Electronic Registration in Complementary/Homeopathic Medical Practice with Identification of ‘Best Homeopathic Cases’: A Pilot Study

Abstract

Background Practice-based registration could identify ‘general’ and ‘homeopathic’ prognostic factors for therapeutic success in patients who seek complementary and alternative medicine (CAM)/homeopathic treatment. Identification of ‘best homeopathic cases’ within a database could inform clinical research and improve homeopathic practice.

Objective To investigate the feasibility of registration in daily CAM/homeopathic practice, evaluate patient-reported outcome measures and tools for identifying ‘best homeopathic cases’ and to make recommendations for an electronic database.

Methods In 2015 and 2016, 25 homeopathic doctors registered details of a maximum of 20 patients each, with 6 months of follow-up (extended follow-up for ‘best homeopathic cases’), in Excel or in the Homeopathic Administration and Registration Program (HARP) database. Informed consent was obtained from each patient. Patient-perceived change of main complaint was measured by a 7-point Likert scale. Best homeopathic cases were defined by treatment with one homeopathic medicine, ≥ 2 months of follow-up, result score +2 to +4 on a 9-point Likert scale by the doctor, and by changes that could be attributed to the homeopathic medicine. Association between scores for change of main complaint and scores for ‘best homeopathic case’ was analysed by the Kruskal gamma test.

Results Three-hundred and ninety-nine patients were included. In 49.1%, the main complaint was present for ≥ 2 years. The most common diagnosis was ‘fatigue’ (N = 56; 14%). Major improvement in the main complaint (score +3) was reported by 22 to 26% at consecutive follow-up visits. One-hundred and ninety-six patients were treated with a single homeopathic medicine, among whom 66 ‘best homeopathic cases’ were identified. The correlation between patient-reported changes of main complaint and assessment by the doctor was significant (gamma = 0.832; p < 0.001).

Conclusions Registration of (co-)diagnoses, chronicity, treatments and outcomes in homeopathic practice with identification of ‘best homeopathic cases’ is feasible, using the tools provided. A user-friendly electronic database for efficient recording is recommended.

Keywords

complementary medicine - homeopathy - ‘best homeopathic cases’ - data collection - prognostic factors

• References

• 1 Witt CM, Lüdtke R, Baur R, Willich SN. Homeopathic medical practice: long-term results of a cohort study with 3981 patients. BMC Public Health 2005; 5: 115
• 2 Spence DS, Thompson EA, Barron SJ. Homeopathic treatment for chronic disease: a 6-year, university-hospital outpatient observational study. J Altern Complement Med 2005; 11: 793-798
• 3 Witt CM, Lüdtke R, Mengler N, Willich SN. How healthy are chronically ill patients after eight years of homeopathic treatment?–Results from a long term observational study. BMC Public Health 2008; 8: 413
• 4 Thompson EA, Mathie RT, Baitson ES. , et al. Towards standard setting for patient-reported outcomes in the NHS homeopathic hospitals. Homeopathy 2008; 97: 114-121
• 5 Rossi E, Endrizzi C, Panozzo MA, Bianchi A, Da Frè M. Homeopathy in the public health system: a seven-year observational study at Lucca Hospital (Italy). Homeopathy 2009; 98: 142-148
• 6 Mathie RT, Robinson TW. Outcomes from homeopathic prescribing in medical practice: a prospective, research-targeted, pilot study. Homeopathy 2006; 95: 199-205
• 7 Stock G, Sydow S. Personalised medicine. Paradigm shift within drug research and therapy [Article in German]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2013; 56: 1495-1501
• 8 Swayne J. International Dictionary of Homeopathy. Edinburgh: Churchill Livingstone; 2000: 121
• 9 WONCA International Classification Committee. ICPC-2: International Classification of Primary Care. 2nd ed. United Kingdom: Oxford University Press; 1998
• 10 MedicineNet. Definition of Chronic Disease. (2016). Available at: http://www.medicinenet.com/script/main/art.asp?articlekey=33490 . Last Editorial Review: 05-13-2016. Accessed February 2, 2018
• 11 Bernell S, Howard SW. Use your words carefully: what is a chronic disease?. Front Public Health 2016; 4: 159
• 12 Rutten L. Data collection: treat every variable as a treasure. Homeopathy 2015; 104: 190-196
• 13 Naranjo CA, Busto U, Sellers EM. , et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 1981; 30: 239-245
• 14 van Haselen RA. Homeopathic clinical case reports: Development of a supplement (HOM-CASE) to the CARE clinical case reporting guideline. Complement Ther Med 2016; 25: 78-85 [Appendix 1: Modified Naranjo Criteria as proposed by the HPUS Clinical Data Working Group (status, December 2015)]
• 15 Gagnier JJ, Kienle G, Altman DG, Moher D, Sox H, Riley D. ; CARE Group. The CARE guidelines: consensus-based clinical case report guideline development. J Clin Epidemiol 2014; 67: 46-51
• 16 Goodman LA, Kruskal WH. Measures of association for cross classifications. J Am Stat Assoc 1954; 49: 732-764
• 17 Heiligers PJM, de Groot J, Koster D, van Dulmen S. Diagnoses and visit length in complementary and mainstream medicine. BMC Complement Altern Med 2010; 10: 3
• 18 Statistics Netherlands [CBS]: Available at: https://www.cbs.nl . Bijna 1 miljoenmensenonderbehandeling van eenalternatievegenezer [Almost one million people visit alternative healer]. Webpage in Dutch, last updated 10-3-2014. Accessed April 9, 2016
• 19 Margry PJ. Healing en 'alternatiefgenezen'. Eenculturele diagnose [Healing and ‘alternative medicine’. A cultural diagnosis]. Amsterdam University Press; 2018: 29-35
• 20 van Dulmen S, de Groot J, Koster D, Heiligers P. Why seek complementary medicine? An observational study in homeopathic, acupunctural, naturopathic and mainstream medical practice. J Complement Integr Med 2010; 7: 1
• 21 National Institute for Public Health and the Environment. Ministry of Health, Welfare and Sport. (RIVM) The Public Health Foresight Study 2018 RIVM, VTV-2018 Trendscenario. www.vtv20178.nl/trendscenario Available at: https://www.vtv2018.nl/en/diseases . Accessed April 9, 2018
• 22 Reilly D, Mercer SW, Bikker AP, Harrison T. Outcome related to impact on daily living: preliminary validation of the ORIDL instrument. BMC Health Serv Res 2007; 7: 139
• 23 Paterson C. Measuring outcomes in primary care: a patient generated measure, MYMOP, compared with the SF-36 health survey. BMJ 1996; 312: 1016-1020
• 24 Thompson E, Viksveen P, Barron S. A patient reported outcome measure in homeopathic clinical practice for long-term conditions. Homeopathy 2016; 105: 309-317
• 25 Chung VC, Wong VC, Lau CH. , et al. Using Chinese version of MYMOP in Chinese medicine evaluation: validity, responsiveness and minimally important change. Health Qual Life Outcomes 2010; 8: 111
• 26 Krug K, Kraus KI, Herrmann K, Joos S. Complementary and alternative medicine (CAM) as part of primary health care in Germany-comparison of patients consulting general practitioners and CAM practitioners: a cross-sectional study. BMC Complement Altern Med 2016; 16: 409
• 27 Stolper CF, Lugten RF, Rutten L. Materia medica validation: Phosphoricum acidum and Phosphorus [Article in Dutch]. Similia Similib Curent 2000; 30: 34-35
• 28 Stolper CF, Barthels RJ, Lugten RF, Rutten ALB. Materia medica validation: Natrum muriaticum [Article in Dutch]. Similia Similib Curent 2007; 37: 12-14
• 29 Stolper CF, Barthels RJ, Lugten RF, Rutten ALB. Materia medica validation: Pulsatilla [Article in Dutch]. Similia Similib Curent 2005; 35: 19
• 30 Stolper CF, Barthels RJ, Lugten RF, Rutten ALB. Materia medica validation: Lachesis and Tarentula [Article in Dutch]. Similia Similib Curent 2000; 30: 18-20
• 31 Klein-Laansma CT, Rutten ALB, Jansen JPCH, van Wietmarschen H, Jong MC. Evaluation of a prognostic homeopathic questionnaire for women with premenstrual disorders. Complement Med Res 2018; 25: 173-182
• 32 Rutten AL, Stolper CF, Lugten RF, Barthels RW. Statistical analysis of six repertory rubrics after prospective assessment applying Bayes' theorem. Homeopathy 2009; 98: 26-34
• 33 Rutten AL, Stolper CF, Lugten RF, Barthels RW. Is assessment of likelihood ratio of homeopathic symptoms possible? A pilot study. Homeopathy 2003; 92: 213-216
• 34 Stolper CF, Rutten AL, Lugten RFG, Barthels RJ. Improving homeopathic prescribing by applying epidemiological techniques: the role of likelihood ratio. Homeopathy 2002; 91: 230-238
• 35 Scholte RA, Opmeer BC, Ploem MC. From record keeping to scientific research: obstacles and opportunities for research with electronic health records [Article in Dutch]. Ned Tijdschr Geneeskd 2017; 161: D1738