To our knowledge, this was the first study assessing patient characteristics including health behavior and consultation patterns of patients consulting HPs in comparison to patients consulting GPs in Germany. We found similarities but also a series of relevant differences between patients cared for by the two GP groups (with low and high use of CAM) and patients of HPs. Significantly more women and patients with psychological problems consult HPs compared to GPs. Furthermore, patients seeing HPs seemed to have more favorable health behavior. Among HP patients, we found a considerably higher proportion of patients with long term complaints. Altogether, our results indicate that characteristics and consultation patterns of HP patients are different from those of GP patients, and GPs providing CAM seem to have an “in-between status”.
Our results are in alignment with studies from the UK, which have shown that a large number of patients consulting CAM practitioners have musculoskeletal problems [13, 19]. Our results clearly show that this was a main symptom among HP patients as a typical reason for encounter within primary health care. The only differences found across the three practitioner groups were for psychological problems and respiratory diseases. A simple explanation for the latter might be that HPs are not allowed to provide medical certificates for sick leave for patients. One of the most frequent reasons for acute consultations in German GP practices and for medical certificates for sick leave are respiratory complaints as symptoms of cold [20].
HPs were considerably more frequently consulted for long-term problems compared to GPs, a circumstance that has already been shown by Paterson two decades ago [13]. The higher percentage of HP patients with long-term diseases might be due to dissatisfaction with GP care in the course of the disease. Or maybe HPs are seen as a “last resort” when patients fail to recognize improvements with the orthodox approach offered by physicians. Still, the self-reported severity of the symptoms did not differ between patients cared for by HPs or GPs. Additionally, HP patients more often consulted other physicians and HPs and might be especially frequent users of health care services.
The high percentage of psychological symptoms among the HP patient group was surprising. Reasons may be that patients consulting a HP hope for more time to talk about their problems at “eye-level” or fear of getting a stigmatizing diagnosis when they go to a physician. In one review, we found a high usage of CAM among patients with depressive disorders was described [21].
In Germany, patients with all kinds of symptoms may consult a general practitioner. In our study, GPs offering CAM therapies and HPs did not differ with respect to the broad spectrum of therapies offered, although GPs more often provided evidence-based methods like acupuncture and herbalism, which are covered by statutory health insurance. To elaborate on reasons why patients go to one provider or another who offers the same intervention, studies with a qualitative approach are needed.
Previous studies have been inconsistent with regard to gender: while the higher probability that women use CAM is well known and described in several studies [22–24], in the study of Paterson [13] gender and age did not differ significantly between patients consulting CAM practitioners and physicians. In our study, the gender distribution on the patient side is mirrored in the professional side: more female health practitioners also offer CAM (either as HPs or CAM-GPs).
Contrary to the findings of a large German study of acupuncture users among internal medicine patients [25], our patients using CAM did not differ in age from non-CAM users, whereas the percentage of current smokers was also highest in patients of nCAM-GPs; the HP patients in our study were less often currently smoking and more physically active. The observed positive relationship between CAM use and health behavior was also shown in a study with childhood cancer survivors [26]. The relationship between higher education and higher CAM use was also described in an international review [23] and in a population-based German study [27], although the relationship was weaker in the patients of our study.
Limitations
Although our study has gathered exploratory information about consulting patterns and wishes of patients, the different methods of data collection in GP and HP practices might have influenced the results. However, there were only a few questions asking for a subjective judgment of the patients, most questions were related to quantifiable aspects.
Additionally, the participation rates of GPs, HPs, and their patients were generally lower than expected. Due to logistic reasons, we were not able to recruit more participants. Nevertheless, this was the first study assessing patients in the setting of the HP practice.