The profiles of adults who consult alternative health practitioners and/or general practitioners

Objective. To compare the profiles of people visiting only a general practitioner (GP), those visiting only a practitioner of complementary and alternative medicine (CAM), and those visiting both (GP&CAM). Design. A comparative total population health survey in central Norway (HUNT 2). Subjects. A total of 54 448 persons 20 years of age and over who answered questions about their use of health services during the previous 12 months. Variables. Sociodemographic characteristics, self-perceived health, subjective health complaints, and a variety of common diseases. Results. Some 34 854 (64.0%) of those who answered the health service use question had visited only a GP, 837 (1.5%) only a CAM practitioner, and 4563 (8.4%) both during the last 12 months. The likelihood of being a CAM-only user as compared to a GP-only user was significantly increased (p < 0.005) if the participant was male; aged between 30 and 69; and without cardiovascular disease. The likelihood of being a GP&CAM user compared with a GP-only user was significantly increased (p < 0.005) for those who were female; aged between 30–59; had a higher education level; were non-smokers; had lower perceived global health; had a limiting chronic complaint; had experienced a health complaint during the last 12 months; had musculoskeletal disease; had a psychiatric complaint; and had hay fever. Conclusion. There were few CAM-only users and they differ from GP-only users by being male, aged 30–69, and without cardiovascular disease. Users of both GP&CAM were less healthy with more complaints and poorer self-reported health than GP- and CAM-only users.     

Perceptions of person-centred care amongst individuals with chronic conditions who consult complementary medicine practitioners

ObjectivesChronic conditions require continuous, multi-factorial care – such as person-centred care – to address patients’ individual health needs and quality of life. Many patients with chronic conditions seek additional care outside mainstream medicine, often consulting complementary medicine (CM) practitioners. This study examines person-centred care experienced by patients with chronic conditions consulting CM practitioners.DesignCross-sectional survey.SettingCM clinics around Australia, conducted November 2018 to March 2019.ParticipantsPatients with chronic conditions (n = 153) consulting osteopaths (n = 39), naturopaths (n = 33), massage therapists (n = 29), chiropractors (n = 28) and acupuncturists (n = 24).Main outcome measuresPatient-Centred Care Scale, Perceived Provider Support Scale, Empowerment Scale, and Patient Assessment of Chronic Illness Care measure.ResultsPatient perceptions of person-centred care were consistently high during consultation with CM practitioners (Patient-centred Care scale mean range 4.22–4.70; Perceived Provider Support scale mean range 4.39–4.69; Empowerment scale mean range 2.20–2.50; Patient Assessment of Chronic Illness Care mean summary 3.33). Ratings of person-centred care were higher for consultations with CM practitioners than for medical doctors. Patients of naturopaths reported the highest means for perceived person-centred care. Variation in participant ratings for different items between professions indicate nuance in consultation experiences across different CM professions.ConclusionsPerson-centred care appears characteristic of CM consultation, which may reflect holistic philosophies. Variations in patient experiences suggest diverse practices across CM professions. CM practitioners may present a resource of person-centred care for addressing unmet needs of individuals with chronic conditions, and reducing the health burden associated with rising rates of chronic conditions.     

Contact with primary health care physicians before an acute hospitalisation

Abstract

Objectives: To assess contacts with general practitioners (GPs), both regular GPs and out-of-hours GP services (OOH) during the year before an emergency hospital admission.

Design: Longitudinal design with register-based information on somatic health care contacts and use of municipality health care services.

Setting: Four municipalities in central Norway, 2012–2013.

Subjects: Inhabitants aged 50 and older admitted to hospital for acute myocardial infarction, hip fracture, stroke, heart failure, or pneumonia.

Main outcome measures: GP contact during the year and month before an emergency hospital admission.

Results: Among 66,952 identified participants, 720 were admitted to hospital for acute myocardial infarction, 645 for hip fracture, 740 for stroke, 399 for heart failure, and 853 for pneumonia in the two-year study period. The majority of these acutely admitted patients had contact with general practitioners each month before the emergency hospital admission, especially contacts with a regular GP. A general increase in GP contact was observed towards the time of hospital admission, but development differed between the patient groups. Patients admitted with heart failure had the steepest increase of monthly GP contact. A sizable percentage did not contact the regular GP or OOH services the last month before admission, in particular men aged 50–64 admitted with myocardial infarction or stroke.

Conclusion: The majority of patients acutely admitted to hospital for different common severe emergency diagnoses have been in contact with GPs during the month and year before the admission. This points towards general practitioners having an important role in these patients’ health care.

• KEY MESSAGES

• There is scarce knowledge about primary health care contact before an emergency hospital admission.

• The percentage of patients with contacts differed between patient groups, and increased towards hospital admission for most diagnoses, particularly heart failure.

• More than 50% having monthly general practitioner contact before admission underscores the general practitioners’ role in these patients’ health care.

• Our results underscore the need to consider medical diagnosis when talking about the role of general practitioners in preventing emergency hospital admissions.

     

Predictive factors of complementary and alternative medicine use in the general population in Europe: A systematic review

AimTo identify predictive factors of CAM use in the general population in Europe.MethodsWe performed a systematic review to summarize and analyse the published data on factors predictive of CAM use by the general population in Europe. The Cumulative Index to Nursing and Allied Health Literature, Google Scholar, PsycInfo, PubMed and the Web of Science databases were systematically searched up to August 2, 2018. We selected observational studies (case-control, cohort and cross-sectional) of adults conducted in Europe. Risk of bias was determined using the ROBINS-I tool recommended by the Cochrane Group.ResultsOver six thousand articles were identified of which 49 met our inclusion criteria. Twenty three studies investigated the consultation of CAM practitioners, five looked at the use of CAM products, one concerned CAM practices and twenty studied combinations of these. Female gender and self-reported chronic disease are predictive factors of CAM practitioner use. In contrast, marital status is not a predictive factor for consulting a CAM practitioner. Female gender is also a predictive factor of CAM product use. For all other factors investigated, no clear conclusions could be drawn.ConclusionWe found no clear specificity of the use of CAM practitioners versus conventional health practitioners. Other directions of public health research should be explored, rather than assuming that there is specificity.     

Perception and use of herbals among students and their practitioners in a university setting

PURPOSE: To determine the extent of herbal use among students at Rutgers, the State University of New Jersey, and to examine the campus health services practitioners' attitudes toward herbals. DATA SOURCES: An exploratory study of a nonrandom sampling of 1,754 students and 40 practitioners. The student t test and chi-square comparisons were used to analyze the data. CONCLUSIONS: Over half of the students surveyed were using herbals, primarily for relief of physical symptoms, prevention of illness, and improvement of general well-being. Many students lacked accurate or sufficient information about herbals and were not seeking medical guidance. Although the practitioners asked students about herbal use and sometimes even encouraged it, 75% noted the need for additional professional education about herbals. IMPLICATIONS FOR PRACTICE: Practitioners in the college health setting need to be cognizant of students' self-medication with herbals and need to have the knowledge to guide students appropriately.     

Use of complementary and alternative medicine practitioners by people with physical disabilities: Estimates from a National US Survey

Purpose. To estimate the prevalence of complementary and alternative medicine (CAM) practitioner use, assess the reasons for use, and determine the symptoms for which CAM practitioners were consulted in a national US sample of insured adults with physical disabilities.

Methods. Data for this study come from a longitudinal survey conducted in 2000 and 2001 on a national sample of 830 adults with health insurance who had one of four disabling conditions: multiple sclerosis, cerebral palsy, spinal cord injury, and arthritis. Estimates of annual prevalence and reasons and symptoms for which CAM practitioners were consulted are derived from cross-sectional analysis of the 2001 survey data. Prior use of CAM was assessed using the 2000 survey.

Results. CAM practitioners were consulted by 19% of the sample, a rate similar to, or higher than the general population. CAM use was more prevalent among women than men (24 vs. 10%), in the Western US (30%) compared to the Midwest (20%) Northeast (14%), and South (10%) and among prior users (62%) compared to non-users (8%). There were no significant differences in CAM use by condition, although individuals with spinal cord injury reported the lowest use (14%). Common symptoms treated were pain (80%), decreased functioning (43%), and lack of energy (24%). Common reasons for using CAM practitioners included lifestyle choice (67%) and because they are perceived to be more effective than conventional medicine (44%).

Conclusions. Evidence from the current survey suggests that a significant proportion of people with physical disabilities consult CAM practitioners. Many of those who use CAM do so because it fits their lifestyle and because they perceive it to be more effective than conventional medicine for treating common symptoms including pain and decreased functioning.     

Use of complementary and alternative medicine practitioners by people with physical disabilities: estimates from a National US Survey

Purpose. To estimate the prevalence of complementary and alternative medicine (CAM) practitioner use, assess the reasons for use, and determine the symptoms for which CAM practitioners were consulted in a national US sample of insured adults with physical disabilities.

Methods. Data for this study come from a longitudinal survey conducted in 2000 and 2001 on a national sample of 830 adults with health insurance who had one of four disabling conditions: multiple sclerosis, cerebral palsy, spinal cord injury, and arthritis. Estimates of annual prevalence and reasons and symptoms for which CAM practitioners were consulted are derived from cross-sectional analysis of the 2001 survey data. Prior use of CAM was assessed using the 2000 survey.

Results. CAM practitioners were consulted by 19% of the sample, a rate similar to, or higher than the general population. CAM use was more prevalent among women than men (24 vs. 10%), in the Western US (30%) compared to the Midwest (20%) Northeast (14%), and South (10%) and among prior users (62%) compared to non-users (8%). There were no significant differences in CAM use by condition, although individuals with spinal cord injury reported the lowest use (14%). Common symptoms treated were pain (80%), decreased functioning (43%), and lack of energy (24%). Common reasons for using CAM practitioners included lifestyle choice (67%) and because they are perceived to be more effective than conventional medicine (44%).

Conclusions. Evidence from the current survey suggests that a significant proportion of people with physical disabilities consult CAM practitioners. Many of those who use CAM do so because it fits their lifestyle and because they perceive it to be more effective than conventional medicine for treating common symptoms including pain and decreased functioning.     

The seduction of general practice and illegitimate birth of an expanded role in population health care

To reduce health inequalities and improve quality in health care, health policy initiatives in countries including New Zealand and the United Kingdom are expecting general practice to share responsibilities for a population approach to health care. This is giving increased emphasis to preventative care, including health promotion. Reasoned debate on this policy is overdue, not least in New Zealand, where clinicians within general practice appear to have been seduced by the lack of clarity in health policy into accepting this policy without question. They appear to disregard implications of the policy for redefining the nature and scope of their discipline (and of public health), including their own role as providers of personal care. This paper suggests that a population health approach is inappropriate in general practice when this approach weakens personal care and involves health promotion activity of unknown safety and effectiveness. The example of intentional weight loss to reduce overweight is used to illustrate these issues. We argue for a restricted range of general practice services.     

Factors related to self-rated health: a survey among patients and their general practitioners

ObjectiveTo explore associations between general practice patients’ SRH and symptoms, diagnoses, chronic conditions, unexplained conditions, and life stressors.DesignA cross-sectional study. Data were collected from GP and patient questionnaires.SettingGeneral practices in Southeast Norway.Subjects47 general practitioners (GPs) who included 866 consecutive patients.Main outcome measuresSRH was measured with a single question from the COOP-WONCA overall health chart and dichotomized into good/poor SRH. Binary logistic regression models were used in the analyses.ResultsPoor SRH was reported by 48% of the patients in the past week. A higher prevalence of poor SRH was found for women, middle-aged, recipients of social security grants, patients diagnosed with asthenia, lower back pain, and depression/anxiety, and for patients with reported life stressors and unexplained conditions. We found an almost linear association between the number of symptoms and the likelihood of reporting poor SRH. The probability of reporting poor SRH increased along with an increasing number of symptoms for common diagnoses. In a multivariate analysis, the only number of symptoms, being in receipt of social security grants and being retired was associated with poor SRH.ConclusionThe likelihood of reporting poor SRH increased with an increasing number of symptoms, partly independent of the diagnosis given by GPs. This result coincides with our previous findings of a strong association between the number of symptoms, function, and health. The symptom burden thus appears to be an important factor for SRH among patients in general practice.

KEY POINTS

• There is a high prevalence of poor SRH in general practice patients.
• The likelihood of reporting poor SRH is partly independent of the diagnosis given.
• The number of symptoms was the factor strongest associated with poor SRH.

     

Prevalence of burnout among Swiss cancer clinicians, paediatricians and general practitioners: who are most at risk?

Goals of work  Increasing economical and administrative constraints and changes in health-care systems constitute a risk for burnout, especially for cancer physicians. However, little is known about differences across medical specialties and the importance of work characteristics. Methods  A postal questionnaire addressing burnout, psychiatric morbidity, sociodemographics and work characteristics was administered to 180 cancer physicians, 184 paediatricians and 197 general practitioners in Switzerland. Results  A total of 371 (66%) physicians participated in the survey. Overall, one third of the respondents expressed signs indicative of psychiatric morbidity and of burnout, including high levels of emotional exhaustion (33%) and depersonalisation/cynicism (28%) and a reduced feeling of personal accomplishment (20%). Workload (>50 h/week), lack of continuing education (<6 h/month) and working in a public institution were significantly associated with an increased risk of burnout. After adjustment for these characteristics, general practitioners had a higher risk for emotional exhaustion (OR: 2.0, 95% CI: 1.1 to 3.6) and depersonalisation (OR: 2.7, 95% CI: 1.4 to 5.3). Conclusion  In this Swiss sample, cancer clinicians had a significant lower risk of burnout, despite a more important workload. Among possible explanations, involvement in research and teaching activities and access to continuing education may have protected them.     

The impact of dementia on the use of general practitioners among the elderly in Norway

Objective. To assess the use of general practitioners (GPs), in elderly home-dwelling persons in Norway and explore the impact of cognitive decline, age, and living situation. Design. Prospective longitudinal study. Setting. Data were collected from municipalities in four counties in Norway in the period from January 2009 to August 2012. Subjects. Home-dwelling persons 70 years of age or older, receiving in-home care. Main outcome measures. Use of GPs over a period of 18 months related to cognitive state, functional status, neuropsychiatric symptoms, and demographics. Results. A total of 599 persons were included. The mean annual number of consultations per participant was 5.6 (SD = 5.4). People with moderate to severe dementia had fewer consultations per year compared with those with mild or no dementia (3.7 versus 5.8 per year, p = 0.004). In the multivariate model higher age predicted fewer consultations while affective neuropsychiatric symptoms were associated with an increase in frequency of consultations. The most frequent reason to consult a GP was cardiovascular diseases (36.8% of all consultations), followed by musculoskeletal complaints (12.1%) and psychiatric diagnoses (8.7%). Conclusion. Our study shows that the home-dwelling elderly with moderate to severe dementia in Norway consult their GP less often than persons with mild or no dementia. This could indicate a need for better interaction between the municipal care and social services and the general practitioners.     

Non-participation in preventive child health examinations at the general practitioner in Denmark: a register-based study

Objective

To examine demographic and socioeconomic characteristics of parents and children in families not participating in preventive child health examinations at the general practitioner in a society with free and easy access to healthcare.

Design

Population-covering register linkage study.

Setting

Denmark, 2002–2004.

Subjects

Two cohorts comprising all children born in Denmark between 1 July 1998 and 30 June 1999 (n =70 891) and in 2002 (n =65 995), respectively. The demographic and socioeconomic characteristics of these children and the adults living in the same household as these were identified through register linkage.

Main outcome measures

Crude and mutually adjusted odds ratios for non-participation in scheduled preventive child health examinations at the GP (age 5 weeks, 5 months, 12 months, 4 years, and 5 years) according to child characteristics (sex, number of hospitalizations, and older siblings) and parental characteristics (age, educational level, attachment to labour market, ethnicity, household income, and number of adults in the household).

Results

Children of young and single parents were less likely to receive a preventive child health examination. Increased odds ratios for non-participation were found for children of parents outside the labour market, with low educational level, and especially for the combination of these. Non-participation increased with decreasing household income and with the number of older siblings.

Conclusion

Despite the fact that Denmark has free and easy access to the GP, the utilization of preventive child health examinations is lower among the more deprived part of the population.     

New medicines in primary care: a review of influences on general practitioner prescribing

Background and objective: The uptake of new medicines is slower in the UK than in many other countries. Previous research found that cost and price have little influence on general practitioner (GP) behaviour, but recent UK government policy may have heightened cost‐consciousness. Focussing on new medicines, this review aimed to explore the determinants of uptake, the causes of geographical variations, and the influence of price, cost and financial incentives on prescribing behaviour. Methods: Two separate searches were conducted on nine electronic databases. Strategy 1, an update of a previous review, used key terms for primary care physicians, uptake, medicines and ‘new’. Strategy 2 focussed on terms relating to incentives and prescribing. Records were screened for eligibility and data from relevant papers were extracted using Bonair and Persson’s typology for determinants of the diffusion of innovation, which classified influences into three groups: actors, structural/environmental characteristics and product characteristics. Results: The searches identified 550 records and 28 studies were included in the updated review. Prescribing of new medicines needs to be understood in the context of individual patient‐centred care, which is characterized by stability and continuity. Hospital doctors, pharmaceutical representatives and prescribing advisers are all influential, but GP attitudes towards these actors vary and there are notable differences between high and low prescribers of new pharmaceuticals. Support systems can help provide appropriate guidance and increase the uptake of new medicines by identifying patients who may benefit from pharmaceutical therapy. There is evidence of a shift in GP attitudes towards central policy initiatives, with doctors slowly accepting the need for external scrutiny and national standards. Although cost does appear to inform prescribing decisions, it is typically of lower importance than both safety and efficacy concerns and does not represent a significant barrier to uptake of new medicines. The impact of financial incentives on prescribing behaviour remains unclear, but is unlikely to be straightforward. No evidence exploring the reasons for geographical variations in GP uptake of new medicines was found. Conclusion: General practitioner care has historically been patient‐centred, and it is unclear whether and how GPs consider the impact of their decisions upon the wider patient population. Incorporating cost considerations into GP decision making is one way to reflect the broader impact of individual treatment decisions. Current UK government policies use incentives to improve quality and encourage financial responsibility. Although these initiatives may help foster cost‐consciousness, there is a risk that unintended consequences may ensue. Therefore, future policy evaluations should assess benefits, harms and costs so that the overall impact is transparent.     

Use of complementary and alternative therapies: a national multicentre study of oncology health professionals in Norway

Goals of work It is well documented that an increasing proportion of cancer patients today use complementary and alternative medicine, mostly alongside conventional therapies. This study investigates the use of complementary and alternative medicine among oncology health workers and the reported effects.Patients and methods In June 2002, we conducted a national multicentre survey including 828 Norwegian oncologists, nurses, clerks and therapeutic radiographers. The response rate was 61.5%.Main results We found that females were more often users of both complementary and alternative methods than males (39% versus 15% and 47% versus 17%) and that few oncologists had tried such treatments compared to nurses, therapeutic radiographers and clerks (20/12% versus 50/40%, 41/33% ,and 31/50%). Interestingly, the majority of those who had tried unconventional methods reported some or very good effects. Acupuncture, homeopathy, aromatherapy and massage were the most popular therapies. Sub-group analyses including only oncologists showed that female physicians were more often users of both complementary and alternative methods compared to males (33% versus 12%, 25% versus 3%). Moreover, participants below the age of 35 years and Christians more often reported use.Conclusions This survey demonstrates that significant proportion of oncology health workers in Norway have used non-proven therapies and that most have had a positive experience. Differences in use is highly dependent on gender, profession, age and religion.