Radovčić Z, Nola I A
Acta Med Croatica. 2015;69(5):451-8.
Since the turn of the century, Complementary and Alternative Medicine (CAM) has been on the fast track in Croatia, particularly in big cities. Following the examples of developed health systems in the world, it was to be expected that sooner or later CAM would be integrated within primary health care system in Croatia as well. The main aim of this survey was to reveal the actual attitude and opinion of the Croatian primary health care physicians toward CAM. Specific aims were to reveal the physicians’ need for additional education and to reveal the need for keeping CAM therapy records in patient history of illness. On-line questionnaire consisted of 10 questions with two possible answers, Yes or No. The questionnaire was sent to 388 e-addresses and 84 (21.6%) of them responded. This response rate we considered sufficient for further statistical analyses. Although most of the respondents could differentiate alternative and complementary medicine, 21.4% of them still did not know the difference between these two types of medical approach. Furthermore, 79.8% of the respondents confirmed patient interest in CAM. Almost 72% of the respondents considered they did not have sufficient knowledge for informative conversation about CAM with their patients. Only 27.4% of the respondents had enrolled some kind of formal education related to CAM, and almost 73% confirmed their need for formal education on the topic; 88.1% of the respondents considered that CAM methods should be combined with conventional medicine and 97.6% believed that primary health care physicians should keep records on patient use of CAM methods. Interestingly, 76.2% of the same randomly chosen primary health care physicians considered that there is strong resistance among medical doctors towards CAM methods, but our results did not show it. According to the results of our survey, although the majority of respondents (primary care physicians) distinguished alternative and complementary medicine, 21.4% of respondents still did not differentiate these two concepts. Accordingly, it is concluded that as many as 21.4% of general practitioners and family physicians lack even basic knowledge about CAM and thus are not qualified for even initial communication with their patients on the subject of CAM. These physicians show no interest in CAM since they could have learned about this difference independently of their formal education through numerous articles published daily in popular media. Furthermore, the results showed that 79.8% of respondents received queries from their patients with regards to CAM, and this indicator clearly shows that there is strong market demand for this service. In order to meet this demand, it is necessary to urgently organize or expand the existing formal education with regards to CAM with the aim of encompassing as many primary health care physicians as possible, which is also considered necessary by physicians themselves (76.2%). These data indicate the need for urgent organization of teaching and training programs on the subject of CAM, as well as expansion and increased scope of the existing programs. Unresolved legislation and lack of appropriate registered academic state and private institutions and programs for education in CAM certainly contribute to the current situation in which the position of CAM in Croatia is not regulated. Acts and declarations do not automatically make CAM services safer, but will start the new age of CAM integration in the health care system, thus empowering patient rights.
自世纪之交以来,补充替代医学(CAM)在克罗地亚发展迅速,尤其是在大城市。效仿世界上发达的卫生系统,人们预计CAM迟早也会被纳入克罗地亚的初级卫生保健系统。本次调查的主要目的是揭示克罗地亚初级卫生保健医生对CAM的实际态度和看法。具体目标是揭示医生对额外教育的需求以及在患者病史中记录CAM治疗情况的必要性。在线问卷包含10个问题,有“是”或“否”两种可能答案。问卷被发送到388个电子邮箱,其中84个(21.6%)回复了。我们认为这个回复率足以进行进一步的统计分析。尽管大多数受访者能够区分替代医学和补充医学,但仍有21.4%的人不知道这两种医学方法之间的区别。此外,79.8%的受访者证实患者对CAM感兴趣。近72%的受访者认为他们没有足够的知识与患者就CAM进行信息交流。只有27.4%的受访者参加过某种与CAM相关的正规教育,近73%的人确认他们需要关于该主题的正规教育;88.1%的受访者认为CAM方法应与传统医学相结合,97.6%的人认为初级卫生保健医生应记录患者使用CAM方法的情况。有趣的是,同样这些随机挑选的初级卫生保健医生中有76.2%认为医生对CAM方法存在强烈抵触,但我们的结果并未显示出这一点。根据我们的调查结果,尽管大多数受访者(初级保健医生)能够区分替代医学和补充医学,但仍有多达21.4%的受访者没有区分这两个概念。因此,可以得出结论,多达21.4%的全科医生和家庭医生甚至缺乏关于CAM的基本知识,因此甚至没有资格就CAM主题与患者进行初步沟通。这些医生对CAM不感兴趣,因为他们本可以通过大众媒体每天发表的大量文章,在正规教育之外独立了解这种差异。此外,结果显示79.8%的受访者收到患者关于CAM的询问,这一指标清楚地表明对这项服务有强烈的市场需求。为了满足这一需求,有必要紧急组织或扩大现有的关于CAM的正规教育,以涵盖尽可能多的初级卫生保健医生,医生自身(76.2%)也认为这是必要的。这些数据表明迫切需要组织关于CAM主题的教学和培训项目,并扩大现有项目的范围和规模。未解决的立法以及缺乏合适的注册学术机构和私立机构以及CAM教育项目,肯定导致了目前克罗地亚CAM地位未得到规范的状况。法规和声明不会自动使CAM服务更安全,但将开启CAM融入医疗保健系统的新时代,从而赋予患者权利。