Romeyke T, Nöhammer E, Scheuer HC, Stummer H. Integration of naturopathic medicine into acute inpatient care: an approach for patient-centred medicine under diagnosis-related groups. Complement Ther Clin Pract. 2017;28:9-17.
To assess patient satisfaction and perceptions related to the use of naturopathy as part of acute inpatient care
This prospective study surveyed patients who received complementary naturopathic treatment in a licensed acute care hospital. The survey included questions about patients’ experience and views on the treatment they received. The study was conducted over a period of 2 years and all patients entering the acute care facility were invited to participate.
A total of 1,711 (376 men and 1,335 women) patients in an acute care hospital for general medicine in Germany were surveyed; average patient age was 63.3 and average hospital stay was 11.9 days.
Patient care was overseen by integrated health teams that were composed based on the specific needs of the patient. These teams included specialists in general medicine, specialists in naturopathy, anesthesiologists, orthopedic surgeons and neurologists, as well as allied healthcare providers (ie, dieticians, massage therapists, balneotherapists, physiotherapists, ergotherapists, and psychotherapists). The healthcare teams established treatment aims based on the diagnosis or diagnoses associated with each patient.
The high levels of patient satisfaction and strong patient-reported adherence to treatment in holistic acute care settings such as the one reviewed here should pique the interest of hospital administrators.
Naturopathic treatment in hospital settings in Germany is governed by the operations and procedures catalog (OPS), which stipulates the requirements for naturopathic care in those settings. For instance, it is stipulated that the care team must evaluate treatment aims at least twice weekly. Specific naturopathic therapies and the minimum level of management is also specified. For instance, at least 5 of 8 designated management approaches must be employed in naturopathic care. Naturopathic care in this inpatient setting followed the European traditions of naturopathy, as well as Asian medicine practices.
Naturopathic care included methods with scientific evidence of efficacy first. If no study evidence was available, use of methods that have history of long-term empirical evidence were deemed acceptable.
Study Parameters Assessed
The study recorded patient diagnoses using the Diagnosis Related Groups (DRG) classification system. Diagnoses were further classified and assigned to a Major Diagnostic Category (MDC) using the International Classification of Diseases (ICD)-10 diagnosis codes.
Hospital patients were assessed before medical intake using extensive validated questionnaires, so that all members of the care team had in-depth 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 the intake.
At the end of their hospital stay, in writing, and anonymously, patients completed surveys that asked about their satisfaction with the integration of care that included naturopathy, including their perceptions of adherence to treatment and their satisfaction with the amount of time care staff spent with them during their inpatient stay. Confounding factors were reduced by using the same conditions for distribution and response to the surveys.
Primary Outcome Measures
Primary outcome measures included the following, gleaned from the surveys: 1) the evaluation of holistic care measures; 2) holistic care measures and influence on adherence; and 3) the time nursing personnel spent on communication with patients. Patients used the following grading scale to rate satisfaction: Grade 1=very good; Grade 2=good; Grade 3=satisfactory; Grade 4=adequate; Grade 5=poor, Grade 6=unsatisfactory; undecided. The grading scale was adapted from the German school grading system so it could be commonly understood.
Holistic care measures that included naturopathy were rated as “very good” by 62% of respondents and “good” by 28%; 42.5% of participants responded to the question. Perception of the effect of care on adherence to treatment was similarly positive, with 69% reporting adherence as “very good “and 24% as “good”; response rate was 43.5%. Rating of amount of time care staff spent communicating with patients was “very good” for 61% of participants, “good” for 28%, and “satisfactory” for 5%. Response rate for this question was 42.5%.
Classification of diagnoses showed that most patients were admitted for diseases and disorders of the musculoskeletal system and connective tissue, followed by disorders of the nervous system, mental diseases and disorders, diseases of the circulatory system, and diseases of the endocrine and metabolic systems.
The results of patient surveys in this study revealed a high degree of satisfaction with the combination of naturopathy and academic medicine (defined in the paper as “evidence-based academic medicine, which is guaranteed by medical specialists”) within an inpatient acute care facility in Germany. Studies of this sort 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, use of complementary and alternative medicine (CAM) therapies in the United States increased between 2002 and 2007; in 2007, 38% of adults used some form of CAM.1 The report also notes that therapies used by members of the public showed little correlation with the number of published studies on particular CAM therapies or with the most practitioner-recommended therapies. The integration of naturopathic care into hospital inpatient care would provide greater and possibly more cost effective access to naturopathic care, which would provide an opportunity for safer and more effective use of CAM treatment.
The high levels of patient satisfaction and strong patient-reported adherence to treatment in holistic acute care settings 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 within Brampton Civic Hospital, and they experience greater than 90% patient satisfaction from patients in the clinic. Further, there is increasing evidence for both the efficacy of naturopathic treatments2-5 and the economic benefits of naturopathic care to the patient and the healthcare provider.6,7 This evidence is now being disseminated in forums that encourage group insurance providers and health maintenance organizations (HMOs) to better integrate naturopathic treatment into the care provided for reasons of client/patient satisfaction, adherence to treatment, and economics.8
- Barnes PM, Bloom B, Nahin R. Complementary and alternative medicine use among adults and children: United States, 2007. Natl Health Stat Report. 2008;10(12):1-23.
- Seely D, Szczerko O, Cooley K, et al. Naturopathic medicine for the prevention of cardiovascular disease: a randomized clinical trial. CMAJ. 2013;185(9):E409-16.
- Szczurko O, Cooley K, Busse J, et al. Naturopathic care for chronic low back pain: a randomized trial. PLoS One. 2007;2(9):e919.
- Szczurko O, Cooley K, Mills E, Zhou Q, Perri D, Seely D. Naturopathic treatment of rotator cuff tendinitis among Canadian postal workers: a randomized controlled trial. Arthritis Rheum. 2009;61(8):1037-1045.
- Cooley K, Szczurko O, Perri D, et al. Naturopathic care for anxiety: a randomized controlled trial. PLoS One. 2009;4(8):e6628.
- Herman PM, Szczurko O, Cooley K, Seely D. A naturopathic approach to the prevention of cardiovascular disease: cost-effectiveness analysis of a pragmatic multi-worksite randomized clinical trial. J Occup Environ Med. 2014 Feb;56(2):171-176.
- Herman PM, Szczurko O, Cooley K, Mills EJ. Cost-effectiveness of naturopathic care for chronic low back pain. Altern Ther Health Med. 2008;14(2):32-29.
- Bernhardt B. Reducing benefit expenditures through evidence-based expansion of care. Benefit and Pensions Monitor. 2016:26-29.