Focus on Alternative and Complementary Therapies
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Focus Alternat Complement Ther©2005 Pharmaceutical Press
Focus Altern Complement Ther 2003; 8: 139
An effectiveness gap (EG) is an area of clinical practice where available treatments are not fully effective, for any reason. Effectiveness gaps in general practice have not been previously researched. Complementary and alternative medicine (CAM) interventions, by definition, are not generally available through normal health care channels. Objectives were to determine the nature, frequency and causes of EGs in general practice and to obtain preliminary data on whether CAM may offer effective interventions in these clinical areas.
Semi-structured telephone interviews; bibliometric study; 22 general practitioners (GPs) in London, UK. A total of 152 GPs that had responded to an earlier survey on attitudes to CAM were approached. Respondents were asked to specify EGs and to give reasons why current treatment is unsatisfactory, and estimate the frequency and severity of clinical problems relating to EGs. Sampling was continued to redundancy. A bibliometric study examined the volume and type of published evidence on the effectiveness of CAM interventions in the identified clinical areas.
There was good concordance among responding GPs on EGs encountered in general practice. A total of 78 clinical problems were cited as suffering from EGs. The EGs are encountered quite frequently: 68/78 (87%) of EGs were encountered at least once per month. Musculoskeletal problems were cited by 20/22 (91%) of GPs as being affected by EGs. Depression, eczema, chronic pain and irritable bowel syndrome were also frequently mentioned. Systematic reviews and meta-analyses conclude that there is evidence for the effectiveness of various CAM interventions in most of these areas.
Effectiveness gaps in general practice have not previously been researched. In this cohort of GPs there was good agreement on the nature, scale and causes of EGs, but further work is required for confirmation. There is some evidence for the effectiveness of CAM interventions in most of these areas. Where effective CAM interventions exist but are not being applied, EGs form part of the ‘avoidable burden of illness’ identified by early work on evidence-based medicine. Practice guidelines should incorporate CAM interventions where there is evidence. The CAM research agenda should focus on areas affected by EGs.
