Focus on Alternative and Complementary Therapies
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Focus Alternat Complement Ther©2005 Pharmaceutical Press
Focus Altern Complement Ther 2003; 8: 141–2
Data for baseline healing rates of acupuncture and homoeopathy in uncontrolled, normal clinical practice are missing. German health insurance companies launched so-called trial phases in which CAM therapies could be evaluated in real practice settings.
The research objective is to evaluate the overall effectiveness in general practice of acupuncture and homoeopathy and to identify further research needs.
Prospective documentation of all patients insured with an insurance company (Innungskrankenkasse) who are provided with free treatment. The aim was to include about 5000 patients. All patients have been followed up from the beginning of treatment for another 4 years. Doctors provided data on each visit (diagnoses, treatment, change of symptoms), patients filled in questionnaires at the beginning and after treatment as well as once a year (in the case of acupuncture). In the case of homoeopathy patients had to provide data twice a year (complaints, current treatment, general health status as measured by the MOS SF-36). Insurance data on workdays lost was provided by the insurance company. A matched control sample was intended – a goal that could not be achieved.
About 3600 acupuncture patients and about 750 patients treated with homoeopathy have been entered into the study. These were patients for whom at least one component of the documentation was available. The doctors’ rating of the change of the main diagnosis showed improvement of 1 point on a 7-point Likert Scale ( > 1 SD). This impression of effectiveness is indicated by the patients’ follow-up questionnaire: About 40% of the patients rated the therapy as efficacious and further 25% as partly efficacious. Quality of life, as measured by the MOS SF-36, improved in most dimensions highly significantly. Despite good ratings of improvement, over 85% of the patients did not show up for further treatmently. This could be due to success of treatment as well as declining motivation to continue documentation. The intended control group could not be made because of patients’ preferences for CAM and not conventional treatment within trial phases of alternative approaches.
Change can be observed within a clinically significant range. Even though a high number of patients treated in real-life practice could be included in the study, some questions remained unclear because of the nature of documentation in the study.
