2.  WHAT CONTRIBUTION CAN
COMPLEMENTARY MEDICINE
MAKE TO PRIMARY HEALTH CARE?


The service provided an opportunity for patients with a range of different problems to receive non-conventional treatments, particularly patients with longer-term problems, patients with musculo-skeletal pain and discomfort, and patients with problems which had not responded to other forms of treatment.

This section provides a profile of the patients being referred to the service, the reasons for their referral, and their response to treatment as indicated by a number of different outcome measures.


2.1  Referrals to the service

During the three years that the project was funded, GPs referred over 600 patients to the service (around 17% of the overall patient population). The majority of referrals (71.4%) made to the service were patients suffering from long term health problems. Most commonly these were musculo-skeletal problems (59%), particularly long-term back or joint pain (Table 1). There was also a significant group of referrals with psycho-social problems (15%), related to anxiety, stress or depression, as well as patients referred for problems of the nervous, respiratory, genito-urinary and gastro-intestinal systems.

Many patients referred had multiple health problems and two thirds of patients described their problems as either severe, or very severe. (For more details about the characteristics of patients and problem referred, please see Appendix A).

Table 1:  Problem referred, as identified by GP

Problem*	Number (all referrals)	%	Number (first time referrals)	%
Musculo-skeletal	389	58.9	287	57
Psycho-social	97	14.7	77	15.3
Multi-system (eg. M.E.)	35	5.3	28	5.6
Nervous system	17	2.6	15	3
Respiratory	23	3.5	19	3.8
Gastro-intestinal	22	3.3	18	3.6
Genito-urinary	18	2.7	14	2.7
Cardio-vascular	10	1.5	7	1.4
Metabolic-hormonal	14	2.1	10	2
Skin	12	1.8	10	2
Smoking cessation	6	.9	5	1
Other	7	1	5	1
No information	11	1.7	8	1.6
Total	661		503

* from referral forms; main problem identified by GP

Osteopathy was the therapy most widely used at the practice, reflecting the high proportion of patients with musculo-skeletal problems that were referred to the service (Table 2). Acupuncture was the second most widely used, again dealing with a high proportion of musculo-skeletal problems. The low number of patients referred for homeopathy was partly a reflection of the fact that fewer sessions of homeopathy were available, and partly of the fact that two of the GPs also prescribed homeopathic treatments.

Table 2.  Therapy to which patient referred

Therapy to which patient referred	Number	%
Osteopathy	229	34.6
Acupuncture	188	28.4
Massage	119	18
Homeopathy	30	4.5
Herbal medicine	95	14.4
Total	661

GPs referred patients to the service for a variety of reasons (Table 3). Patients themselves frequently requested complementary medicine, but the GPs also frequently recommended the therapies to patients who might not have tried such therapies themselves, particularly where patients had problems which had failed to respond to conventional treatment.

Table 3  Reason given by GP for referral of patient

Reason for referral*	Number	%
Patient asked for treatment	274	41.5
Conventional medicine not effective	225	34
Doctors recommended treatment	173	26.2
Patient not happy with conventional medicine	86	13
Patient intolerant of conventional treatment	18	2.7
Total	661

* From referral forms.  Doctors could identify more than one reason for referral.

The reason for referral varied considerably from one GP to another, and according to problem and therapy (Table 4). Patients themselves were significantly more likely to request complementary medicine when suffering from long-term problems, and when the problem was an ‘other problem’: ie. not musculo-skeletal or psycho-social. They were more likely to request herbalism and osteopathy than other therapies.

Complementary medicine was most often recommended by the GPs when the problem was long term, (which was itself significantly related to conventional treatment having had no effect). Massage was frequently recommended by GPs for patients with stress and emotional problems. Referrals to acupuncture and homeopathy were most frequently used in cases in which problems had failed to respond to conventional treatment, while patients who were intolerant of, or unhappy with conventional medicines, were most likely to be referred to the herbalist or homeopath. Trainee doctors (with little experience of the complementary therapies) tended to refer mainly on the request of patients themselves, or for fairly ‘obvious’ problems, such as referring patients with chronic back pain to the osteopath.

Table 4  Reasons for referral to different therapies

	Osteopathy	Acupuncture	Massage	Homeopath	Herbalist
Patient asked for therapy	46.7%	40.4%	31.9%	26.7%	47.4%
GP’s recommendation	31.6%	22.3%	39.5%	-	12.6%
Conventional treatment not effective	27.1%	47.3%	29.4%	43.3%	27.4%
Patient intolerant of conventional treatment	.4%	3.7%	3.4%	3.3%	5.3%
Patient unhappy with conventional treatment	7.9%	28.4%	18%	4.5%	14.4%

All relationships significant at .05 level or above.

The reasons for patients requesting complementary medicine were quite complex. A high proportion 83%) already had experience of complementary medicine, and for over half, this bad taken place in the context of the practice itself, or on their GP’s suggestion. Many also expressed a clear preference for non-conventional treatments, either because they had found these to be beneficial in the past, or because they were wary of the side-effects of conventional treatments.

Table 5  Reason for using complementary medicine in the past

Reason indicated by patient for use of therapies	Number	% of all patients receiving CAT in past
Doctor recommended or referred*	206	58
Preferred alternative or non-conventional treatments*	163	46.7
Family member recommended it*	142	40.7
Patient decided Doctor could not help with the problem*	70	20.1
Patient not happy with Doctors' approach to problem*	64	18.4
Patient decided to get another opinion*	61	17.5
Doctor decided s/he couldn’t help with problem*	49	14.2
Likes to combine conventional and complementary approaches	14	14.1
Alternative therapies have worked before	13	13.1
Conventional medicine didn’t help	12	12.1
Reluctant to take drugs/concern about side effects	28	6.8

* these statements were provided for patients to agree/disagree with. Other reasons are grouped versions of other reasons volunteered.

Usage of complementary medicine was generally high in the practice population:  a survey of patients attending the practice during a two week period showed that nearly half had some experience of complementary therapies (somewhat higher than the proportion elsewhere in the country), with nearly a third having experienced such therapies at the practice itself (Table 6).

Table 6  Number of therapies experienced by general practice population

Number of therapies experienced	At the practice	%	Elsewhere	%	All patients %
None					51
1	43	21.5	26	13	19
2	13	6.5	14	7	12
3 or more	13	6.5	24	12	18

Although having the service at the practice was a common reason for patients having had experience of complementary therapies, there were a number of patients who had turned to complementary therapies ‘in desperation’ or because they were willing to ‘try anything to improve the situation’ when suffering from a long term health condition. There was a significant relationship between the length of time a patient had been suffering with their problem, and their use of complementary therapies (Table 7).


Table 7  Length of time with problem by number of therapies experienced

	Number of therapies previously experienced
Time with problem	0	1	2	>3	Total
Under 3 months	53	11	7	9	80
3 months to one year	8	6	4	2	20
Over a year	28	16	12	18	74
Total	89	33	23	29	174

Chi squared 16.28    Degree of freedom 6    P value 0.012:   Significant at 0.05 level

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