Suche
Relation
Romeyke T, Nöhammer E, Scheuer HC, Stummer H. Integration of naturopathy into acute inpatient care: an approach for patient-centered medicine among diagnosis-related groups.Complete Ther Clin Pract. 2017;28:9-17.
Objective
To assess patient satisfaction and perception regarding the use of naturopathy as part of acute inpatient care
Draft
This prospective study surveyed patients receiving complementary naturopathic treatment in an accredited acute care hospital. The survey included questions about patients' experiences and views about the treatment they received. The study was conducted over a 2-year period and all patients entering the acute care facility were invited to participate.
Participant
A total of 1,711 (376 men and 1,335 women) patients from an acute general medicine hospital in Germany were surveyed; the average patient age was 63.3 years and the average hospital stay was 11.9 days.
intervention
Patient care was overseen by integrated healthcare teams assembled based on the patient's specific needs. These teams included general practitioners, naturopathic specialists, anesthesiologists, orthopedists and neurologists, as well as allied health providers (e.g. dietitians, massage therapists, balneotherapists, physiotherapists, occupational therapists and psychotherapists). Health care teams established treatment goals based on the diagnosis or diagnoses associated with each patient.
The high levels of patient satisfaction and strong patient-reported adherence in holistic acute care facilities such as the one reviewed here should pique the interest of hospital administrators.
Naturopathic treatment in hospitals in Germany is regulated by the Operations and Procedure Catalog (OPS), which defines the requirements for naturopathic care in these facilities. For example, it is stipulated that the care team must evaluate the treatment goals at least twice a week. Specific naturopathic therapies and the minimum level of management are also determined. For example, at least 5 of 8 identified management approaches must be used in naturopathic care. Naturopathic care in this inpatient setting followed European traditions of naturopathy and Asian healing practices.
Naturopathic care initially included methods with scientifically proven effectiveness. When trial evidence was not available, the use of methods with long-standing empirical evidence was considered acceptable.
Study parameters assessed
In the study, patient diagnoses were recorded according to the Diagnosis Related Groups (DRG) classification system. Diagnoses were further classified and assigned to a major diagnosis category (MDC) using International Classification of Diseases (ICD)-10 diagnosis codes.
Hospital patients were assessed using comprehensive validated questionnaires before medical admission so that all members of the care team had well-informed information about the patients' health status. Questionnaires included the Hannover Functional Status Questionnaire, the Visual Analogue Scale, the Mainz Pain Staging System and the Nottingham Health Profile. Diagnoses (primary and secondary) were made or confirmed after ingestion.
At the end of their hospital stay, patients completed written and anonymous surveys asking about their satisfaction with the integration of naturopathic care, including their perception of treatment adherence and their satisfaction with the time spent by nursing staff during their inpatient stay. Confounding factors were reduced by using the same survey distribution and response conditions.
Primary outcome measures
Primary outcome measures that emerged from the surveys included the following: 1) the assessment of holistic care interventions; 2) holistic care measures and influence on adherence; and 3) the time nurses spend communicating with patients. To assess satisfaction, the patients used the following grading scale: Grade 1=very good; Grade 2 = good; Grade 3 = satisfactory; Grade 4 = sufficient; Grade 5 = bad, Grade 6 = unsatisfactory; draw. The grading scale was adapted to the German school grading system so that it is generally understandable.
Key insights
Holistic care measures involving naturopathy were rated “very good” by 62% of those surveyed and “good” by 28%; 42.5% of participants answered the question. Perceptions of the effect of care on adherence were similarly positive, with 69% reporting adherence as “very good” and 24% reporting adherence as “good”; The response rate was 43.5%. The time spent by nursing staff communicating with patients was rated as “very good” by 61% of participants, “good” by 28%, and “satisfactory” by 5%. The response rate for this question was 42.5%.
The classification of the diagnoses showed that most patients were admitted for diseases and disorders of the musculoskeletal system and connective tissue, followed by diseases of the nervous system, mental diseases and disorders, diseases of the circulatory system and diseases of the endocrine system and metabolism.
Practice implications
The results of the patient surveys in this study showed a high level of satisfaction with the combination of naturopathy and conventional medicine (defined in the paper as “evidence-based conventional medicine guaranteed by specialists”) within an acute inpatient facility in Germany. Studies of this type provide evidence that supports greater integration of naturopathic care into the medical care systems of countries around the world.
According to a report from the National Center for Health Statistics, the use of complementary and alternative medicine (CAM) therapies increased in the United States between 2002 and 2007; In 2007, 38% of adults used some form of CAM.1The report also found that therapies used by members of the public showed little correlation with the number of published studies on specific CAM therapies or with the therapies most commonly recommended by physicians. Integrating naturopathic care into inpatient hospital care would provide better and potentially more cost-effective access to naturopathic care, providing an opportunity for safer and more effective use of CAM treatment.
The high levels of patient satisfaction and strong patient-reported adherence in holistic acute care facilities such as the one reviewed here should pique the interest of hospital administrators. The Canadian College of Naturopathic Medicine operates an ambulatory care teaching clinic at Brampton Civic Hospital and has a patient satisfaction rate of more than 90% among patients at the clinic. Additionally, there is increasing evidence of the effectiveness of naturopathic treatments2-5and the economic benefits of naturopathic care for the patient and the health care provider.6.7These findings are now being disseminated in forums encouraging group insurance providers and health care organizations (HMOs) to better integrate naturopathic treatment into care for reasons of customer/patient satisfaction, treatment adherence and cost-effectiveness.8