Subhranil Saha

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.

A validation study of homeopathic prescribing and patient care indicators.

A preliminary version of the homeopathic prescribing and patient care indicators was available. The instrument was modified further in this study with an intention to address formally its validity and reliability, audit prescriptions, identify areas of sub-optimal prescribing, and highlight target areas for improving the quality of practices. A cross-sectional study with record analysis was conducted on systematically sampled 377 patients of Mahesh Bhattacharyya Homeopathic Medical College and Hospital (MBHMC and H), Howrah, West Bengal, India. The outcome measures were homeopathic prescribing indicators (6 items) and patient care indicators (5 items). Individualized homeopathic prescriptions predominated in the encounters. Areas demanding immediate attention were extremely poor labeling of drugs dispensed from the hospital pharmacy, improper record of case history and disease diagnosis, ongoing therapies, and investigational findings in the prescriptions. Internal consistency of the overall instrument was estimated to be good (Cronbach′s alpha: Prescribing indicators 0.752 and patient care indicators 0.791). The prescribing indicators, except items 1 and 3, reflected acceptable item-corrected total correlations - Pearson′s r from 0.58 (95% CI: 0.52-0.65) to 0.74 (95% CI: 0.69-0.78). The patient care indicators, except item 2, showed acceptable correlations - Pearson′s r from 0.40 (95% CI: 0.31-0.48) to 0.82 (95% CI: 0.78-0.85). The instrument also showed high discriminant validity (prescribing indicators P < 0.0001 and patient care indicators P < 0.0001). Improper prescribing practice was quite rampant and corrective measures are warranted. The developed indicators appeared to be validated and reliable; however, they are amendable for further development.

Patient-Assessed Chronic Illness Care (PACIC) scenario in an Indian homeopathic hospital

Homeopathy research has focused on chronic conditions; however, the extent to which current homeopathic care is compliant with the Chronic Care Model (CCM) has been sparsely shown. As the Bengali Patient-Assessed Chronic Illness Care (PACIC)-20 was not available, the English questionnaire was translated and evaluated in a government homeopathic hospital in West Bengal, India. The translation was done in six steps, and approved by an expert committee. Face validity was tested by 15 people for comprehension. Test/retest reliability (reproducibility) was tested on 30 patients with chronic conditions. Internal consistency was tested in 377 patients suffering from various chronic conditions. The questionnaire showed acceptable test/retest reliability [intraclass correlation coefficient (ICC) 0.57–0.75; positive to strong positive correlations; p < 0.0001] for all domains and the total score, strong internal consistency (Cronbach’s α = 0.86 overall and 0.65–0.82 for individual subscales), and large responsiveness (1.11). The overall mean score percentage seemed to be moderate at 69.5 ± 8.8%. Gender and presence of chronic conditions did not seem to vary significantly with PACIC-20 subscale scores (p > 0.05); however, monthly household income had a significant influence (p < 0.05) on the subscales except for “delivery system or practice design.” Overall, chronic illness care appeared to be quite promising and CCM-compliant. The psychometric properties of the Bengali PACIC-20 were satisfactory, rendering it a valid and reliable instrument for assessing chronic illness care among the patients attending a homeopathic hospital.

A Double-Blind Randomized Placebo-Controlled Feasibility Study Evaluating Individualized Homeopathy in Managing Pain of Knee Osteoarthritis

Few homeopathic complexes seemed to produce significant effects in osteoarthritis; still, individualized homeopathy remained untested. We evaluated the feasibility of conducting an efficacy trial of individualized homeopathy in osteoarthritis. A prospective, parallel-arm, double-blind, randomized, placebo-controlled pilot study was conducted from January to October 2014 involving 60 patients (homeopathy, n = 30; placebo, n = 30) who were suffering from acute painful episodes of knee osteoarthritis and visiting the outpatient clinic of Mahesh Bhattacharyya Homeopathic Medical College and Hospital, West Bengal, India. Statistically significant reduction was achieved in 3 visual analog scales (measuring pain, stiffness, and loss of function) and Osteoarthritis Research Society International scores in both groups over 2 weeks (P < .05); however, group differences were not significant (P > .05). Overall, homeopathy did not appear to be superior to placebo; still, further rigorous evaluation in this design involving a larger sample size seems feasible in future. Trial registration: Clinical Trials Registry, India (CTRI/2014/05/004589).

Documentation of Prescriptions and Clinical Outcomes in a Homeopathic Hospital Setting in West Bengal, India:

Documentation of prescriptions and clinical outcomes in routine homeopathic practice is a prerequisite for conducting targeted research in homeopathy. Six homeopathic physicians participated in methodical data collection over a 3-month period in 6 outpatient departments of Mahesh Bhattacharyya Homeopathic Medical College and Hospital, West Bengal, India. A specifically designed Microsoft Excel spreadsheet enabled recording of consecutive appointments—date, patient identity, medical condition/complaint, whether chronic/acute, new/follow-up case, patient-assessed outcome (7-point Likert-type scale: −3 to +3), prescribed homeopathic medication, and whether other medication/s being taken for the condition. Spreadsheets were submitted monthly for data synthesis and analysis. A total of 1972 patients’ follow-up generated data of 2905 appointments, of which 2272 (78.2%) were positive, 183 (6.3%) negative, and 450 (15.5%) showed no change. Strongly positive outcomes (scores of +2/+3) were recorded in osteoarthritis, piles, cough, dysfunctional uterine bleeding, chronic suppurative otitis media, and conjunctivitis. This systematic recording short-listed promising areas of future homeopathic research.

Developing the criteria for evaluating quality of individualization in homeopathic clinical trial reporting: a preliminary study

OBJECTIVE This study describes the development of a preliminary version of an instrument that attempts to assess the quality of reports of individualized homeopathic prescriptions in clinical trials and observational studies. METHODS A multidisciplinary panel of 15 judges produced an initial version of the instrument through iterative Delphi rounds and pilot-tested the instrument on five clinical trials. Later they assessed, under blind conditions, the individualization quality of 40 randomly-selected research reports. The final version of the instrument included six criteria. These items were scored consistently by all the raters regardless of background. RESULTS The instrument appeared to have adequate face and content validity, acceptable internal consistency or reliability (Cronbachs α 0.606 - 0.725), significant discriminant validity (F = 398.7; P < 0.000 1), moderate interrater reliability (Fleiss κ 0.533), agreeable test-retest reliability (Cohens κ 0.765 - 0.934), moderate sensitivity (0.4; 95% confidence interval 0.253-0.566), and high specificity (1.0; 95% confidence interval 0.891-1.000). CONCLUSION The initial data suggest that this instrument may be a promising systematic tool amendable for further development.

Prospective Evaluation of Few Homeopathic Rubrics of Kent’s Repertory From Bayesian Perspective

Absolute grading system of homeopathic repertories poses substantial threat to reliability; however, it may be resolved by evaluating rubrics prospectively using likelihood ratio (LR). The authors evaluated few “physical general” rubrics from Kent’s repertory—“chilly,” “hot,” “ambithermal,” “preference for hot/cold food,” “desire/aversion for fish/egg/meat/sour/pungent/salt/sweet/bitter”—prospectively in West Bengal, India, for 1.5 years using the Outcome Related to Impact on Daily Living scale. Per symptom/rubric, LRs < 1.5 were discarded. A total of 2039 encounters were analyzed for thermal relations and 4715 for desires/aversions for specific food items. Comparison with Kent’s repertory revealed discrepancies. One new rubric with corresponding medicines was suggested to be introduced, new entries of medicines were recommended, and some seemed to maintain their ascribed importance. The authors refrained from converting LRs into typefaces prematurely; still they propose introducing LR to repertories for a structural update, changing its use, and enabling homeopaths to make more reliable predictions.

Access to and utilization of the health services among the patients in a government homeopathic hospital in West Bengal, India: a cross-sectional study.

Accessibility to and utilization of the hospital health services is a complex and multifaceted issue. This study aimed to assess the knowledge of the patients of health services, current level of access to and utilization of services and to identify barriers and socioeconomic disparities in an Indian homeopathic hospital. A cross-sectional survey was conducted in December 2013 on systematically sampled 377 patients. Responses were analyzed using descriptive statistics and univariate logistic regression. Mean knowledge score and perceived mean difficulties in access to and utilization of services were 68.4% and 78.5%, respectively. Knowledge of the services was influenced by age, residence, education, speaking and reading of Bengali language, and income status (P < .05). Difficulty in access to and utilization of the health services were influenced by residence, understanding of Bengali language, and monthly household income (P < .05). Overall, health service access and utilization appeared promising, but needs improvement.

Dental Practice Scenario in a Government Homeopathic Hospital in West Bengal, India.

This pilot investigation initiated a research-targeted systematic dental homeopathy data collection in the dental outpatient section in a government homeopathic hospital in West Bengal, India. One conventionally trained dentist and 3 homeopathic doctors collected data from 949 appointments of 411 patients over 3 months. A specifically designed Excel spreadsheet enabled recording of consecutive dental appointments that was subjected to data synthesis and analysis in the end. A total of 87.3% conditions were chronic, and chronic periodontitis was most frequent (27.5%). Positive outcome was observed in 72.3% appointments. Strongly positive outcomes (scores of +2 or +3) were achieved most notably in toothache (84.6%). Single medicines were prescribed in 83.5% encounters, and mostly in tincture form (29.9%). Arnica montana constituted of 17.8% prescriptions. Considerable insight was gained into the homeopathic dental practice scenario in West Bengal, India. Positive findings suggest that dental homeopathy is a promising area for research in near future.

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.