Auditing outcomes and costs of integrated complementary medicine provision--the importance of length of follow up.
ABSTRACT A retrospective audit was carried out on 58 patients with chronic health problems who were referred by 22 general practitioners (GPs) for acupuncture, aromatherapy, homeopathy, massage and osteopathy, or a combination. Costs of GP consultations, prescriptions, secondary care referrals, and diagnostic tests from records of 33 of these patients were compared pre (24 months), during (mean 4.3 months) and post (mean 5.7 months) complementary medicine (CM) treatment. Patient centred outcome data included the Measure Yourself Medical Outcome Profile (MYMOP) and content analysis of patient and practitioner comments. Costs of GP consultations/patient/month were significantly higher during (20.10 pounds, p<0.001) and post (17.53 pounds, p<0.01) CM treatment compared with pre-treatment costs (11.27 pounds). Total prescription costs were not significantly higher during and post-treatment than pre-treatment. Prescription costs for referred conditions were lower during (2.26 pounds) and higher post-treatment (3.75 pounds) compared with costs pre-treatment (3.24 pounds). Pre- and post-treatment MYMOP scores indicated significant improvements in health and well-being. Longer follow up, is required in order to demonstrate significant cost savings related to CM provision. Cost comparisons with conventional medicine should consider quantitative and qualitative data to capture the wider benefits experienced by patients.
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ABSTRACT: Introduction Integrative medicine (IM), the integration of complementary therapies (CTs) and conventional care, is common despite a scarce evidence base of cost-effectiveness. Aim To explore the cost-effectiveness of IM from a healthcare perspective comparing conventional primary care to a comprehensive IM model in the management of 80 patients with chronic non-specific back/neck pain. Methods Data on clinical management (planning and delivering IM), resource use (conventional care, CTs, prescription and non-prescription analgesics) and outcome effectiveness (SF-6D) were derived alongside a pragmatic randomised clinical pilot trial with 16 weeks follow-up. Costs and effects, i.e. quality-adjusted life years (QALYs), were estimated over different time periods and willingness-to-pay thresholds. Net monetary benefit and bootstrapping methods were used to explore the level of cost-effectiveness. Results The IM model, on average integrating 7 CT sessions with conventional primary care over 10 weeks, resulted in increased QALYs, somewhat higher cost of health care provision but a reduced cost of using health care resources, including less use of analgesics compared to conventional primary care. The costs/QALY ranged between euro 24 000 and 41 000. Conclusion Given the threshold value of euro 50 000 per QALY gained, and a remaining effect of one year, it is indicated that IM might be cost-effective compared with conventional primary care. Future cost-effectiveness studies of IM should be carried out from a societal perspective and should be based on large scale randomised clinical trials.European Journal of Integrative Medicine 01/2013; DOI:10.1016/j.eujim.2013.09.001 · 0.65 Impact Factor
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ABSTRACT: Objectives To understand the following about patients using an acupuncture teaching clinic: 1) Sociodemographic characteristics and main complaints. 2) Self-reported level of patient-centered outcomes regarding pain management. Methods/Design: Retrospective chart review. Subjects 458 new patients at NESA clinic during October 1, 2009 to July 31, 2010. Interventions A variety of styles of Oriental medicine: primarily Chinese and Japanese style acupuncture, and also heat treatments (MOXA or heat lamps) and Tui Na (Asia bodywork). Results Results from Objective 1 were descriptive (n=421). Objective 2 focused on the 59 patients from the larger sample who completed both an initial and a follow-up Measure Your Medical Outcome Profile (MYMOP) form and who used acupuncture for pain management of 1) diseases of the musculoskeletal system and/or connective tissue or 2) migraine/headache. Both the symptom severity and activity of daily living/well-being scales of the MYMOP showed over 15.8% improvement from baseline to at least 6 weeks of treatment: 28.6% for Symptom 1, 19.4% for Symptom 2, 35.7% for activities of daily living, and 25.0% for wellbeing. The relative majority for each sociodemographic trait investigated were as follows: female, about 40 years old, white, not Hispanic or Latino, married, highly educated, and employed, respectively. Most patients were confident in acupuncture treatment. Out of the 421 acupuncture patients, 68.2% wanted acupuncture in order to manage pain. 20.6% patients (59, N=287) completed 6th week follow-up MYMOP who used acupuncture for pain management for diseases of the musculoskeletal system and/or connective tissue, or migraine or headache. Of these, 57.6% (34, N=59) patients returned for 6 acupuncture treatments, and reported clinical improvement in at least one MYMOP severity score and no score got worse. Conclusions The information about sociodemographic characteristic and patient-centered outcomes of pain management can be used for service provision, future study planning, and marketing. Future studies should address the low follow-up rate, the quality of self-reported clinic data, and the reasons that patients chose acupuncture treatments and teaching clinics.EXPLORE The Journal of Science and Healing 09/2014; 10(5). DOI:10.1016/j.explore.2014.06.004 · 0.94 Impact Factor