Impact of physician preferences for homeopathic or conventional medicines on patients with musculoskeletal disorders: results from the EPI3-MSD cohort.
OBJECTIVE
The objective of this study was to assess the effect of physician practicing preferences (PPP) in primary care for homeopathy (Ho), CAM (Complementary and alternative medicines) with conventional medicine (Mx) or exclusively conventional medicine (CM) on patients with musculoskeletal disorders (MSDs), with reference to clinical progression, drug consumption, side effects and loss of therapeutic opportunity.


METHODS
The EPI3-MSD study was a nationwide observational cohort of a representative sample of general practitioners (GP) and their patients in France. Recruitment of GP was stratified by PPP, which was self-declared. Diagnoses and comorbidities were recorded by GP at inclusion. Patients completed a standardized telephone interview at inclusion, one, three and twelve months, including MSD-functional scales and medication consumption.


RESULTS
1153 MSD patients were included in the three PPP groups. Patients did not differ between groups except for chronicity of MSDs (>12 weeks), which was higher in the Ho group (62.1%) than in the CM (48.6%) and Mx groups (50.3%). The twelve-month development of specific functional scores was identical across the three groups after controlling for baseline score (p > 0.05). After adjusting for propensity scores, NSAID use over 12 months was almost half in the Ho group (OR, 0.54; 95%CI, 0.38-0.78) as compared to the CM group; no difference was found in the Mx group (OR, 0.81; 95% CI: 0.59-1.15).


CONCLUSIONS
MSD patients seen by homeopathic physicians showed a similar clinical progression when less exposed to NSAID in comparison to patients seen in CM practice, with fewer NSAID-related adverse events and no loss of therapeutic opportunity.
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada. Michel.Rossignol@CRR-Intl.com
Michel
M
Rossignol
Bernard
B
Begaud
Pierre
P
Engel
Bernard
B
Avouac
France
F
Lert
Frederic
F
Rouillon
Jacques
J
Bénichou
Jacques
J
Massol
Gerard
G
Duru
Anne-Marie
AM
Magnier
Didier
D
Guillemot
Lamiae
L
Grimaldi-Bensouda
Lucien
L
Abenhaim
D000293:Adolescent; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D015331:Cohort Studies; D003695:Delivery of Health Care; D005194:Family Practice / Q000639:trends*; D005260:Female; D005602:France; D049674:History, 21st Century; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008419:Materia Medica / Q000627:therapeutic use*; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000188:drug therapy / Q000628:therapy*; D010820:Physicians / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires
D000894:Anti-Inflammatory Agents, Non-Steroidal; D008419:Materia Medica