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Attitudes of Hungarian Healthcare Professionals (Mds, Nurses) According To Cam Homeopathy: A Cross-Sectional, Qualitative Accumulated Survey's Data

Habil Hegyi Gabriella1*, Csütörtöki Krisztina1, Pfeifenróth Anna1 and Paolo Roberti di Sarsina2*

1Department of Dietetic and CAM, Pecs University, Hungary

2Observatory and Methods for Health, University of Milano-Bicocca, Italy

*Corresponding Author:
Dr. Hegyi Gabriella
Department of Dietetic and CAM, Pecs University
Vörösmarty u.4, Pecs, Baranya 7646, Hungary
Tel: 0036309225347, 003612813035
Fax: 003612813035
E-mail: [email protected]

Received date April 13, 2014; Accepted date May 22, 2014; Published date May 24, 2014

Citation: Gabriella HH, Krisztina C, Anna P, Roberti di Sarsina P (2014) Attitudes of Hungarian Healthcare Professionals (Mds, Nurses) According To Cam Homeopathy: A Cross-Sectional, Qualitative Accumulated Survey's Data. Altern Integr Med 3:162. doi:10.4172/2327-5162.1000162

Copyright: © 2014 Gabriella HH, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

Aim of the study: In Eastern-Central Europe, homeopathy has a long history starting from XIXth century which has however been interrupted and later renewed in 1997. A large number of physicians and pharmacists have been trained in homeopathy since. This survey is aimed to measure attitudes to homeopathy in Hungarian GPs and nurses for pediatric and adult population. Materials and methods: An identical original self-administered questionnaire was submitted in 2012 to 550 general physicians's nurses. 536 (98.9 %) women and 6 (1.1 %) men replied. Results: Approximately one third of GPs is using homeopathy. The usage of homeopathy is quite similar to other European countries in spite of the controversal and refusal habit of academic medicine. Effects of gender, age and location are weak and inconsistent. Discussion/Conclusions: Homeopathy has firmly been integrated into the Hungarian health care system and has sustained despite the worse economic conditions of the population and no public support from the official health insurance system (only private health insurance companies accepted it). Accumulated survey data were concluded with future achievements of harmonization in this CAM field. The life-style advice given by nurses can influence homeopathic usage among patients; further education is necessary for the ethical application of homeopathy and remedies after CEU-courses at University. We emphasize the ethical application of any CAM method, such as homeopathy for patients. CAM courses should be involved into curricula of nurses and MDs according to interest either in basic or in further education  

Keywords

CAM; Homeopathy; Legislation of CAM-Homeopathy; Usage of CAM; Usage of homeopathy; Nurse-education; Curriculum

Abbreviations

CAM: Complementary and Alternative Medicine; NADA: National Acupuncture Detoxification Association; SPSS: Frequently used Evaluating Software for Statistical Analysis; CAMbrella: Mosaic-Word Originated form “CAM” and “Umbrella”, for Pan-European Project on CAM, international research for 31 countries in EU, 2010-2013, Frame Work 7, European Union Tender; CME: Continuous Medical Education (credit); CEP: Continuous Education Point (credit); UV: Ultraviolet

Introduction- background

The study was completed in Hungary (country situated on eastern part of Europe). Homeopathy being one amongst so called complex systems sorted in CAM therapies. Our aim was to investigate different attitudes of health care professionals using this therapy including their opinion on usage, education level, indication for usage, study they participated in past.

The comprehensive CAM legislation came into force on 1 July 1997. The Act CLIV of 1997 on Health Care institutionalized the “National health care promotion program” with the principles “health for all” and “equal access to health care services” [1]. The Act on Health, the Governmental Decree on CAM [1,2] and the Decree of the Ministry of Social Welfare on the practice of CAM [1,2] confirm a definition of CAM treatment, regulate the scope of CAM treatments, and state that “non-conventional procedures that substitute conventional therapy shall only be applied under the supervision of a physician”. The non-medical practitioners have to be officially registered members of the public health system. The recent Hungarian CAM law is under reconstruction by the Ministry of Health and the revised version is expected to come out in the last months of 2014 to be more rigorous. Hungary follows the tradition of detailed regulation of practitioners and treatments; consequently each CAM treatment has been included in the public health system and legislation with regulation of education, licenses, authorization etc. [3]. Act XXVIII of 1994 made membership of the Hungarian Medical Chamber compulsory for practicing physicians and dentists. The Chamber of Non-medical Health Professionals (2003/13) was established to extend professional self-regulation to other qualified health care workers. The Chambers are responsible for the follow-up of CAM regulations. There are three categories of authorized medical practitioners in Hungary; physicians, practitioners with a non-academic higher health qualification and other practitioners. In 2011 a wide range of CAM treatments were regulated in detail and most medical universities and schools offer training courses. Only physicians are allowed to practice acupuncture, anthroposophy medicine, Ayurveda medicine, chiropractic, homeopathy, manual medicine, Traditional Chinese Medicine (TCM), Traditional Tibetan Medicine and Kneipp practices. Acupressure, kinesiology, shiatsu (in complementary moving and massage therapies), phytotherapy and reflexology may be provided by practitioners (non- medical doctors). The University of Pécs is the unique CAM educational institution for medical doctors in Hungary. All providers of CAM in Hungary must take a 2-year education in CAM and pass a license exam. Medical doctors are offered continuing medical education (CME) mostly at universities; non-MD practitioners take courses mostly at the Institute of Continuing Education for health workers in registered evaluated courses. Use of Homeopathy: Only medical doctors may practice homeopathy in Hungary. The “Magyar Homeopata Orvosi Egyesület” (Hungarian Homeopathic Medical Association) was founded in 1991).

Materials and Methods

The works described in this article have been carried out in accordance with The Code of Ethics of the World Medical Association (Declaration of Helsinki) for experiments involving humans.

We composed a special questionnaire (Homeo-CAMQ), sharing in more province in Hungary among health care providers (nurses) and collecting answers finally we made a statistical analysis for data forming recent data on usage of homeopathy. Criteria definition of Homeo-CAMQ was the following: trial type was exploratory, descriptive, cross-sectional and qualitative. Our target groups were the follows: Health Care employees: GPs, pharmacists, pharmaceutical assistants, nurses. The Qualification criteria were the selection of healthcare employees was carried out using layered sampling, the further selection was done by random sampling. Exclusion criteria were: missing medical qualification. Sampling process was: amongst leading health visitors, pharmacists, chief physicians of the counties-provincial (10 of 18) were requested to participate in the sampling survey.

Sample quantity definition

The originally planned sample quantity was 550 from which 544 Homeo-CAMQs have been distributed, processed and assessed. Within this study we are trying to set a comparison to a survey carried out in 2011 which studied laymen, people buying homeopathic substances in pharmacies with the sample quantity n=386. The survey was carried out in 10 counties (Heves, Nógrád, Borsod-Abaúj-Zemplén, Hajdú, Jász-Nagykun-Szolnok, Békés by doctors, health visitors, pharmacists, pharmaceutical assistants at pharmacies and doctors’ offices. Survey duration: The survey lasted 5 months: June – October of 2012.

Contains of Homeo-CAMQ: For the data gathering a self-composed survey was used. An anonym, self-filling survey method was chosen. The questionnaire contained 21 questions, which were multiple choice, half-closed, ranking (Likert), evaluating, index- and scale type and focused mainly on the opinion of the subject. During the definition of the types of questions asked the following considerations were made: topic of the survey, particularities of healthcare employees and the planned processing and analyzing methods. Using the questionnaire we gathered following types of information:

a. Socio-demographic data (age, highest degree of education, pharmaceutical purchasing habits, usage of pharmaceuticals)

b. cognition (definitions, rules)

c. health-disease behavior study (pharmaceuticals used for acute and chronic diseases)

d. attitude questions (opinions, attitudes, feelings, explanations, beliefs, satisfaction)

Definition of studied variables pending variables: Purchased homeopathic medicine and its characteristics (price, way of purchase) subjective medical effect, homeopathic knowledge, sources of knowledge, independent variables: sociodemographic data, usage of homeopathic medicine, qualification of healthcare employees

Methods of statistical analysis

Software used: Microsoft Word for gathering the data, SPSS v. 18 for processing and Microsoft Excel for creating tables and diagrams. The following statistical methods and tests are included in this article: base-frequency, partial correlation, cross-table analysis, chi square test. During the statistical analysis a significance level of p<0.05 was used.

Results

The results of the primary study conclude that the distribution of healthcare employees by sex is as previously expected, 536 (98.9%) women and 6 (1.1%) men completed the questionnaire. Main age of the subjects: 49 years. Study range: the youngest subject was a woman from Budapest born in 1990 (22 years of age), while the oldest subject was a health visitor born in 1940 (62 years of age).

The oldest healthcare employees were found in county Nógrád where the main year of birth was 1966 (46 years of age, n=66), while the youngest were found in county Szabolcs-Szátmár-Bereg with the mean year of birth 1972 (40 years of age, n=18). According to the hypothesis of knowledge about homeopathic methods the younger age groups (25-40 years) were aware of homeopathic methods, according to the data however it can be concluded that the 5-10 years older age group is also familiar with it. The following results are displayed using the circle diagram (Figure 1) below.

alternative-integrative-Health-Care-providers

Figure 1: Data of birth of Health Care providers (n=544)

Counties found the most active subjects in Budapest (n=81). In the capital 81 questionnaires were completed, but the healthcare employees in county Pest were very cooperative as well (n=71). The distribution between the capital and the counties is displayed by the diagram (Figure 2) below.

alternative-integrative-provinces-Hungary

Figure 2: Responsers in different provinces of Hungary (n=544)

We concluded the following results by highest degree of the subjects: 58% (n=310) have an academic degree or higher (university). Within the category “other” we have experienced a variety of other types of health care qualifications: psychologist, nurse, social caretaker, laboratory assistant, masseur, physiotherapeutic assistant, etc. (Figure 3).

alternative-integrative-Distribution-according

Figure 3: Distribution according qualification degree (n=544)

99.8% (n=543) of the healthcare employees completing the questionnaire have already heard of the method, only one woman from county Nógrád did not know homeopathy. According to the answers almost half of the subjects (48%, n=266) received the knowledge by postgraduate courses, 30 % (n=163) from medical literature and only 67 – which amounts to 12 percent - claimed to have received their knowledge from the press. Nurses for children have formed a big group (Figure 4).

alternative-integrative-Homeopathy

Figure 4: Where do you have got knowledge on Homeopathy from?

The above 4th figure shows that 83% (n=449) of the subjects does have a book on homeopathy in possession while 17 percent does not possess such literature. It is remarkable that a very high percentage (94.5%, n=514) of the subjects has already used homeopathic medicine while 30 of them (6%, n=30) have claimed not having used any. Within the acute diseases the first places were taken by illnesses presenting symptoms of the cold and influenza. Two thirds (70.6%, n=489) of the subjects have marked an illness presenting with these symptoms in their answers.

Homeopathy as a method of treatment was most often used against coughing (n=265) and for increasing milk production (n=167). Concerning acute diseases 55 of the 544 subjects (which amounts to 10.1%) have not answered this question. We need to mention that not all subjects having marked acute diseases (n=489) have not always marked chronic diseases (n=405) and vice versa, a sum of 84 subjects – 15%- have only marked either acute or chronic diseases (Figure 5).

alternative-integrative-homeopathic-remedy

Figure 5: Usage of homeopathic remedy in acute problems (y axis: number of answering health care professionals)

Within chronic diseases 25,75% of the subjects has not named any disease. The other 405 have named 822 answers. This averaged two naming’s. The patients have mostly used homeopathic medicine for allergies, stress and symptoms of joint problems (Figure 6).

alternative-integrative-number-answering-professionals

Figure 6: Homeopathic remedies usage for different problem (y axis: number of answering professionals)

We have also asked questions regarding the usage of pharmaceuticals concerning treatment of both acute and chronic diseases. In both cases the subjects could choose on a scale of five where the meaning of the lowest value was: “I have experienced no change whatsoever” and the highest value meant: “I have soon experienced the effect and felt a definitive improvement, were healed”.

While evaluating the answers concerning cases of acute illness we have found that 85,8% (n=415) have given the evaluation excellent or good. Average: 4.15 (Figure 7).

alternative-integrative-Satisfaction-homeopathy

Figure 7: Satisfaction with homeopathy in acute cases (n=484) (y axis: number of answering professionals)

The result is intriguing even if we assume some degree of the placebo effect in some of these cases. Based on these answers a serious re-thinking of opinion towards homeopathic treatment should be concluded involving their stronger recommendation to patients for their own good.

In the usage of homeopathic medicine for chronic diseases 74,4% of the subject have given good or excellent evaluation. The average was 3,94 (Figure 8). Only 6 subjects who have marked chronic diseases for which they used homeopathic medicine have not given an answer to its results.

alternative-integrative-feeling-chronic-cases

Figure 8: Satisfaction feeling in chronic cases (y axis: number of answering professionals)

Aside of the positive effects of the medication we also asked about eventual side effects. 95,3% (n=482) of the subject has not noticed any unwanted side effects (Figure 10). The other 24 who represent 5 percent of the subjects mainly mentioned the following effects: “allergic to sugar of milk”, “symptoms have increased in intensity”.

alternative-integrative-chronic-problems

Figure 9: Comparing effect in acute and chronic problems.

alternative-integrative-experienced-any-side

Figure 10: Have you experienced any side effect in homeopathy?

It is a well-known occurrence in related medicine that the patients’ symptoms may increase in intensity temporarily. This is explained to the patient by the homeopath, furthermore this is described as a warning in the usage recommendation of homeopathic complexes. The unwanted effects of homeopathic substances are – according to the received answers – minimal, compared for example with the side-effects of non-steroidal anti-inflammatory drugs, drugs containing herbal agents or prescription-free substances available at pharmacies - used for similar indications. The preference list (Figure 11) in medical treatment of the sampled health care employees was the following:

alternative-integrative-homeopathy-health-care-providers

Figure 11: Used forms in homeopathy by health care providers (y axis: number of answering professionals)

The 520 subjects who answered the question could name multiple forms of medication – used and tested by them. This amounted to a total of 1359 naming’s with an average of 2,61. 22 of them gave no answer to the question, which is 4%.

83% of the ones answering the question have no problems taking the medication (Figure 12). 89 of the subjects had difficulties with following the recommendations of taking the medicine. They gave the following answers to this half-closed question: “I smoke”, “I forget to take it”, “menthol, chewing gum”, “I forget it during work”.

alternative-integrative-any-difficulties-taking

Figure 12: Was any difficulties with taking homeopathic remedies- (according taking-law)? (n=516)

The above circle diagram (Figure 13) shows that 98% of the subjects would welcome the therapy every day, 8 subjects would not welcome this one person gave no answer. Those who “do not want the solid therapy to become general” unfortunately gave no further explanation. Those who would welcome homeopathy to become general and gave further explanations gave the following common reasons: natural, free of chemicals, does not harm the intestinal flora, humane, easy on antibiotics, free of side-effects, easy to use, organism-friendly, quick and easy, especially important when treating children, the best medicine from an ecological point of view. A further question was: concerning the profession of healthcare, which medical fields could you put homeopathy in? The next 14th Figure talks on medical professions, which should to be built Homeopathy in:

alternative-integrative-introduce-common-usage

Figure 13: Do you suggest to introduce in common usage homeopathy? (n=528)

The graph shows quite well that the subjects mostly see the role of the solid treatment within the base-services in health care, but more than half of them would also apply it within obstetrics and gynecology. The 524 subjects who gave answers provided 1773 nominations. Average nominations per subject: 3.38. 20 gave no answer.

A further question was whether patients already enquired about the treatment method by the health care professional. The results to this question show that in 66% of the subjects there already have been enquiries. Also two thirds of the answering subjects have already participated in postgraduate courses in the field of homeopathy (Table 1).

  Frequency % Real % Cumulative %
  yes 508 93% 97,1 97,1
no 15 3% 2,9 100,0
total 523 96,1 100,0  
Missing values 99 21 3,9    
Totally 544 100,0    

Table 1: Would you like to participate on homeopathy courses?

The above 15th Figure shows answers to the question if nurses would like to participate. 93% of the subjects would like to participate in homeopathy courses while only 3 percent would not. We think the high proportion of positive answers could be an indication to the open mindedness of the subjects, the popularity of the healing method, changes in attitude. After analyzing the answers received regarding the solid therapy we can conclude that this field of complementary medicine divides the trade. The subjects selected 1 for “absolutely not recognized” and 10 for “absolutely recognized”. The diagram (Figure 15) below shows that only 0,2% (n=1) of the subjects thinks this method is absolutely not recognized. More than half of the subjects (57%) evaluated the method at a value of 5-moderately recognized-or higher. The average was 4,9, which concludes that healthcare professionals evaluate the recognition of homeopathy as moderate. The above results are shown by the diagram below on scale 1-9 (Figure 16).

alternative-integrative-Medical-professions

Figure 14: Medical professions for homeopathy could be built in (y axis: number of answering professionals)

alternative-integrative-regarding-homeopathy

Figure 15: Would you like to participate on any further courses regarding homeopathy?

alternative-integrative-believing-acceptance

Figure 16: Scale from 1-9 believing of acceptance according homeopathy, (1: not accepted totally, 9: well accepted totally.) (y axis: number of answering professionals)

Around half (49.2%) of the subjects purchasing pharmaceuticals found the price of these substances similar to other medicine. The other half (47.1%) found these substances cheaper than other medicine. Only 19 persons, which are 3.7 percent of the ones who gave an answer, found these substances more expensive than other OTC medicine. 24 subjects (4%) did not provide an answer to the question (Figure 17).

alternative-integrative-health-care-providers

Figure 17: Price of homeopathic remedies according to opinion of health care providers (N=518)

In 33% of the cases they never had any difficulties acquiring the medicine, in 40% there is no difficulty anymore since they know where to purchase them now. 90 (16.5%) subjects could acquire the medicine after one day, while 6 (1,1%) of them could only get the medicine within a few weeks. This can be explained by the fact that in cases of some rare constitutional (chronic) diseases even the pharmacist faces difficulties acquiring the homeopathic remedy which might have to be imported privately from abroad, while other more often used homeopathic remedies can be kept in stock within the pharmacy. 18th figure shows a summary on legislation of homeopathy in EU.

Conclusion

Homeopathy is sorted to “whole medical systems” that originated in German, widely officially used in Hungary (1.17). The fundamental idea of homeopathy is the “Similarity Principle”, which implies that remedies capable of causing disorder in healthy subjects are used as medicines to treat similar patterns of disorder experienced by ill people [4,5]. Homeopathic medicines are aimed to direct and stimulate the body’s self-regulatory mechanisms. Homeopathy is highly individualized while taking into account the symptoms and signs of the disease, patient’s physical attributes, personality, temperament and genetic predispositions. Apart from homeopathic medication, advice on change of lifestyle, diet and remedies abuse behaviors, acquisition of stress-reduction techniques and exercise are part of the package of care provided by the nurses working close together in praxis. Number of patients and medical, paramedical employers tend to use homeopathy as in Europe, as in Hungary [4-11].

Discussion

According to increasing demand of patient and nurses, doctors, homeopathy is accepted in Hungary by health care providers as an additional part of health care profession in spite of negative attitude of academic medicine schools [1-3]. The health care professionals in Budapest -being the capital of Hungary- are more interested and involved in newer complementary therapies, they visited more frequently on courses jointed to topic and introduced knowledge sooner into daily use.

The unified “education-teaching system-control” is necessary to achieve safety of patients who wanted to be cured with homeopathy [3]. It is necessary to organize further education for nurses at Health Science Faculties of Universities. They have a closer connection to patients in their daily practice. The demand for CAM therapies is getting larger by patients. This generates more interest by the following practitioners. This recent situation according to international trends in EU has a similarity in Hungary too [12]. Additionally we recognized some negative attitudes of medical universities for introducing of Homeopathy into medical curriculums of medical students with arguments of skeptical opinions.

To summarize the recent situation in the European Union in relation of Homeopathy and university: Postgraduate training courses in homeopathy for doctors are provided at universities in Bulgaria, France, Germany (five universities), Greece (some universities), Italy (one university), Lithuania, Poland (eight universities), Romania (eight universities) and Spain (three universities), in other countries at private teaching centers only, but the final exam after the courses is provided in Hungary et University Pécs, CAM Department (one only in Hungary) [12-14]. Homeopathy is an official part of the Continuous Education Program for doctors in Hungary and Romania. CAM has, however, not been given a similar degree of attention despite its widespread and advised use [8]. A lectureship specifically for homeopathy exists only in the Netherlands (Amsterdam), a professorial chair of CAM including homeopathy in Hungary (Pécs) and Switzerland (Bern) [15].

Despite of recent bad economic situation in Europe (and Hungary), (it means there is no reimbursement by state insurance) health care professional nurses use homeopathy more frequently. Furthermore, they have more knowledge and homeopathy has implanted into their daily practice in the last two decades [4,5,16].

According to old proverb: “What you cannot arrest, you should lead…”, we propose scientific explanation, more research on effectiveness and efficacy in the frame of University. Further advice is to address organizers additional Homeopathic courses for nurses as a part of obligatory further education, which could be useful for ethical application for shake of patient’ safety they want to use homeopathic remedies [17,18]. Health care professionals meet patients frequently giving them “life style advises” including not only use of medicaments, they should know indications and contraindications of different natural healing methods like Homeopathy.

It seems to be useful application of CAM therapies like homeopathy because easy medication of antibiotics became less for unnecessary reason (“preventive”) in pediatric profession where practitioner was educated in Homeopathy too.

Declaration: There is no conflict of interest of any authors, (including pharmaceutical companies existing in Europe, Hungary)

Supplement

The CAM Department of the University of Pécs (established 1367) provides education, controls and exams. Studies are offered for MDs only, and the following treatments are examples of courses provided: acupuncture, TCM, manual medicine (chiropractic, osteopathy), neural therapy, anthroposophy medicine, life-style adviser. Courses at other educational institutions offer studies for non-medical professionals (= natural healers, additionally part of the health care system) for courses like acupressure, reflexology, NADA (detoxification), eye training, herbal medicine, kinesiology, complementary moving and massage therapies, complementary physiotherapies (Kneipp courses, electro, magneto, UV e.t. practice) [1-3]. Health care practitioners (non-medical educated practitioners: nurses and natural healers) may offer CAM treatments like; acupressure, reflexology, NADA (special acupuncture techniques of detoxification), eye training, herbal medicine, kinesiology, complementary moving and massage therapies, complementary physiotherapies (Kneipp courses, electro, magneto, UV e.t.) practice after state exam [1-3]. National CAM legislation regulates health products and the use, practice and education of CAM (Homeopathic remedies are regulated by the pharmaceutical law). However, CAM non-medical practitioners (herbalist, many non-MDs, and acupressure therapist and others) are not regulated by the state. The Provincial and Territorial Government Agency regulates and controls regional health care practitioners. This public health system constitutes a heterogeneous regulation system in Hungary and challenges the CAM legislation. Legislative review and re-organization in several provinces have resulted in the establishment of permanent mechanisms for regulation of CAM practitioners including possible statutory self-regulation as health care practitioners in the future. The governmental supervision of CAM Practices: The national government of Hungary exercise statutory supervision of health services, including the Health Insurance Fund (HIF). The National CAM Supervisor Committee has the right to control and punish. Regulated CAM providers are included in the governmental supervisor Head Physician-system [1-3]. The University of PéCS (Faculty of Health Science, CAM Department) offers a 3-year educational program for homeopathy with CME, CEP points only for medical doctors. Homeopaths have to be registered in a statutory register for legal practice. Pharmacists can be involved into courses without personal practice [19-22].

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