Havelhoehe Research Institute, Berlin, Germany.
BMC Geriatr. 2010 Jul 21;10:48. doi: 10.1186/1471-2318-10-48.
Pharmacotherapy in the older adult is a complex field involving several different medical professionals. The evidence base for pharmacotherapy in elderly patients in primary care relies on only a few clinical trials, thus documentation must be improved, particularly in the field of complementary and alternative medicine (CAM) like phytotherapy, homoeopathy, and anthroposophic medicine. This study describes diagnoses and therapies observed in elderly patients treated with anthroposophic medicine in usual care.
Twenty-nine primary care physicians in Germany participated in this prospective, multicenter observational study on prescribing patterns. Prescriptions and diagnoses were reported for each consecutive patient. Data were included if patients were at least 60 years of age. Multiple logistic regression analysis was used to determine factors associated with anthroposophic prescriptions.
In 2005, a total of 12 314 prescriptions for 3076 patients (68.1% female) were included. The most frequent diagnoses were hypertension (11.1%), breast cancer (3.5%), and heart failure (3.0%). In total, 30.5% of the prescriptions were classified as CAM remedies alone, 54.4% as conventional pharmaceuticals alone, and 15.1% as a combination of both. CAM remedies accounted for 41.7% of all medications prescribed (35.5% anthroposophic). The adjusted odds ratio (AOR) for receiving an anthroposophic remedy was significantly higher for the first consultation (AOR = 1.65; CI: 1.52-1.79), treatment by an internist (AOR = 1.49; CI: 1.40-1.58), female patients (AOR = 1.35; CI: 1.27-1.43), cancer (AOR = 4.54; CI: 4.12-4.99), arthropathies (AOR = 1.36; CI: 1.19-1.55), or dorsopathies (AOR = 1.34; CI: 1.16-1.55) and it decreased with patient age (AOR = 0.97; CI: 0.97-0.98). The likelihood of being prescribed an anthroposophic remedy was especially low for patients with hypertensive diseases (AOR = 0.36; CI: 0.32-0.39), diabetes mellitus (AOR = 0.17; CI: 0.14-0.22), or metabolic disorders (AOR = 0.17; CI: 0.13-0.22).
The present study is the first to provide a systematic overview of everyday anthroposophic medical practice in primary care for elderly patients. Practitioners of anthroposophic medicine prescribe both conventional and complementary treatments. Our study may facilitate further CAM-research on indications of, for example, dementia or adverse drug reactions in the elderly.
老年患者的药物治疗是一个涉及多个不同医学专业的复杂领域。在初级保健中，老年患者的药物治疗的证据基础仅依赖于少数临床试验，因此必须改进记录，特别是在补充和替代医学（CAM）领域，如植物疗法、顺势疗法和人智学医学。本研究描述了在常规护理中接受人智学医学治疗的老年患者的诊断和治疗情况。
德国的 29 名初级保健医生参与了这项关于处方模式的前瞻性、多中心观察性研究。为每位连续就诊的患者报告处方和诊断。如果患者年龄至少为 60 岁，则纳入数据。多变量逻辑回归分析用于确定与人智学处方相关的因素。
2005 年，共纳入了 12314 名 3076 名患者（68.1%为女性）的处方。最常见的诊断是高血压（11.1%）、乳腺癌（3.5%）和心力衰竭（3.0%）。总的来说，30.5%的处方被归类为 CAM 疗法单独使用，54.4%为常规药物单独使用，15.1%为两者结合使用。CAM 疗法占所有开出处方药物的 41.7%（35.5%为人智学）。首次就诊时接受人智学治疗的调整后优势比（AOR）显著更高（AOR=1.65；CI：1.52-1.79），由内科医生治疗（AOR=1.49；CI：1.40-1.58），女性患者（AOR=1.35；CI：1.27-1.43），癌症（AOR=4.54；CI：4.12-4.99），关节炎（AOR=1.36；CI：1.19-1.55）或脊柱疾病（AOR=1.34；CI：1.16-1.55），并且随着患者年龄的增加而降低（AOR=0.97；CI：0.97-0.98）。患有高血压病（AOR=0.36；CI：0.32-0.39）、糖尿病（AOR=0.17；CI：0.14-0.22）或代谢紊乱（AOR=0.17；CI：0.13-0.22）的患者接受人智学治疗的可能性尤其低。
本研究首次提供了初级保健中老年人接受人智学医学治疗的系统概述。人智学医学从业者既开常规治疗处方，也开补充治疗处方。我们的研究可以促进对老年人痴呆或药物不良反应等适应症的进一步 CAM 研究。
