Introduction:
We report findings from a pilot data collection study within a programme of quality
assurance, improvement and development across all five homeopathic hospitals in the
UK National Health Service (NHS).
Aims:
(1) To pilot the collection of clinical data in the homeopathic hospital outpatient
setting, recording patient-reported outcome since first appointment; (2) to sample
the range of medical complaints that secondary-care doctors treat using homeopathy,
and thus identify the nature and complexity of complaints most frequently treated
nationally; (3) to present a cross section of outcome scores by appointment number,
including that for the most frequently treated medical complaints; (4) to explore
approaches to standard setting for homeopathic practice outcome in patients treated
at the homeopathic hospitals.
Methods:
A total of 51 medical practitioners took part in data collection over a 4-week period.
Consecutive patient appointments were recorded under the headings: (1) date of first
appointment in the current series; (2) appointment number; (3) age of patient; (4)
sex of patient; (5) main medical complaint being treated; (6) whether other main medical
complaint(s); (7) patient-reported change in health, using Outcome Related to Impact
on Daily Living (ORIDL) and its derivative, the ORIDL Profile Score (ORIDL-PS; range, –4 to +4, where a score ≤−2 or ≥+2 indicates an effect on the quality
of a patient's daily life); (8) receipt of other complementary medicine for their
main medical complaint.
Results:
The distribution of patient age was bimodal: main peak, 49 years; secondary peak,
6 years. Male:female ratio was 1:3.5. Data were recorded on a total of 1797 individual
patients: 195 first appointments, 1602 follow-ups (FUs). Size of clinical service
and proportion of patients who attended more than six visits varied between hospitals.
A total of 235 different medical complaints were reported. The 30 most commonly treated
complaints were (in decreasing order of frequency): eczema; chronic fatigue syndrome
(CFS); menopausal disorder; osteoarthritis; depression; breast cancer; rheumatoid
arthritis; asthma; anxiety; irritable bowel syndrome; multiple sclerosis; psoriasis;
allergy (unspecified); fibromyalgia; migraine; premenstrual syndrome; chronic rhinitis;
headache; vitiligo; seasonal allergic rhinitis; chronic intractable pain; insomnia;
ulcerative colitis; acne; psoriatic arthropathy; urticaria; ovarian cancer; attention-deficit
hyperactivity disorder (ADHD); epilepsy; sinusitis. The proportion of patients with
important co-morbidity was higher in those seen after visit 6 (56.9%) compared with
those seen up to and including that point (40.7%; P < 0.001). The proportion of FU patients reporting ORIDL-PS ≥ +2 (improvement affecting
daily living) increased overall with appointment number: 34.5% of patients at visit
2 and 59.3% of patients at visit 6, for example. Amongst the four most frequently
treated complaints, the proportion of patients that reported ORIDL-PS ≥ +2 at visit
numbers greater than 6 varied between 59.3% (CFS) and 73.3% (menopausal disorder).
Conclusions:
We have successfully piloted a process of national clinical data collection using
patient-reported outcome in homeopathic hospital outpatients, identifying a wide range
and complexity of medical complaints treated in that setting. After a series of homeopathy
appointments, a high proportion of patients, often representing “effectiveness gaps”
for conventional medical treatment, reported improvement in health affecting their
daily living. These pilot findings are informing our developing programme of standard
setting for homeopathic care in the hospital outpatient context.
Keywords
Clinical data collection - Homeopathic hospitals - Patient-reported outcomes
