Homeopathy satisfaction in Iran.

BACKGROUND: Patient satisfaction is a key indicator of the quality and effectiveness of a therapeutic method. Assessing the satisfaction of patients undergoing homeopathic therapy is essential in the early steps of educating the community, if suitable outcomes are to be achieved.
MATERIALS AND METHODS: This descriptive cross-sectional study was conducted in 2008 on 125 patients from the city of Isfahan. Patients aged above 15 years who had referred to the homeopathic practitioners and received homeopathic drugs for at least three times were randomly selected and included in the study. Patient satisfaction was assessed in three main areas (general health, physician performance, and symptoms relief) using a valid questionnaire. The results were compared with those of a similar study conducted in 2004 on 240 patients.
RESULTS: Mean score of satisfaction with homeopathic treatment was 77.48 ± 6.36 out of 100. In 2004, it was 77.4 ± 8.13. Median age was 36.41 ± 11.25 years. Median time of therapy was 16.80 ± 17.94 months. The highest level of satisfaction was related to relief of symptoms. Satisfaction of physician performance and improvement of general health came next. The degree of satisfaction with therapy was not significant between the different groups with regard to their sex and different levels of education, but there was significant difference in the duration of treatment. The four symptoms that showed better improvement in 2008 were headache, gastrointestinal (GI) disturbances, fatigue, and insomnia.
CONCLUSIONS: After using homeopathy for several years, patients' satisfaction was found to be still high. Shifting the area of satisfaction from general health to relief of symptoms could be related to physicians' experiments for remedy selection. Scientific centers should do more surveys about the effectiveness of homeopathic treatment. Integration of homeopathy with medicine may bring in more success at less cost. It seems rational to support homeopathy as an effective practice.

INTRODUCTION

The complaints and illnesses which cause individuals to seek help from health professionals have taken on new aspects. Patients’ expectations of treatment have also moved to higher levels. People are in search of ways to regain health using the simplest methods and with the fewest complications. They are no longer satisfied with symptomatic relief only. In some instances, the use of a single method of treatment does not yield the expected outcome.

Patients seek alternative and complementary medical treatments for a variety of reasons and the number of such patients is growing.[12345678] Alternative medical treatments have diverse effects, and one of the ways for assessing such methods is through measuring the patients’ satisfaction with treatment.[9]

Homeopathy is an alternative medical practice in which a specific health problem is treated by the ingestion of minute amount of a substance that, in large amount, might cause the same problem in a healthy individual.[1011]

Homeopathic remedies are prepared by diluting a substance, such as an herbal extract, mineral, or animal tissue, with water or alcohol. The substance is successively diluted to one-tenth or one-hundredth of the original and is vigorously shaken between dilutions.[1213] The homeopathic remedy to be prescribed is decided based on patient's history and symptoms, including mind, belief, and particular characteristics, with a holistic view.[1415] Based on the principle “no two similar disease entities can simultaneously exist in an individual,” the vital human forces which have fallen out of balance are restored to normal, resulting in resolution of disease symptoms.[1617] The body cannot accept the actual disease alongside similar symptoms caused by the homeopathic remedy, hence resolves the disease. The symptoms caused by the remedy are short-lived and wane without intervention. However, the homeopathic remedies’ precise mechanisms of action remain unknown.[18]

Homeopathy is very popular in some countries; for instance, in Norway, 37% of the population was found to use homeopathic remedies.[19] In a telephone survey of 351 allergic patients, 26.5% said they had used some form of alternative medicine and 35.3% of these patients had sought homeopathic treatment.[20] In recent years, homeopathic treatments have gained popularity in Iran also.

Patient satisfaction is an important indicator of the quality and effectiveness of a therapeutic method. Success of homeopathic treatments depends primarily on the physician's experience and ability to match the evidence obtained from patient history with the symptoms documented for homeopathic drugs. In fact, differences of opinion among homeopathic practitioners about the type of drug to be prescribed for a given condition are not infrequent.

It is essential to assess the satisfaction of patients undergoing homeopathic therapy and if acceptable outcomes have been achieved as an early step of educating the community.

MATERIALS AND METHODS

This descriptive cross-sectional study was conducted in 2004 on the patients who referred to physicians practicing homeopathy in the city of Isfahan. The offices of these practitioners were identified using the information obtained from the Homeopathy Association and the Vice-Chancellery for Treatment of Isfahan province.

Patients aged above 15 years who had referred to the homeopathic practitioners and received homeopathic drugs for at least three times were randomly selected and included in the study. Subjects using conventional medicines before or during homeopathic treatment were included in the study, but those who started new therapies during homeopathic treatment were excluded.

Sampling continued until the desired number of subjects was reached. Using a valid questionnaire, patient satisfaction was assessed in three main areas: General health, physician performance, and symptoms relief. The questionnaire was validated through expert assessment and several patient interviews. The reliability of the questionnaire was verified in a pilot study, and Cronbach's alpha reliability coefficient was calculated at 71%.

We explained the study objectives for patients in the clinics. All patients at each clinic meeting the inclusion criteria were selected. They completed the questionnaires. Poorly educated subjects were interviewed. Of the maximum satisfaction score of 100, symptoms relief, improvement of general health by homeopathic treatment, and patient satisfaction with the performance of homeopathic practitioners accounted for 35, 35, and 30 points, respectively. For ethical considerations we didn’t enter any patient to the study unless he/she have given permission.

RESULTS

Twenty men and 105 women meeting the study requirements completed the questionnaires. Median age was 36.41 ± 11.25 years. Of the participants, 17.6% had achieved primary level of education, 13.6% had lower or higher secondary level of education, 36% had high school diploma, and 30% had university or upper diploma level of education. Median time of therapy was 16.80 ± 17.94 months. Mean score of satisfaction with homeopathic treatment was 77.48 ± 6.36. Figure 1 shows the prevalence of symptoms of patients under homeopathic treatment in 2008 and 2004. Table 1 shows the mean score of satisfaction for homeopathy assessed in the three main areas.

Figure 1

The prevalence of symptoms in patients treated with homeopathy in 2008 and 2004

Table 1

The mean score of satisfaction with homeopathy in the main areas*

The highest level of satisfaction was related to relief of symptoms. Satisfaction with the physician's performance and improvement of general health came next. No significant difference was seen between groups with regard to their sex and different levels of education (in terms of the degree of satisfaction with therapy), but there was significant difference in the duration of treatment. The four symptoms that showed better improvement were headache, gastrointestinal (GI) disturbances, fatigue, and insomnia.

Men and women had the same degree of satisfaction with homeopathic treatment (total satisfaction: 75% vs. 78%). There was significant difference between the degree of satisfaction with therapy and the duration of treatment.

Figure 2 represents the changes in symptoms following homeopathic treatment in 2008. On average, the three commonest symptoms showed improvement in 83% and worsened in 1.2% of the subjects. Motivations for selecting homeopathy are shown in Table 2. Sources of information about homeopathy were family, friends, and physicians (26%, 23%, and 5%, respectively).

Figure 2

The changes in three main complaints following homeopathic treatment in 2008

Table 2

Motives behind opting for homeopathic treatment

DISCUSSION

The results of this study are indicative of the high degree of satisfaction obtained with homeopathy. Similar studies conducted in Europe, Japan, and the United States have also indicated the high satisfaction level of patients with homeopathic treatment.[21222324252627] A study conducted by Riley found the level of satisfaction of patients undergoing homeopathic and conventional treatment to be 79% and 65%, respectively.[28] Attena revealed that 1 year after the first examination, 73.5% of 609 patients reported a marked or moderate improvement in their health status, which was significantly higher in subjects who stated they were satisfied with the care they had received.[25] A study of patients undergoing homeopathic treatment in six European countries also showed a high degree of satisfaction with homeopathy in spite of the slight exacerbation of symptoms in 25% of patients at the beginning of the homeopathic treatment.[29] On the other hand, some studies have shown less than moderate patient satisfaction with self-perceived efficacy of homeopathic therapies.[303132]

Several factors influence patient satisfaction with homeopathic treatment; these include the outcome, method and type of treatment, type of drugs, reasons for turning to homeopathy, and performance of the homeopathic practitioner.[33]

Simultaneous use of homeopathy and conventional medicine seems to yield the best outcomes. Slade studied physicians simultaneously practicing the two methods and found that they obtained better clinical results; also, the overall treatment costs, including surgery and hospitalization expenses, had decreased.[34] A few researchers have proposed strategies for combining alternative and conventional medical practices.[35]

About 30% of patients in our study had a high level of education. Some studies have shown that patients seeking homeopathic treatment are more educated than those opting for conventional medicine,[3637383940] but their knowledge about homeopathy before entering treatment is limited.[40] Greater knowledge of conventional medicine possessed by more educated individuals and earlier, unsuccessful outcome from this form of treatment seem to be the chief reasons for this.[4142434445] One study demonstrated no difference in age between those who used complementary medicine and those who did not,[37] but most others have shown that patients using homeopathic therapies tended to be younger.[4345] Less than a third of the patients in the present study also were old.

Individuals seek homeopathic treatment for a wide variety of reasons. In addition to the factors identified by the present study, other studies have referred to lower treatment costs,[454647484950] ineffectiveness of conventional treatments,[3651] side effects of conventional drugs or drug interactions,[454652] high costs of diagnostic procedures,[3647] less time-consuming nature of homeopathic treatments,[53] and belief in the role of psychosomatic factors in the development of disease which constitutes the cornerstone of many alternative medical practices[53] as the most important motives behind patients’ choice of alternative medical practices. While one study has highlighted religious beliefs and traditionalism as the most important reason for using homeopathy,[54] two other studies have reported exactly the opposite, i.e. nonreligious families were more likely to use complementary medicine.[3740] Females seek homeopathic treatment more than males,[3744] which was observed in our study also. The effectiveness of homeopathic remedies on multiple mental and physical symptoms was found to be an important motive for turning to this method of treatment, i.e. besides improvement of symptoms which underlie the patients’ chief complaints, the patients seemed to experience an improvement in their general health status.[2122232425262728293031323334353637383940414243444546474849505152535455] The latter factor seems to have elicited patient satisfaction in a larger number of cases in the current study. Aneilli showed that European patients undergoing homeopathic treatment experienced an improvement, however small, in their quality of life.[21]

Other studies have tested homeopathy in the treatment of many disease conditions. Although some placebo-controlled studies have demonstrated the effectiveness of homeopathic drugs to be equal to placebos,[565758596061626364656667] some others have documented the success of these drugs in controlling the symptoms and/or treating the disease compared to placebos.[676869707172737475767778] For example, a study conducted by Schroder on patients with heart failure has shown the effectiveness of a drug prepared from Crataegus with homeopathic methods in decreasing blood pressure in these patients.[79] Also, in vitro studies have demonstrated the effectiveness of super-diluted drugs (as true drugs, not placebo) on cells and bacteria.[81828384]

Headache, anxiety, and angriness were the most common symptoms in patients presenting to homeopathy practitioners in 2008, but in 2004, they were angriness, fatigue, and anxiety. May be perception of the effectiveness of homeopathy by patients and sharing it with other patients results in selection of homeopathy by others. The most common symptoms in a Portuguese study were musculoskeletal pains, headache, and anxiety.[85] In Europe also, children used complementary and alternative medicine (CAM) for different kinds of symptoms; for example, in Germany, the usage was 53% among children for acute illnesses, and in Germany and the Netherlands, the usage of CAM for oncology was more than 30%.[86] Differences in lifestyle and distribution of symptoms throughout the community probably account for the differences observed between the studies. Headache, depression, and menstrual disturbances showed the highest improvement following homeopathic treatment. To explain this finding, the pathophysiological mechanisms of these conditions should be studied and matched with the philosophy underlying the practice of homeopathy.

Shifting the area of satisfaction from general health to relief of symptoms could be related to physicians’ experiments for remedy selection.

Although understanding the mechanisms whereby homeopathic remedies exert their healing effects requires more efforts, the results of this study provide some clues as to the applications of this alternative medical practice.

CONCLUSION

After use of homeopathy for several years, patients’ satisfaction was found to be still high. Given the documented benefits of homeopathy, it seems rational to encourage its scientific practice and not to overlook its therapeutic potential. Integration of homeopathy with medicine may result in more success at less cost.