GPs are defined essentially by analyzed structures. The results are to be considered for evaluations in primary health care, particularly when quality of health care is assessed.

Medical pluralism, equity and holism.

Medical pluralism, equity and holism: these are research issues and perspectives arising in the Swiss Programme for the Evaluation of Complementary Medicine (PEK). This evaluation was commissioned by the Swiss Government in order to provide scientific data on 5 complementary therapies (anthroposophic medicine, homeopathy, neural therapy, phytotherapy and traditional Chinese medicine). The aim of PEK was to inform a policy decision about whether or not these disciplines, if provided by physicians in primary care, should be covered by basic health insurance. As PEK assessed a model of primary care which integrated conventional and complementary medicine – by comparing it with conventional primary care – I will also use the denomination ‘integrative medicine’. PEK was carried out from 1998 to 2005. In that time, the government as well as the responsible authorities changed and decided against the definitive inclusion of the CAM methods in compulsory health coverage in June 2005. This was a political decision not supported by PEK data, and associated with a lack of fairness at several levels (e.g. exercise of political influence on the research process; the decision-making process itself). As equity and fairness are often neglected issues in the research literature on complementary and alternative medicine (CAM), they are investigated in two articles presented here. Holism, however, is very often mentioned and addressed in CAM research. The PEK data confirm the importance of holism as a core dimension for both physicians and patients. Moreover, they allow to include the aspect of physician satisfaction into a four-dimension model which comprises wholeness of patient, wholeness of physician, integration of therapeutic approaches and a relational dimension. The thematic focus of this supplement is influenced by my own experience as a researcher participating in the PEK observational studies conducted in Swiss primary care and especially in the study on physicians’ philosophy of care. Moreover, the daily confrontation with political and academic pressure and misuse of power motivated me to explore equity issues in more detail. My background in medical and cultural anthropology may also have contributed to a reflection on equity which takes into account both the role of the participant and the role of the observer. As a consequence, three methodological approaches are combined in the articles of this supplement: (1) an empirical approach, (2) a normative approach (a form of ethical enquiry and reflection on what should be or what a fair process would look like, and (3) a theoretical approach (discussing concepts of equity and holism). Such an interdisciplinary approach to both methodology and concerned fields, i.e. ethics, political science, primary care and complementary medicine, shows many valuable ways for CAM research. Without questioning the importance of clinical studies and the adaption of biomedical research methods to CAM, this supplement shows the need for new ways in CAM research and for a transfer of knowledge from other fields. One of the lessons to be learnt from PEK is the paradox, that the question about effectiveness of complementary medicine cannot simply be answered through more and more studies on effectiveness! Equally important is a reflection about the reasons, why it is so difficult for CAM research to be acknowledged (as a research field and regarding its results). PEK allows an analysis of equity issues interrelated within an equity circle. This is not only relevant for Switzerland. Anthropological, policy and practice dimensions of equity are identified and linked to different concepts of equity and conceptual frameworks: medical pluralism, cultural imperialism, accountability of reasonableness, distributive justice. The issues addressed in this supplement are closely connected to two of the four principles of biomedical ethics, i.e. beneficence, non-maleficence, respect for autonomy and justice. So I hope to contribute to acknowledging that respect for autonomy (as closely related to the recognition of medical pluralism), fairness and justice are important issues in research and debate on CAM. Moreover, I hope to show that the dialogue with other fields and disciplines may contribute to sustain the demands for more transparency, democracy and justice in the context of research and health policy. Florica Marian Bern