Who seeks primary care for musculoskeletal disorders (MSDs) with physicians prescribing homeopathic and other complementary medicine? Results from the EPI3-LASER survey in France
1 Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Canada and LA-SER Centre for Risk Research, Montreal, Canada
2 INSERM U657, Université Bordeaux2, Bordeaux, France
3 LA-SER, Paris, France
4 INSERM, Centre for Epidemiology and Population Health, Villejuif, France
5 Centre Hospitalier Sainte-Anne, Université Paris V René Descartes, Paris, France
6 INSERM U657 Pharmacoepidemiology and evaluation of the impact of health products on human health, France, and Department of Biostatistics, University Hospital of Rouen, Rouen, France
7 UFR de Médecine, Université de Franche Comté, Besançon, France
8 CNRS (French National Center for Scientific Research), Université Claude Bernard, Lyon, France
9 Faculté de médecine Université Pierre et Marie Curie, Paris, France
10 Institut Pasteur and Université Paris-Ile de France Ouest, Paris, France
11 Equipe d'acceuil Pharmacoépidémiologie et maladies infectieuses, Institut Pasteur, and LA-SER, Paris Cochin santé, France
12 Department of Epidemiology, London School of Hygiene & Tropical Medicine, London, U.K., and LA-SER, London, U.K
BMC Musculoskeletal Disorders 2011, 12:21 doi:10.1186/1471-2474-12-21Published: 19 January 2011
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).
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.
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 were1.75; 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.
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.