SYNOPSIS

Treatments available

Acupuncture, Herbal Medicine, Homeopathy, Massage and Osteopathy - all patients receive up to 3 hours of treatment at variable intervals, determined by the practitioner.

These therapies were chosen because:
    - They provide more than 70% of consultations in complementary care in the UK today.
    - They are widely known and understood - they have a 'pedigree'.
    - Already featuring in formal health care systems,  eg. in India, China.
    - Therapeutic efficacy in part is already established.
    - All practitioners undergo formal training and accreditation.
    - The five therapies chosen are generally considered safe.


About our research project

Our research question was:
what happens when you offer Complementary Medicine in Primary Health Care?
    - what contribution can Complementary Therapy make to Primary Health Care?
    - which patients can benefit from Complementary Therapy?
    - what are the advantages and disadvantages for a GP practice?
    - can such a service be cost-effective?

Research Methodology.  Our survey comprised analysis of data from patient referral forms and standard health profiles (SF-36, Becks Depression Inventory, Functional Limitation Profile and Pain Index).   The schedule of data collection was as follows:

1) Forms completed by GP at the time of referral comprising patient data and clinical details.
2) Forms assessing outcome at end of treatment completed by the complementary practitioners.
3) Patient questionnaires including health profiles (SF36 etc) at referral, on completion of treatment, and six months post-referral.
4) Interviews with practitioners / GPs / Health Centre staff / Sample of patients

Response-rate on questionnaires:
    82% completed after referral
    76% completed after treatment
    56% completed six months' post-referral

Funded by Somerset Health Authority at £22,000/year, including a P-T researcher (plus a medicines grant from J A Clark Foundation Trust).


SUMMARY OF RESULTS  (1994-1997)

Our research question was not to examine the efficacy of complementary medicine, but to see what happens when it is employed in an NHS GP practice.

1.  More than 600 patients were referred for treatment during the evaluation period (approx 17% of the practice population).  Most were for chronic health problems, especially problems relating to muscles and joints.  34% were referred because their problem had failed to respond to conventional treatment.

2.  85% of patients reported improvement in their illness which most ascribed to the treatment itself.  This was statistically confined on SF-36 assessment.  85% of patients were satisfied with their treatment.

3.  Complementary therapy seemed to be most effective for people with more severe symptoms, people with musculo-skeletal problems, people with problems of shorter duration, and it also proven helpful for people with psychosocial distress.

4.  A cost evaluation of a sub-sample of patients with long-term health problems demonstrated that their utilisation of health services changed after treatment.  Savings appeared to be made in the overall care of these patients which paralleled the cost of providing the complementary medicine service, although it is not known whether this change in health costs can be ascribed to the complementary medical treatment.

See Tables 1 and 2 below.

Table 1:  Mean SF36 scores (high scores imply a better level of health and wellbeing):

Category on SF36 scale	On referral	At end of treatment	Six months after referral
Physical functioning	68.1	72.9 ***	74.8
Physical role performance	32.5	49.9 ***	59.2
Body pain	43.1	53.8 ***	53.8
General health	58.4	60.9	64.5
General vitality	41.9	48.3 **	48.6
Social functioning	62.6	73.6 ***	75.3
Emotional role performance	53.6	65.1 *	73.1
Mental health	59.5	67 ***	69.3
Total questionnaires	425	224	93

  *** significant at .001
  ** significant at .005
  * significant at .05

The SF36 scale was quite a sensitive measure of change, in spite of the variability in the patients referred for treatment.  Significant improvement was seen in all except one dimension of the scale by the end of treatment, and most dimensions showed a continued improvement at the six month stage.  The significance of change was lower at the six month stage probably due to the smaller number of questionnaires returned by patients at this stage.

Table 2.  Total costs for subsample of patients 1 year before and 1 year after treatment

Number of patients in subsample 41	Total cost before treatment - medication, secondary care, investigations, GP consultations £3773.05	Total cost 1 year after treatment - medication, secondary care, investigations, GP consultations £1523.28	Difference in cost before and after treatment £2509.77
Cost of complementary treatment			£2567.50

The small number of patients in the subsample was due to the difficulty of identifying patients on whom the practice had reliable before and after data for the duration of the study period. Nevertheless it appears that some savings can be made in some areas of treatment. It is of note that the cost of the complementary treatment was similar to the difference in the patient costs before and after treatment.


Problems

We did have problems with the service, including:

    - Appointments/waiting lists (up to three months at times)
    - Time limitations on service (some patients needed longer than three hours of treatment)
    - Appropriateness of referral (it is difficult always to know who will do well and who should not be referred)
    - Funding (a perennial NHS-type problem)
    - Administrative demands (at times, matching the referrals with appointments was frustrating and time-consuming)

Benefits

Undoubtedly, the gains were positive and substantial:

    - Therapeutic gains for patients
    - Financial savings for patients
    - Wider therapeutic options for doctors
    - Professional communications improved

Go to a full report of this research.


And finally, some patient comments...

    ..."Treatment was well carried out and explained.  It worked well for me - and I am a non-believer in this sort of treatment"....

    ..."Although the treatment has not been a complete cure, the gradual easing of a long-term problem has been most welcome"....

    ..."A terrific help:  it made me very aware of my tension and I feel I really do need to make changes in my way of life in order to help alleviate the problems"....

    ..."Because the pain in my back has almost ceased I am far less tired and so can tackle more and enjoy this"....

    ..."I am extremely impressed with having the facility of complementary medicine.  It is important to me to have this available through the NHS so that all people have access to this medicine"....

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