Utilization of complimentary and alternative medicine in primary care : what are the relations between it and conventional medicine?

Backgroud: Complementary and alternative medicine (CAM) utilization among various groups of patients in western countries is increasing. Objectives: To describe the utilization of various CAM methods in parallel with conventional pri- mary care medicine and the relations between it and conventional medicine. Study Design: Four hundred and eighty patients in two primary care clinics participated in the survey. The participants answered a structured questionnaire, which included socio-demographic information and details of CAM therapy utilization. Results: Eighty percent of those seeking CAM therapy received conventional medical treatment for the same complaint as well. When asked if CAM should be funded 69% agreed, 14% disagreed and 8.3% were undecided. The most frequent causes for using CAM therapy were insufficient improve- ment by conventional treatment (36%), a reluctance to take medications (19%) and willingness to try a new modality (13%). Most of those who received CAM therapy felt it was beneficial and claim they would return to use it in the future under similar circumstances. Conclusions: We found that the term complementary is more appropriate as most patients use CAM in parallel to conventional medicine. Patients using CAM are satisfied and intend to use CAM in the future.peer-reviewe

An audit of discharge summaries

Background: In the continuum of patient care, admission to the department of medicine constitutes a brief yet critical period. Subsequent patient care depends on the discharge summary (DS) and its implementation. Aim: To evaluate the department of medicine -family physician interface by a discharge summaries audit. Method: A retrospective study analyzing all admissions and discharges between a department of medicine and a primary care clinic over a period of ten months. Results: 129 DS were evaluated and compared to 97 available primary care medical charts. Most admissions were due to a medical emergency (95%), the patients were often elderly and 23% lived alone. Hospital stay averaged 4.0±2.4 days, readmission rate was 15.8%. In 73% of the DS at least one new drug was prescribed. The family physician was the one expected to continue treatment in most of the cases, but in over a third of the patients, a referral to further consultation was deemed necessary. The DS was found in 82% of the primary care charts. Median time interval between discharge and consultation with the family physician was three days (range 1-30). Home visits by physicians were documented in eight cases only. Conclusion: Most discharged patients require further evaluation and newly prescribed medications, making a timely and coordinated continuous care in the community mandatory. A high quality, rapidly available DS is therefore important for the family physician. Whether improved communication will reduce readmissions and improve patient prognosis and quality of care should be clarified by further study.peer-reviewe

The knowledge and expectations of parents about the role of antibiotic treatment in upper respiratory tract infection – a survey among parents attending the primary physician with their sick child

BACKGROUND: Upper respiratory tract infections (URTI) are common. The etiologic factor is usually viral, but many physicians prescribe antibiotics. We aimed to evaluate parents' expectations of and knowledge about the role of antibiotics in childhood URTI. METHODS: The study was conducted in thirteen primary care pediatric clinics. Parents of children aged 3 months to 6 years who attended with URTI symptoms were included when it was the first attendance in the current illness. Questionnaire about the current illness, reasons for attending and expectations from the visit, knowledge about URTI was filled before the visit. RESULTS: In 122 visits the average age was 2.8 ± 1.9 years. The main reasons for the visit were to avoid complications (81%) and to be examined (78%). Expected treatment was: cough suppressants (64%), anti-congestants (57%), paracetamol (56%), natural remedies (53%) and antibiotics (25%). In 28% the child had received antibiotics in past URTI. Only 37% thought that antibiotics would not help in URTI and 27% knew that URTI is a self-limited disease. 61% knew that URTI is a viral disease. Younger parental age and higher education were associated with lower expectations to receive antibiotics (p = 0.01, p < 0.005 respectively). While previous antibiotic treatment (p < 0.001), past perceived complications (p = 0.05) and the thought that antibiotics help in URTI (p < 0.001) were associated with a greater expectation for antibiotics. CONCLUSIONS: A quarter of the parents attending the physician with URTI are expecting to get antibiotics. Predictors were lower education, older parental age, receiving antibiotics in the past and the belief that antibiotics help in URTI

Primary care follow up of patients discharged from the emergency department: a retrospective study

BACKGROUND: The visit to the emergency department (ED) constitutes a brief, yet an important point in the continuum of medical care. The aim of our study was to evaluate the continuity of care of adult ED visitors. METHODS: We retrospectively reviewed all ED discharge summaries for over a month 's period. The ED chart, referral letter and the patient's primary care file were reviewed. Data collected included: age, gender, date and hour of ED visit, documentation of ED referral and ED discharge letter in the primary care file. RESULTS: 359 visits were eligible for the study. 192 (53.5%) of the patients were women, average age 54.1 ± 18.7 years (mean ± SD). 214 (59.6%) of the visits were during working hours of primary care clinics ("working hours"), while the rest were "out of hours" visits. Only 196 (54.6%) of patients had a referral letter, usually from their family physician. A third (71/214) of "working hours" visits were self referrals, the rate rose to 63.5% (92/145) of "out of hours" visits (p < 0.0001). The ED discharge letter was found in 50% (179/359) of the primary care files. A follow-up visit was documented in only 31% (111/359). Neither follow up visit nor discharge letter were found in 43% of the files (153/359). CONCLUSIONS: We have found a high rate of ED self referrals throughout the day together with low documentation rates of ED visits in the primary care charts. Our findings point to a poor continuity of care of ED attendees

Non-specific symptoms as clues to changes in emotional well-being

Background: Somatic symptoms are a common reason for visits to the family physician. The aim of this study was to examine the relation between non-specific symptoms and changes in emotional well-being and the degree to which the physician considers the possibility of mental distress when faced with such patients. Methods: Patients who complained of two or more symptoms including headache, dizziness, fatigue or weakness, palpitations and sleep disorders over one year were identified from the medical records of a random sample of 45 primary care physicians. A control group matched for gender and age was selected from the same population. Emotional well-being was assessed using the MOS-SF 36 in both groups. Results: The study group and the control group each contained 110 patients. Completed MOS questionnaires were obtained from 92 patients, 48 patients with somatic symptoms and 44 controls. Sixty percent of the patients with somatic symptoms experienced decreased emotional well being compared to 25% in the control group (p =0.00005). Symptoms of dizziness, fatigue and sleep disturbances were significantly linked with mental health impairments. Primary care physicians identified only 6 of 29 patients (21%) whose responses revealed functional limitations due to emotional problems as suffering from an emotional disorder and only 6 of 23 patients (26%) with a lack of emotional well being were diagnosed with an emotional disorder. Conclusions: Non-specific somatic symptoms may be clues to changes in emotional well-being. Improved recognition and recording of mental distress among patients who complain of these symptoms may enable better follow up and treatment

Methemoglobinemia Caused by Topical Teething Preparation: A Case Report

Methemoglobinemia (MetHb) remains an uncommon, but potentially fatal disorder. Benzocaine (ethyl aminobenzoate), a topical anesthetic, has been reported to cause acquired MetHb when used during endoscopic or other ambulatory procedures. Reports of severe MetHb following benzocaine-containing preparations in the community, however, are very rare. We discuss this entity by describing an unusual case of severe MetHb in a 5-year-old child, caused by unattended self-use of a benzocaine-containing, pain-relief gel for teething. This case story illustrates the potential lethal risk of over-the-counter topical anesthetics for pediatric use. We review the risks of this potentially deadly disorder and the associated diagnostic challenges. Physicians not familiar with this rare complication may face diagnostic dilemmas, as its presentation is often nonspecific and rapid treatment is essential to prevent life-threatening complications