Abstract
BackgroundThere has been a marked increase in the use of complementary and alternative medicine (CAM) in recent years worldwide. In Germany, apart from 'Heilpraktiker' (= state-licensed, non-medical CAM practitioners), some general practitioners (GPs) provide CAM in their practices. This paper aims to explore the attitudes of GPs about the role of CAM in Germany, in relation to the healthcare system, quality of care, medical education and research. Furthermore, experiences of GPs integrating CAM in their daily practice were explored.MethodsUsing a qualitative methodological approach 3 focus groups with a convenience sample of 17 GPs were conducted. The discussions were transcribed verbatim and analysed using qualitative content analysis.ResultsThe majority of the participating GPs had integrated one or more CAM therapies into their every-day practice. Four key themes were identified based on the topics covered in the focus groups: the role of CAM within the German healthcare system, quality of care, education and research. Within the theme 'role of CAM within the healthcare system' there were five categories: integration of CAM, CAM in the Statutory Health Insurance, modernisation of the Statutory Health Insurance Act, individual healthcare services and 'Heilpraktiker'. Regarding quality of care there were two broad groups of GPs: those who thought patients would benefit from standardizing CAM and those who feared that quality control would interfere with the individual approach of CAM. The main issues identified relating to research and education were the need for the development of alternative research strategies and the low quality of existing CAM education respectively.ConclusionThe majority of the participating GPs considered CAM as a reasonable complementary approach within primary care. The study increased our understanding of GPs attitudes about the role of CAM within the German healthcare system and the use of 'Heilpraktiker' as a competing CAM-provider. It seems to be a need for increased funding for research, better education and remuneration by the Statutory Health Insurance in order to improve access to 'Integrative medicine' in Germany.
Highlights
There has been a marked increase in the use of complementary and alternative medicine (CAM) in recent years worldwide
Four key themes were identified based on the topics covered in the focus groups: the role of CAM within the German healthcare system, quality of care, education and research
Regarding quality of care there were two broad groups of general practitioners (GPs): those who thought patients would benefit from standardizing CAM and those who feared that quality control would interfere with the individual approach of CAM
Summary
There has been a marked increase in the use of complementary and alternative medicine (CAM) in recent years worldwide. A national representative survey shows that herbal medicine, exercise therapy and hydrotherapy are the most frequently used CAM modalities in Germany [2]. Besides these so-called classic naturopathic therapies, homeopathy, manual therapy and acupuncture are commonly used CAM therapies [2]. In 2005 the German federal medical chamber documented 46.000 qualifications in CAM relating to around 60.000 general practitioners. Among those qualifications the most prevalent were chiropractic and naturopathy [3] (Table 1). Many physicians are providing CAM in their daily practice without having any CAM qualification or certificate [4]
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