Elsevier

Homeopathy

Volume 97, Issue 3, July 2008, Pages 114-121
Homeopathy

Original paper
Towards standard setting for patient-reported outcomes in the NHS homeopathic hospitals

https://doi.org/10.1016/j.homp.2008.06.005Get rights and content

Introduction

We report findings from a pilot data collection study within a programme of quality assurance, improvement and development across all five homeopathic hospitals in the UK National Health Service (NHS).

Aims

(1) To pilot the collection of clinical data in the homeopathic hospital outpatient setting, recording patient-reported outcome since first appointment; (2) to sample the range of medical complaints that secondary-care doctors treat using homeopathy, and thus identify the nature and complexity of complaints most frequently treated nationally; (3) to present a cross section of outcome scores by appointment number, including that for the most frequently treated medical complaints; (4) to explore approaches to standard setting for homeopathic practice outcome in patients treated at the homeopathic hospitals.

Methods

A total of 51 medical practitioners took part in data collection over a 4-week period. Consecutive patient appointments were recorded under the headings: (1) date of first appointment in the current series; (2) appointment number; (3) age of patient; (4) sex of patient; (5) main medical complaint being treated; (6) whether other main medical complaint(s); (7) patient-reported change in health, using Outcome Related to Impact on Daily Living (ORIDL) and its derivative, the ORIDL Profile Score (ORIDL-PS; range, –4 to +4, where a score ≤−2 or ≥+2 indicates an effect on the quality of a patient's daily life); (8) receipt of other complementary medicine for their main medical complaint.

Results

The distribution of patient age was bimodal: main peak, 49 years; secondary peak, 6 years. Male:female ratio was 1:3.5. Data were recorded on a total of 1797 individual patients: 195 first appointments, 1602 follow-ups (FUs). Size of clinical service and proportion of patients who attended more than six visits varied between hospitals. A total of 235 different medical complaints were reported. The 30 most commonly treated complaints were (in decreasing order of frequency): eczema; chronic fatigue syndrome (CFS); menopausal disorder; osteoarthritis; depression; breast cancer; rheumatoid arthritis; asthma; anxiety; irritable bowel syndrome; multiple sclerosis; psoriasis; allergy (unspecified); fibromyalgia; migraine; premenstrual syndrome; chronic rhinitis; headache; vitiligo; seasonal allergic rhinitis; chronic intractable pain; insomnia; ulcerative colitis; acne; psoriatic arthropathy; urticaria; ovarian cancer; attention-deficit hyperactivity disorder (ADHD); epilepsy; sinusitis. The proportion of patients with important co-morbidity was higher in those seen after visit 6 (56.9%) compared with those seen up to and including that point (40.7%; P < 0.001). The proportion of FU patients reporting ORIDL-PS  +2 (improvement affecting daily living) increased overall with appointment number: 34.5% of patients at visit 2 and 59.3% of patients at visit 6, for example. Amongst the four most frequently treated complaints, the proportion of patients that reported ORIDL-PS  +2 at visit numbers greater than 6 varied between 59.3% (CFS) and 73.3% (menopausal disorder).

Conclusions

We have successfully piloted a process of national clinical data collection using patient-reported outcome in homeopathic hospital outpatients, identifying a wide range and complexity of medical complaints treated in that setting. After a series of homeopathy appointments, a high proportion of patients, often representing “effectiveness gaps” for conventional medical treatment, reported improvement in health affecting their daily living. These pilot findings are informing our developing programme of standard setting for homeopathic care in the hospital outpatient context.

Introduction

The United Kingdom's homeopathic hospitals are located in Bristol, Glasgow, Liverpool, London and Tunbridge Wells. The five have been an intrinsic part of the country's National Health Service (NHS) since its inception in 1948, and are staffed by medically qualified practitioners who possess additional training and certification in homeopathy. The range of skills and services on offer at each hospital varies in a number of ways. For example, the Royal London Homoeopathic Hospital (RLHH) provides a wide range of other Complementary and Alternative Medicine (CAM) services, such as acupuncture, autogenic training and herbal medicine, comprising in total more than 50% of patient appointments. All units have outpatient services only, except Glasgow Homoeopathic Hospital (GHH), which has an additional in-patient service. Services at the other three hospitals are mostly focused on homeopathy only. At Bristol Homeopathic Hospital (BHH), there is a defined package of care, with detailed review at the fifth appointment; other units consider the number of appointments required per patient on a more individual basis. The Liverpool hospital (LHH) is unusual in being part of a Primary Care Trust (PCT), rather than a hospital trust. Continuation of the main PCT contract for patient referrals to Tunbridge Wells Homoeopathic Hospital (TWHH) is currently under review.

Each of the hospitals has previously reported clinical outcomes data from a wide range of medical complaints.1, 2, 3, 4, 5 In each unit, positive outcome has been reported by about 70% of follow-up (FU) patients overall, indicating the need for research initiatives to establish the positive effects of the homeopathic intervention in particular diagnoses.6, 7 From the perspective of quality assurance and improvement, on the other hand, these patient surveys have each been carried out without an explicit aim of identifying what standard of clinical outcome might reasonably be expected in subjects with a given type and complexity of medical complaint. Moreover, the earlier studies have each used different methods and outcome scoring techniques, without an overarching objective to consider unifying approaches to clinical data collection across all hospitals.

The present report is a first step in a programme of quality assurance, improvement and development across all five homeopathic hospitals. It has the ultimate aim of setting standards for homeopathic practice outcomes in patients with medical complaints commonly treated in the outpatient setting nationally. Here we report our findings from a pilot data collection study for this programme. It represents the first collaborative effort by the five individual hospitals.

  • 1.

    To pilot the collection of clinical data in the homeopathic hospital outpatient setting, using Outcome Related to Impact on Daily Living (ORIDL) as outcome measure; to record patient-assessed outcome (in main complaint, MC, and well-being, WB) since the first appointment in the current series at that hospital.

  • 2.

    By obtaining a 4-week sample of clinical data at all five homeopathic hospitals in the UK, to identify the range of medical complaints that doctors treat using homeopathy in hospital outpatients, and thus identify the nature and complexity of complaints most frequently treated nationally.

  • 3.

    To present a cross section of patient-reported outcome scores by appointment number, including that for the most frequently treated medical complaints.

  • 4.

    To explore approaches towards standard setting for homeopathic practice outcome in the most frequently treated medical complaints in outpatients treated at the homeopathic hospitals.

Section snippets

Methods

The study design and methods were agreed by all the authors, many of whom are members of the Faculty of Homeopathy's Clinical Audit Sub-Committee. A total of 51 medical practitioners contributed to the data collection – see Acknowledgements. Each hospital confirmed locally that the work did not require Research Ethics Committee approval.

Data collection took place during the four 5-day periods from 5th to 30th March 2007. No individual patient was expected to receive more than a single

Results

The Access database was used at three of the hospitals, and the Excel version at the other two. Electronic format was used in all hospitals except one, where some practitioners used a hard-copy version of the spreadsheet, necessitating subsequent manual data transcription into Excel. There was a low incidence of missing essential data. Only two records were excluded altogether: one was due to missing “Complaint” data; the other was a second appointment for a single patient during the 4-week

Discussion

A systematic approach to the collection of outpatient data in the homeopathic hospital setting was successfully piloted, using ORIDL to record patient-reported change in MC and WB since the first homeopathic appointment. Information has been obtained on patient demographics and on the most frequently treated complaints. The findings illustrate the range and complexity of chronic disease managed within the homeopathic hospitals. The most frequently treated conditions reflect previously published

Conflict of interest

None of the authors has any financial or personal relationships with other people or organisations that could have influenced this work inappropriately.

Acknowledgements

The work was part-funded by the British Homeopathic Association.

We wish to record our thanks to the following practitioners at the homeopathic hospitals who contributed to this clinical data collection:

BHH: Chris Calcott, Julie Geraghty, Moira Hamilton, Michael Handford, Jonathan Hardy, Gill How, Andrew Morrice, Willa Muir, Richard Savage, Elizabeth Thompson, Trevor Thompson, Roy Welford.

GHH: Leonora Coll, Elaine Hamilton, Martin Innes, Robert Leckridge, Jacqueline Mardon, Alan Mathieson, Iain

References (15)

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