Using Hospital Data and Routines to Estimate Costs and Effects of Integrative Care Programmes for Chronic Pain and Stress Disorders - a Feasibility Study

Abstract

Background: Evidence of cost and effects for comprehensive hospital-based integrative care (IC) is scarce. The aim of this study was to explore the feasibility of using local hospital data and routines to estimate costs and effects of anthroposophic IC programmes for chronic pain and stress disorders in Sweden. Methods: Retrospective analysis of one IC hospital's local administrative registry data. Main outcomes embraced patient demographics, programme duration and costs, patients' health status (EQ-5D index, 0-1) and self-rated health (EQ-5D VAS, 0-100), from hospital admittance to discharge. The use of postal questionnares for collecting follow-up data after hospital discharge was assessed. Results: The IC pain programme had 461 records, all with complete data on costs and duration: average programme cost, EUR 5,925 (95% CI 5,780-6,070), and duration, 17.8 (SD 4.7) days. The IC stress programme had 263 records, all with complete cost and duration data: programme cost, EUR 5,494 (95%CI 5,318-5,671); duration 18.0 (SD 4.7) days. From admittance to discharge, health status improved by 0.23 (95% CI 0.19-0.27) in the pain, and by 0.16 (95% CI 0.12-0.20) in the stress programme. Improvements in self-rated health were 20 (95% CI 18-22), and 21 (95% CI 18-23), respectively. There was a general decrease in questionnaire response rate after hospital discharge, whereby 27-32% of respondents had completed data after 9 months. Conclusions: It was feasible to use hospital registry data to estimate costs and show positive effects of anthroposophic IC programmes for pain and stress disorders in Sweden. Clinical implications and the need for long-term follow-up are discussed.

Patients’ Preference for Integrating Homoeopathy Services within the Secondary Health Care Settings in India

“…Different integrative complementary and alternative medicine models have been developed in different countries for treatment of different conditions, for example, pain and stress disorders in Sweden 22 ; musculoskeletal disorders in the Royal London Hospital for Integrative Medicine, UK 23,24 ; geriatric disorders in Berlin, Germany 25 ; cancer treatment in Vienna, Austria 26,27 ; treating various health issues in Tuscany, Italy 28 ; psychological trauma and chronic disease in Australia 29 ; rheumatoid arthritis in Maharashtra, India 30 ; and so on. As has been suggested by the special panel at the Third International Research Congress on Integrative Medicine and Health in Portland, Oregon, in 2012, on different perspectives on Comparative Effectiveness Research, the same recommendations apply to improve integrated complementary and alternative medicine research, for example, need for innovation and controlling costs in large-scale studies, need to gather the input of stakeholders in shaping the framework for more informative, more decision maker–driven research, importance of balancing rigor and pragmatism, several examples of cost-effectiveness analyses, questions concerning the translation of evidence into practice, the effect of pragmatic trials on funding or policy, evidentiary distinctions between and among pragmatic trials and traditional randomized clinical trials, and the multiple roles of stakeholders, particularly in generating new information and knowledge.…”

Integration between orthodox medicine, homeopathy and acupuncture for inpatients: Three years experience in the first hospital for Integrated Medicine in Italy

“…Therefore, the difficulty and sense of frustration are understandable at the beginning of a cultural exchange in medicine which is a precondition of an interdisciplinary approach to treatment as we have interpreted Integrated Medicine in the project described herein. Although over the last decade there has been a great deal of talk of Integrated Medicine and Integrative Medicine in scientific literature, including the numerous articles published regarding the possible strategies in order to carry out adequate scientific research in order to document the effectiveness, safety, costs, social and economic impact, 35 , 36 , 37 , 38 , 39 , 40 of various CAM therapies, there have not been very many models of Integrated Medicine on trial in state hospitals. The clinical setting of Integrated Medicine in experimentation in the Hospital of Pitigliano is the first in Italy based in a hospital where there are homeopathy and acupuncture (針灸 zhēn jiǔ) therapies available not only for outpatients but also for inpatients, with the intention of studying both a model of integrated assistance and its use in terms of cost, efficacy and effectiveness.…”