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Large majority of patients with joint diseases use manual therapies, acupuncture or homeopathy

A research team in the Netherlands explored patients’ perspectives towards the use of Complementary and Alternative Medicine (CAM), its integration in primary care and the specific role of the GP therein.

The study included a survey on use, attitudes and disclosure of CAM, an e-panel consultation and focus group among patients with joint diseases. A total of 416 patients responded to the survey who suffered from osteoarthritis (51%), rheumatoid arthritis (29%) or fibromyalgia (24%).

The following four research questions were addressed: (1) What is the prevalence of CAM use among Dutch patients with joint diseases? (2) What are these patients’ attitudes toward CAM use? (3) Do these patients disclose CAM use to their GP? (4) How do these patients envision integration of CAM therapies in primary care?

The study demonstrated a high prevalence of CAM use among patients with joint diseases. A two-year prevalence of 86%, including the use of CAM home remedies, and 71% of patients visiting a CAM practitioner. Reasons for CAM use include a wide range of factors. The primary pull factors were an integrative approach to disease management, advice from a different angle and having received positive information about CAM practitioners. Push factors for CAM use were searching for an alternative to conventional medication and no further progress with conventional treatment. These results largely confirm earlier observations, that nowadays patients intentionally seek CAM because they want to be treated in an integrative or holistic way, rather than for reasons of negative experiences with conventional treatment.

Manual therapies, acupuncture and homeopathy were most frequently used. Currently, there seems to be a gigantic gap in conventional medicine between patients who would like to discuss CAM and physicians who do not talk about it with their patients. A minority (30%) actively communicated CAM use with their General Practitioner (GP). The majority (92%) preferred a GP who informed about CAM, 70% a GP who referred to CAM, and 42% wanted GPs to collaborate with CAM practitioners. Similar attitudes were found in the focus group and upon e-panel consultation.

Interestingly, almost one quarter of patients with joint diseases reported to use less conventional medication and to pay less visits to their GP upon CAM use. Since conventional medication, especially those for rheumatoid arthritis, is associated with high expenditure of healthcare costs, this observation may indicate possible cost-effectiveness upon CAM use.

The authors conclude that most patients in primary care want a GP who listens, inquires about CAM and if necessary refers to or collaborates with CAM practitioners.
To meet needs of patients, primary care disease management would benefit from an active involvement of GPs concerning CAM communication/referral. This study presents a model addressing the role of patients and GPs within such an integrative approach.

Jong MC, et al.(2012) Integration of complementary and alternative medicine in primary care: What do patients want? Patient Education and Counseling, [PubMed]

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