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Use of Complementary and Alternative Medicine in Germany–A Survey Of BMC Complementary and Alternative Medicine BioMed Central Research article Open Access Use of complementary and alternative medicine in Germany – a survey of patients with inflammatory bowel disease Stefanie Joos*1,2, Thomas Rosemann1, Joachim Szecsenyi1, Eckhart G Hahn2, Stefan N Willich3 and Benno Brinkhaus2,3 Address: 1Department of General Practice and Health Services Research, University of Heidelberg, Germany, 2Department of Medicine I, Friedrich Alexander University of Erlangen Nuremberg, Erlangen, Germany and 3Institute of Social Medicine, Epidemiology, and Health Economics, Charité University Medical Center, Berlin, Germany Email: Stefanie Joos* - [email protected]; Thomas Rosemann - [email protected]; Joachim Szecsenyi - [email protected]; Eckhart G Hahn - [email protected]; Stefan N Willich - [email protected]; Benno Brinkhaus - [email protected] * Corresponding author Published: 22 May 2006 Received: 23 November 2005 Accepted: 22 May 2006 BMC Complementary and Alternative Medicine 2006, 6:19 doi:10.1186/1472-6882-6-19 This article is available from: http://www.biomedcentral.com/1472-6882/6/19 © 2006 Joos et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background: Previous studies have suggested an increasing use of complementary and alternative medicine (CAM) in patients with inflammatory bowel disease (IBD). The aim of our study was to evaluate the use of CAM in German patients with IBD. Methods: A questionnaire was offered to IBD patients participating in patient workshops which were organized by a self-help association, the German Crohn's and Colitis Association. The self- administered questionnaire included demographic and disease-related data as well as items analysing the extent of CAM use and satisfaction with CAM treatment. Seven commonly used CAM methods were predetermined on the questionnaire. Results: 413 questionnaires were completed and included in the analysis (n = 153 male, n = 260 female; n = 246 Crohn's disease, n = 164 ulcerative colitis). 52 % of the patients reported CAM use in the present or past. In detail, homeopathy (55%), probiotics (43%), classical naturopathy (38%), Boswellia serrata extracts (36%) and acupuncture/Traditional Chinese Medicine (TCM) (33%) were the most frequently used CAM methods. Patients using probiotics, acupuncture and Boswellia serrata extracts (incense) reported more positive therapeutic effects than others. Within the statistical analysis no significant predictors for CAM use were found. 77% of the patients felt insufficiently informed about CAM. Conclusion: The use of CAM in IBD patients is very common in Germany, although a large proportion of patients felt that information about CAM is not sufficient. However, to provide an evidence-based approach more research in this field is desperately needed. Therefore, physicians should increasingly inform IBD patients about benefits and limitations of CAM treatment. Page 1 of 7 (page number not for citation purposes) BMC Complementary and Alternative Medicine 2006, 6:19 http://www.biomedcentral.com/1472-6882/6/19 Background 2002 [5]. A recently published national representative The use of complementary and alternative medicine sample shows that herbal medicine, exercise therapy and (CAM) is widespread and still increasing in the Western hydrotherapy are the most frequently used CAM methods world [1,2]. The term complementary medicine refers to a [7] – all of them belonging to the so-called classic group of diagnostic and therapeutic disciplines that exist naturopathy, also known as kneippism from its originator largely outside the institutions where conventional health Sebastian Kneipp (1821–97), a German priest. Besides the care is provided and taught [3]. The wide range of disci- classic naturopathic methods homeopathy, manual ther- plines classified as complementary medicine makes it dif- apy and acupuncture are commonly used CAM therapies ficult to find defining criteria that are common to all. in Germany [7]. Furthermore, the diagnostic and therapeutic approaches which are summarized among the term CAM depend on It is commonly known, that patients with chronic diseases traditions and historical developments of a country and rank high among CAM users. Several surveys in patients therefore, vary considerably among countries [4]. Also, with IBD have shown rates of CAM utilization ranging the extent to which CAM is practiced by physicians or from 39% in Austria to 47% in Switzerland and Canada non-medical therapists differs considerably among coun- [8-11]. A survey among German IBD patients found 51% tries. In Germany, medical doctors can obtain a variety of with experience in CAM. Homeopathy and herbal medi- additional qualifications relating to specific CAM meth- cine were the most commonly used types of CAM in this ods (e.g. chiropractic, homeopathy) or to naturopathic recently published survey [12]. medicine in general (naturopathy). In 2004 the German federal medical chamber documented 15.970 additional The purpose of our study was to estimate the extent of qualifications of medical doctors in chiropractic, 5.538 in CAM experience among IBD patients in Germany and to homeopathy and 13.502 in naturopathy (= 18.5% physi- obtain information about the most commonly used CAM cians working in the ambulatory sector). In addition, methods, about CAM providers and about perceived about 2.5% of the ambulatory physicians are qualified in effects of CAM therapy. the field of physical medicine [5]. Furthermore, around 25% of the physicians in the ambulatory sector have Methods passed a special training in acupuncture. In near future, Participants and data collection acupuncture will also be a qualification accredited by the We surveyed IBD patients meeting at patient workshops local medical chambers such as chiropractic or homeopa- organized by the German Crohn's and Ulcerative Colitis thy. Moreover, in Germany many physicians are provid- Association (DCCV e.V.). The DCCV [13] is a national ing CAM in their daily practice without having an organization established by patients and for patients with additional CAM qualification [6]. Crohn's disease (CD) and Ulcerative Colitis (UC). The patient workshops of the DCCV take place regularly in dif- Other health care professionals such as pharmacists, den- ferent regions of Germany and are open to the public. tists, physiotherapists or midwives also practise some Normally experts are invited to give lectures on recent form of CAM. Official data on CAM qualifications for developments in diagnostic and therapeutic possibilities these health care professions are not available. in order to inform patients. Three of these workshops (which were not specific to CAM) took place in different Apart from the regular health care professionals Germany German federal states (Erlangen; October 1998/Aachen; has one state-regulated profession – the 'Heilpraktiker'. A May 2000/Tübingen; June 2000). A questionnaire was 'Heilpraktiker' has to pass an examination on basic medi- handed out to all participants of the workshops. The ques- cal knowledge and skills at a local public health office to tionnaires were distributed on the tables in the conven- obtain a state license. 'Heilpraktiker' only practice in the tion hall and had to be completed during the workshop or ambulatory sector and their services are not covered by were to be returned by mail. health insurance funds. Any CAM method can be per- formed by a 'Heilpraktiker' as long as it is consistent with Questionnaire the general standards of good professional practice in The 4-page structured self-administered questionnaire health care as supervised by the local public health office. contained questions on patients' demographic data (10 In general 'Heilpraktiker' provide a variety of CAM meth- items) and on characteristics of the disease such as dura- ods. Within the last ten years the number of 'Heilprak- tion of disease, current medication and satisfaction with tiker' increased from 9.000 in the year 1993 to nearly conventional therapy (16 items). Detailed questions were 20.000 today. asked about knowledge and interest in CAM and CAM use specifically for their IBD symptoms (15 items). The items In Germany, the overall percentage of individuals with were designed as yes/no questions or open-ended ques- CAM experience increased from 52% in 1970 to 73% in tions or to be answered on a 5-point Likert scale. Page 2 of 7 (page number not for citation purposes) BMC Complementary and Alternative Medicine 2006, 6:19 http://www.biomedcentral.com/1472-6882/6/19 Within the questionnaire CAM was defined as 'all non- of IBD at least once and 39% had undergone some kind conventional therapy methods, which are based rather on of surgical intervention for their IBD. 45% of the patients personal experience than on a scientific basis'. Seven CAM stated that they were satisfied with their current conven- therapies which are commonly used in Germany were tional treatment: 64% of the patients receiving aminosal- predetermined in the questionnaire: classic naturopathic ycilates, 36% being treated with corticosteroids and 17% medicine (incl. herbal medicine and hydrotherapy), Tra- taking immunosuppressive
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