TUM School of Medicine and Health, Department Clinical Medicine, Technical University Munich, Institute for General Practice and Health Services Research, Munich, Germany.
TUM School of Medicine and Health, Department Health and Sports Sciences, Chair of Social Determinants of Health, Technical University Munich, Munich, Germany.
BMC Complement Med Ther. 2024 Sep 3;24(1):328. doi: 10.1186/s12906-024-04624-w.
Available data suggest that general practitioners (GPs) in Germany use complementary and alternative medicine (CAM) modalities more frequently than GPs in many other countries. We investigated the country differences perceived by general practitioners who have worked in Germany and in one of four other European countries with regard to the role of complementary and alternative treatments in primary care.
In this qualitative study we conducted semi-structured interviews with 12 GPs who had worked both in Germany and Italy, the Netherlands, Norway or the United Kingdom (UK; n = 3 for each of the four countries). Participants were asked how they perceived and experienced country differences regarding health system, relevance of CAM modalities, the role of evidence-based medicine (EBM) and science, and how they handle so-called indeterminate situations. For the analysis, we followed a thematic analysis approach according to Braun and Clarke with focus on themes that cover CAM.
Participants unanimously reported that they perceived CAM to be more relevant in general practice in Germany compared to the other countries. We identified four overarching themes in relation to the perceived reasons for these differences. Firstly, physicians with experiences in countries with a strong EBM and science orientation (Netherlands, Norway and the UK) considered the deeply ingrained view in national healthcare systems and GP communities that CAM modalities are not evidence-based as the main reason for the lower use of CAM by GPs. Secondly, extensive training of communication skills was cited as a reason that reduced the need for CAM in the Netherlands, Norway and the UK. Thirdly, differences in patient expectations and demands were perceived as a factor contributing to greater utilisation of CAM by German GPs compared to the other countries. Finally, country-specific reimbursement mechanisms were considered as a factor influencing the role of CAM in general practice.
The study results point to major differences between countries with regard to the role of CAM in GP care. Differences in basic attitudes in the discipline of general practice, patient expectations and system conditions appear to play an important role here.
现有数据表明，德国的全科医生（GP）比许多其他国家的全科医生更频繁地使用补充和替代医学（CAM）方式。我们调查了在德国和其他四个欧洲国家之一工作的全科医生对初级保健中补充和替代治疗作用的看法所感知到的国家差异。
在这项定性研究中，我们对曾在德国和意大利、荷兰、挪威或英国（英国；每个国家各有 3 名参与者）工作过的 12 名全科医生进行了半结构化访谈。参与者被问及他们如何看待和体验有关卫生系统、CAM 方式相关性、循证医学（EBM）和科学的作用以及如何处理所谓的不确定情况方面的国家差异。对于分析，我们遵循 Braun 和 Clarke 的主题分析方法，重点关注涵盖 CAM 的主题。
参与者一致报告说，与其他国家相比，他们认为 CAM 在德国的全科实践中更为重要。我们确定了与感知到这些差异的原因相关的四个总体主题。首先，在具有强大 EBM 和科学导向的国家（荷兰、挪威和英国）有经验的医生认为，国家医疗保健系统和全科医生社区中根深蒂固的观点认为 CAM 方式没有循证依据，这是 GP 较少使用 CAM 的主要原因。其次，引用了广泛的沟通技巧培训，作为减少荷兰、挪威和英国对 CAM 需求的原因。第三，患者期望和需求的差异被认为是德国 GP 比其他国家更倾向于使用 CAM 的一个因素。最后，认为国家特定的报销机制是影响 CAM 在全科实践中作用的一个因素。
研究结果表明，在 CAM 在 GP 护理中的作用方面，各国之间存在重大差异。在普通实践学科的基本态度、患者期望和系统条件方面的差异似乎在这里起着重要作用。
