AUTHORS
C Güthlin, H Walach, University Hospital Freiburg, Germanyny

BIOGRAPHY
Corina Güthlin is trained as a psychologist and works on the evaluation of Complementary Medicine since 1995. First as a researcher studying the effects of her first project involved massage therapy in pain patients. In 1996 she became the study manager of an observational study of homeopathy and acupuncture in general practice. She is currently employed as a research fellow at the University Hospital in Freiburg/Germany. Apart from evaluating Complementary Medicine she gained experience in the conduct of systematic reviews and meta-analyses during an internship at the NHS Centre for Review and Dissemination (CRD) (University of York). She is a member of International Society of Quality of Life (ISOQOL) and of the former International Society of Technology Assessment in Health Care (ISTAHC) and was part of the organising committee of a conference in Health Technology Assessment in Berlin/2002. She also holds a certificate in basic training of psychotherapy according to Rogers. She is married with one son and enjoys all kinds of cycling.

ABSTRACT

Background:

Clear evidence of baseline response to homoeopathy in uncontrolled, normal clinical practice is missing. German health insurance companies launched so-called trial phases in which homeopathy could be evaluated in real practice settings.

Research Questions:

To evaluate the overall effectiveness in general practice of homoeopathy and to identify research needs as well as problems of evaluation within pragmatic trials.

Methods and Design:

Prospective documentation of all patients insured with an insurance company (Innungskrankenkasse) who are provided with free homoeopathy treatment. The aim was to include about 1000 patients. All patients were followed up from the beginning of treatment for 4 years. Doctors provided data on each visit (diagnoses, treatment, change of symptoms), patients filled in questionnaires at the beginning and twice a year (complaints, current treatment, general health status as measured by the MOS SF-36). Insurance data on work-days lost was provided by the insurance company. We intended to collect data on a matched control sample receiving conventional treatment.

Results:

About 750 patients treated with homoeopathy have been entered into the study. Those were the patients for whom at least one component of the documentation was available. The doctors´ rating of the change of the main diagnosis showed improvement of 1 point on a 7-point Likert Scale (>1 SD). This impression of effectiveness is vindicated by the patient´s follow-up questionnaire: About 38% of the patients rated the therapy as efficacious and further 26% as partially efficacious. Quality of life as measured by the MOS SF-36 improved in most dimensions highly significantly. Despite good ratings of improvement, over 85% of the patients did not show up for further treatment. This might be due to success of treatment or as declining motivation. The intended control group could not be sampled due to patients‘ preferences for homeopathy or acupunture. The documentation of diseases and symptoms was according to ICD-10. Individual symptoms return as well. Both were either too general or too individually focused to form subgroups.

Conclusions:

Clinically significant changes were observed. Even though a high number of patients treated in real life practice were included some questions remained unclear due to the nature of documentation in the study.