NIVEL (Netherlands institute for health services research), PO Box 1568, 3500 BN Utrecht, The Netherlands.
BMC Complement Altern Med. 2010 Jan 25;10:3. doi: 10.1186/1472-6882-10-3.
The demand for complementary medicine (CM) is growing worldwide and so is the supply. So far, there is not much insight in the activities in Dutch CM practices nor in how these activities differ from mainstream general practice. Comparisons on diagnoses and visit length can offer an impression of how Dutch CM practices operate.
Three groups of regularly trained physicians specialized in CM participated in this study: 16 homeopathic physicians, 13 physician acupuncturists and 11 naturopathy physicians. Every CM physician was asked to include a maximum of 75 new patients within a period of six months. For each patient an inclusion registration form had to be completed and the activities during a maximum of five repeat visits were subsequently registered. Registrations included patient characteristics, diagnoses and visit length. These data could be compared with similar data from general practitioners (GPs) participating in the second Dutch national study in general practice (DNSGP-2). Differences between CM practices and between CM and mainstream GP data were tested using multilevel regression analysis.
The CM physicians registered activities in a total of 5919 visits in 1839 patients. In all types of CM practices general problems (as coded in the ICPC) were diagnosed more often than in mainstream general practice, especially fatigue, allergic reactions and infections. Psychological problems and problems with the nervous system were also diagnosed more frequently. In addition, each type of CM physician encountered specific health problems: in acupuncture problems with the musculoskeletal system prevailed, in homeopathy skin problems and in naturopathy gastrointestinal problems. Comparisons in visit length revealed that CM physicians spent at least twice as much time with patients compared to mainstream GPs.
CM physicians differed from mainstream GPs in diagnoses, partly related to general and partly to specific diagnoses. Between CM practices differences were found on specific domains of complaints. Visit length was much longer in CM practices compared to mainstream GP visits, and such ample time may be one of the attractive features of CM for patients.
全球对补充医学（CM）的需求不断增长，供应也随之增加。到目前为止，我们对荷兰 CM 实践中的活动以及这些活动与主流全科医学的差异了解甚少。对诊断和就诊时间的比较可以让我们对荷兰 CM 实践的运作方式有一个大致的了解。
本研究纳入了三组经过专门培训的 CM 医生：16 名顺势疗法医生、13 名医师针灸师和 11 名自然疗法医生。每位 CM 医生都被要求在六个月内最多纳入 75 名新患者。每位患者都需要填写一份纳入登记表，随后记录最多五次复诊期间的活动情况。登记内容包括患者特征、诊断和就诊时间。这些数据可以与参加第二次荷兰全科医学研究（DNSGP-2）的全科医生（GP）的类似数据进行比较。使用多水平回归分析比较 CM 实践之间以及 CM 与主流 GP 数据之间的差异。
CM 医生共记录了 5919 次就诊的 1839 名患者的活动情况。在所有类型的 CM 实践中，与主流全科医学相比，CM 医生更常诊断一般性问题（按照 ICPC 编码），尤其是疲劳、过敏反应和感染。心理问题和神经系统问题也更常被诊断。此外，每种类型的 CM 医生都遇到了特定的健康问题：在针灸中，肌肉骨骼系统的问题更为普遍；在顺势疗法中，皮肤问题更为普遍；在自然疗法中，胃肠道问题更为普遍。就诊时间的比较显示，CM 医生与主流全科医生相比，与患者的交流时间至少要长两倍。
CM 医生与主流全科医生在诊断方面存在差异，部分与一般性诊断有关，部分与特定性诊断有关。在 CM 实践中，不同实践之间在特定的投诉领域存在差异。与主流 GP 就诊相比，CM 就诊时间要长得多，而这种充裕的时间可能是患者选择 CM 的一个吸引力因素。
