Who seeks primary care for musculoskeletal disorders (MSDs) with physicians prescribing homeopathic and other complementary medicine? Results from the EPI3-LASER survey in France.
BACKGROUND
There is a paucity of information describing patients with musculoskeletal disorders (MSDs) using complementary and alternative medicines (CAMs) and almost none distinguishing homeopathy from other CAMs. The objective of this study was to describe and compare patients with MSDs who consulted primary care physicians, either certified homeopaths (Ho) or regular prescribers of CAMs in a mixed practice (Mx), to those consulting physicians who strictly practice conventional medicine (CM), with regard to the severity of their MSD expressed as chronicity, co-morbidity and quality of life (QOL).


METHODS
The EPI3-LASER study was a nationwide observational survey of a representative sample of general practitioners and their patients in France. The sampling strategy ensured a sufficient number of GPs in each of the three groups to allow comparison of their patients. Patients completed a questionnaire on socio-demographics, lifestyle and QOL using the Short Form 12 (SF-12) questionnaire. Chronicity of MSDs was defined as more than twelve weeks duration of the current episode. Diagnoses and co-morbidities were recorded by the physician.


RESULTS
A total of 825 GPs included 1,692 MSD patients (predominantly back pain and osteoarthritis) were included, 21.6% in the CM group, 32.4% Ho and 45.9% Mx. Patients in the Ho group had more often a chronic MSD (62.1%) than the CM (48.6%) or Mx (50.3%) groups, a result that was statistically significant after controlling for patients' characteristics (Odds ratio = 1.43; 95% confidence interval (CI): 1.07 - 1.89). Patients seen by homeopaths or mixed practice physicians who were not the regular treating physician, had more often a chronic MSD than those seen in conventional medicine (Odds ratios were 1.75; 95% CI: 1.22 - 2.50 and 1.48; 95% CI: 1.06 - 2.12, respectively). Otherwise patients in the three groups did not differ for co-morbidities and QOL.


CONCLUSIONS
MSD patients consulting primary care physicians who prescribed homeopathy and CAMs differed from those seen in conventional medicine. Chronic MSD patients represented a greater proportion of the clientele in physicians offering alternatives to conventional medicine. In addition, these physicians treated chronic patients as consulting rather than regular treating physicians, with potentially important impacts upon professional health care practices and organisation.
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Canada and LA-SER Centre for Risk Research, Montreal, Canada. Michel.Rossignol@CRR-Intl.com
Michel
M
Rossignol
Bernard
B
Bégaud
Bernard
B
Avouac
France
F
Lert
Frédéric
F
Rouillon
Jacques
J
Bénichou
Jacques
J
Massol
Gérard
G
Duru
Anne-Marie
AM
Magnier
Didier
D
Guillemot
Lamiae
L
Grimaldi-Bensouda
Lucien
L
Abenhaim
D000293:Adolescent; D000328:Adult; D002908:Chronic Disease; D000529:Complementary Therapies / Q000639:trends*; D005260:Female; D005602:France / Q000453:epidemiology; D019538:Health Care Surveys / Q000379:methods*; D006705:Homeopathy / Q000639:trends*; D006801:Humans; D008297:Male; D008419:Materia Medica / Q000627:therapeutic use; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D010003:Osteoarthritis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D010342:Patient Acceptance of Health Care; D058007:Physicians, Primary Care / Q000639:trends*; D055815:Young Adult
D008419:Materia Medica
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