How does the role of complementary and alternative medicine in general practice differ between countries? Interviews with doctors who have worked both in Germany and elsewhere in Europe.

IF 3.3 2区 医学 Q1 INTEGRATIVE & COMPLEMENTARY MEDICINE
Klaus Linde, Robert Bayer, Jan Gehrmann, Bianca Jansky
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Abstract

Background: Available data suggest that general practitioners (GPs) in Germany use complementary and alternative medicine (CAM) modalities more frequently than GPs in many other countries. We investigated the country differences perceived by general practitioners who have worked in Germany and in one of four other European countries with regard to the role of complementary and alternative treatments in primary care.

Methods: In this qualitative study we conducted semi-structured interviews with 12 GPs who had worked both in Germany and Italy, the Netherlands, Norway or the United Kingdom (UK; n = 3 for each of the four countries). Participants were asked how they perceived and experienced country differences regarding health system, relevance of CAM modalities, the role of evidence-based medicine (EBM) and science, and how they handle so-called indeterminate situations. For the analysis, we followed a thematic analysis approach according to Braun and Clarke with focus on themes that cover CAM.

Results: Participants unanimously reported that they perceived CAM to be more relevant in general practice in Germany compared to the other countries. We identified four overarching themes in relation to the perceived reasons for these differences. Firstly, physicians with experiences in countries with a strong EBM and science orientation (Netherlands, Norway and the UK) considered the deeply ingrained view in national healthcare systems and GP communities that CAM modalities are not evidence-based as the main reason for the lower use of CAM by GPs. Secondly, extensive training of communication skills was cited as a reason that reduced the need for CAM in the Netherlands, Norway and the UK. Thirdly, differences in patient expectations and demands were perceived as a factor contributing to greater utilisation of CAM by German GPs compared to the other countries. Finally, country-specific reimbursement mechanisms were considered as a factor influencing the role of CAM in general practice.

Conclusions: The study results point to major differences between countries with regard to the role of CAM in GP care. Differences in basic attitudes in the discipline of general practice, patient expectations and system conditions appear to play an important role here.

补充和替代医学在全科医疗中的作用在不同国家有何不同?采访在德国和欧洲其他国家工作过的医生。
背景:现有数据表明,德国的全科医生(GP)比其他许多国家的全科医生更经常使用补充和替代医学(CAM)模式。我们调查了曾在德国和其他四个欧洲国家中的一个国家工作过的全科医生对补充和替代疗法在初级保健中的作用的看法差异:在这项定性研究中,我们对 12 名曾在德国、意大利、荷兰、挪威或英国工作过的全科医生进行了半结构化访谈。我们询问了他们如何看待和体验各国在卫生系统、CAM 方式的相关性、循证医学(EBM)和科学的作用等方面的差异,以及他们如何处理所谓的不确定情况。在分析过程中,我们采用了布劳恩和克拉克的主题分析方法,重点关注涉及 CAM 的主题:结果:参与者一致表示,与其他国家相比,他们认为 CAM 在德国的全科实践中更具相关性。我们就这些差异的主要原因确定了四个主题。首先,曾在EBM和科学导向较强的国家(荷兰、挪威和英国)工作过的医生认为,国家医疗系统和全科医生群体中根深蒂固的观点认为,CAM模式并非以证据为基础,这是全科医生较少使用CAM的主要原因。其次,在荷兰、挪威和英国,广泛的沟通技巧培训被认为是减少对 CAM 需求的一个原因。第三,与其他国家相比,患者期望和需求的差异被认为是导致德国全科医生更多地使用 CAM 的一个因素。最后,各国的报销机制被认为是影响全科医生使用 CAM 的一个因素:研究结果表明,不同国家在全科医生护理中使用 CAM 的情况存在很大差异。全科医生的基本态度、病人的期望和系统条件的差异似乎在其中发挥了重要作用。
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来源期刊
BMC Complementary Medicine and Therapies
BMC Complementary Medicine and Therapies INTEGRATIVE & COMPLEMENTARY MEDICINE-
CiteScore
6.10
自引率
2.60%
发文量
300
审稿时长
19 weeks
期刊介绍:
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