Cost analysis in a traditional, complementary and integrative medicine unit in Brazil / Análise de custos em unidade de medicina tradicional, complementar e integrativa no Brasil

ABSTRACT OBJECTIVE To analyze the costs of a specialized service in Traditional Complementary and Integrative Medicines (TCIM) in Northeast Brazil to provide data on the cost linked to the implementation and maintenance of services of this nature and to identify the average cost per user for the Unified Health System. METHODS This is a partial, descriptive, quantitative economic assessment, which used secondary data, later grouped in Microsoft Excel spreadsheets. The method used to analyze such costs was absorption costing, from which the service was divided into three costing centers: productive, administrative and auxiliary. RESULTS After analyzing the data, the total cost of the service in 2014 was estimated at R$ 1,270,015.70, with a proportion of 79.69% of direct costs. The average cost per user in this period was R$ 36.79, considering the total of 34,521 users in individual and collective practices. CONCLUSIONS The service has a cost per user compatible with a specialized service; however, TCIM offers a comprehensive and holistic approach, which can have a positive impact on quality of life.

RESUMO OBJETIVO Analisar os custos de um serviço especializado em Medicinas Tradicionais Complementares e Integrativas (MTCI) no Nordeste brasileiro, com o intuito de fornecer dados sobre o custo atrelado à implantação e manutenção de serviços dessa natureza e identificar o custo médio por usuário para o Sistema Único de Saúde. MÉTODOS Trata-se de uma avaliação econômica do tipo parcial, com caráter descritivo, de natureza quantitativa, que utilizou dados secundários, posteriormente agrupados em planilhas do Microsoft Excel. O método utilizado para analisar tais custos foi o de custeio por absorção, a partir do qual o serviço foi dividido em três centros de custeio: produtivo, administrativo e auxiliar. RESULTADOS Após a análise dos dados, o custo total do serviço em 2014 foi estimado em R$ 1.270.015,70, com proporção de 79,69% de custos diretos. O custo médio por usuário neste período foi R$ 36,79, considerando o total de 34.521 usuários em práticas individuais e coletivas. CONCLUSÕES O serviço apresenta um custo por usuário compatível com um serviço especializado, contudo, as MTCI oferecem abordagem compreensiva e holística, as quais podem impactar de forma positiva a qualidade de vida.

Uso de medicina alternativa y su relación con el nivel socioeconómico, el estado de salud del paciente y el nivel de satisfacción de la medicina convencional en pacientes que acuden a consultorio externo de medicina general del Hospital II ESSALUD Huánuco durante el período de agosto a octubre del 2015 / Use of alternative medicine and its relationship with the socioeconomic level, the health status of the patient and the level of satisfaction of conventional medicine in patients who attend the outpatient clinic of general medicine of Hospital II ESSALUD Huánuco during the period from August to October. 2015

La presente investigación tiene por objetivo: Determinar la prevalencia del uso de medicina alternativa y su relación con el nivel socioeconómico, el estado de salud del paciente y el nivel de satisfacción de la medicina convencional en pacientes que acuden a consultorio externo de Medicina General del Hospital II EsSalud Huánuco, 2015. Diseño: Se realizó un estudio observacional, transversal, retrospectivo, en pacientes que acuden a consultorio externo de Medicina General del Hospital II EsSalud Huánuco en el 2015; para determinar los factores relacionados al uso de medicina alternativa, los datos se obtuvieron a partir de entrevistas. Se contó con una muestra de 278 sujetos, obtenida mediante muestreo probabilístico aleatorio simple para estudios descriptivos transversales. Se estableció asociación estadística (p<0,05) con Chi2 para variables cualitativas. Resultados: La prevalencia del Uso de Medicina Alternativa en pacientes de consultorio externo fue 255 (91,7%). Entre las características clínicas se encontró 226 pacientes (81,3%) con nivel socioeconómico bajo, los problemas de salud más frecuentes fueron los problemas gastrointestinales 139 (50%) y problemas musculo esqueléticos 113 (40,6%). El nivel de satisfacción de la mayoría de pacientes fue baja 95 (34,2%), seguida de moderada 94 (33,8%) y alta 89 (32,0%). En el análisis bivariado de las variables en estudio de los pacientes participantes que usan o no medicina alternativa no se encontró asociaciones estadísticamente significativas (p>0,05). Conclusiones: La prevalencia del Uso de Medicina Alternativa en pacientes de consultorio externo fue 255 (91,7%). No se halló asociaciones estadísticamente significativas entre el uso de medicina alternativa y las variables nivel socioeconómico, el estado de salud del paciente y el nivel de satisfacción de la medicina convencional.

Una aproximación a la medicina complementaria y alternativa en el contexto de su desarrollo como industria en el Perú / An approximation to the complementary and alternative medicine in the context of its development as an industry in Peru

La presente revisión, busca enfatizar y poner en foco la importancia de un esfuerzo coordinado para desarrollar la Medicina Complementaria y Alternativa (CAM en inglés) en el Perú en la próxima década, señalando que se requiere analizar también el entorno económico en función a la demanda real y las ventajas diferenciales que lo integran en la matriz de la industria de la salud, a fin de reafirmar las variables críticas para su desarrollo y sostenibilidad futura. También, se advierte la importancia de una sólida ejecución de investigación clínica en Medicina Complementaria y Alternativa, por ser transversal entre los varios objetivos de consolidación, así como el compromiso de la academia, la industria y los órganos de decisión en relación a un adecuado marco normativo, para facilitar la materialización de una visión compatible al liderazgo sustantivo del Perú en la región.

Prevalence of the use of homeopathy by the population of Montes Claros, Minas Gerais, Brazil / Prevalência do uso da homeopatia pela população da cidade de Montes Claros, Minas Gerais, Brasil

CONTEXT AND OBJECTIVE: Homeopathy is a therapeutic system that uses small doses of substances to stimulate autoregulatory and self-healing processes. The aim of this study was to investigate the prevalence of the use of homeopathy by the population of Montes Claros, Brazil, and the socioeconomic profile of users. DESIGN AND SETTING: Probabilistic cross-sectional study with cluster sampling, in the city of Montes Claros, Minas Gerais. METHODS: This study was conducted by applying semi-structured questionnaires. The sample was composed of 3,080 people. For the statistical analysis, Student's t test and the chi-square test were used. The statistical significance level used was P < 0.05. RESULTS: We interviewed 3,090 people. The prevalence of the use of homeopathy was 2.4 percent. The factors associated with its use were female gender, schooling and income. The main reason that led to seeking homeopathy was "Conventional treatment did not have any effect". For 70.2 percent of the users, the cost of the treatment was considered reasonable or cheap. About 73 percent were satisfied or very satisfied with the treatment received through homeopathy. CONCLUSIONS: The prevalence of the use of homeopathy found here was less than that reported in other countries. People with higher income and schooling levels used homeopathy more frequently. There was higher prevalence among women. Most users declared themselves satisfied with the treatment received.

CONTEXTO E OBJETIVO: A homeopatia é um sistema terapêutico que utiliza pequenas doses de substâncias para estimular processos de autocura e autorregulação. O objetivo deste estudo foi verificar a prevalência de utilização da homeopatia pela população de Montes Claros e o perfil socioeconômico do usuário. TIPO DE ESTUDO E LOCAL: Estudo transversal, probabilístico, por conglomerados, na cidade de Montes Claros, Minas Gerais. MÉTODOS: Estudo realizado por meio da aplicação de questionários semi-estruturados. A amostra foi composta por 3.080 pessoas. Na análise estatística, utilizou-se o teste t de Student e o teste do Qui-quadrado. A significância estatística considerada foi P < 0,05. RESULTADOS: Foram entrevistadas 3.090 pessoas. A prevalência de utilização da homeopatia foi de 2,4 por cento. Os fatores associados à utilização foram: gênero feminino, escolaridade e renda. O principal motivo que levou a procura da homeopatia foi "o tratamento convencional não surtiu efeito". Para 70,2 por cento dos usuários o custo do tratamento foi considerado suportável ou barato. Cerca de 73 por cento ficaram satisfeitos ou muito satisfeitos com o tratamento recebido na homeopatia. CONCLUSÕES: A prevalência de uso de homeopatia encontrada ficou aquém da relatada em outros países. Pessoas com melhores níveis de renda e escolaridade utilizam homeopatia com maior frequência, assim como as mulheres. A maioria dos usuários declarou-se satisfeito com o tratamento recebido.

The Use of Complementary and Alternative Medicine in a General Population in South Korea: Results from a National Survey in 2006

The purpose of this survey was to obtain information on the prevalence, costs, and patterns of use of complementary and alternative medicine (CAM) in a general population in the Republic of Korea. In 2006, we conducted nationwide and population- weighted personal interviews with 6,021 adults ranging from 30 to 69 yr of age; the final sample consisted of 3,000 people with a 49.8% response rate. In addition to their general socio-demographics, the respondents were asked about their use of CAM during the previous 12-month period, costs, sources of information, and reasons for use. The prevalence of use overall was 74.8%, while biologically based CAM therapies were the most likely type of use (65.4%). The median annual out-of-pocket expenditures for CAM therapies was about US$203. The primary reason for using CAM was for disease prevention and health promotion (78.8%). The main source of advice about CAM therapies use was most likely to be from family and friends (66.9%). Our study suggests that CAM use has been and continues to be very popular in South Korea. Conventional western medical doctors and governments should obtain more evidence and become more interested in CAM therapies.

use of complementary/alternative medicine among the general population in Tehran, Iran

This study was conducted to assess the prevalence of CAM use in Tehran, Iran. This cross sectional study was carried out on 6148 citizens of Tehran by cluster sampling. A questionnaires which were tested for validity and reliability in a pilot study, was used to collect data. The prevalence of use, number of methods, the costs and type of diseases were asked. Prayer[94.7%], herbal remedies [94.5%], Hajamat [90.8%] and Hydrotherapy [86.9%] were the most familiar and chiropractic [4.3%], pressure therapy [6.2%], homeopathy [10.3%] were the most unfamiliar reported methods by the study sample. Also, herbal remedies [54.6%] and prayer [24.2%] were the most prevalent and pressure therapy [0.3%], chiropractic [0.4%] and hypnotism [0.5%0 were the least prevalent methods were using by people. The supreme satisfaction was in yuga/meditation, traditional medicine and hydrotherapy. The most common reasons of selection of the CAM methods were successful past experiences of CAM, no response to conventional medicine and lower side effects of CAM. The most chief complaints were gastric and abdominal pain or discomfort, anxiety and other psychological disorders, cough and dyspnea. Peppermint [45.5%], borage [golgavzaban] [24.6%], chartokhmeh [7.9%] and oregano [avishan] [5.9%] were the most common plants have been used. Blood clotting disorders,low back pain and other musculoskeletal disorders, cutaneous disorders in hejamat and headache, musculoskeletal disorders and neuropsychological disorders in other CAM methods were the most common reason to apply. About half of the citizens in Tehran use at least one method of CAM at 1 year before the study. Prayer and herbal remedies were the most common methods have been applied. There is need to plan educational programs for people and train some experts in CAM to use and practice CAM in a more safer and effective way

Usage of and cost of complementary/alternative medicine in diabetic patients.

The purposes of the present survey research in diabetic patients were 1) to determine characteristics of complementary/alternative medicine (CAM) use, 2) to identify factors related to CAM use such as sociodemographic, adverse effects, and quality of life, and 3) to determine differences between patients who used and did not use CAM. The data was collected through developed questionnaires and SF-36 scale Thai version. Samples were 159 diabetes patients over 18 years of age or older who came for treatment at Suppasitthiprasong Hospital, Ubon Ratchathani Province, Thailand. The results indicated that the prevalence of CAM use was rather high (47.8%). The most common types of CAM used were yoga/exercise (32.8%), unchanged form of herbal medicine (29.9%), and changed form herbal medicine (17.8%). The average expense of CAM use was dollar 8.58 per person per month. Thus, if the percentage of CAM use and the cost were true for other Thai diabetic patients throughout Thailand, CAM use expenditure for the whole country would be about dollar 915,250-1,545,750 per month, which is quite high for a small country like Thailand. Most patients (64.4%) who used CAM did not inform their doctors about their CAM use. Results also indicated that government official patients were more likely to use CAM than those of farmer patients significantly (p-value = 0.03, odds ratio = 12.11). In addition, the present study found that patients who had a higher income were more likely to use CAM than those of lower income patients significantly (p - value = 0.04, odds ratio = 1.01). However, other factors such as age, sex, marital status, level of education, health insurance coverage status, duration of time to treat, occurrence of adverse effects, and quality of life were not different between the patients who used CAM and who did not use CAM. Physicians should pay more attention to the CAM use of patients since they used CAM without informing physicians and some herbal medicines may cause hypoglycemia. However, the study results had some limitations to apply to other Thai populations since the sample were Suppasitthiprasong patients who may be different from other Thai populations in many ways such as their local culture, belief, and CAM use types and cost.

Use of Complementary and Alternative Medicine among Korean Cancer Patients

BACKGROUND: Complementary and alternative medicine (CAM) is now being increasingly used among cancer patients. The objectives of our study were to assess the prevalence, types, cost, subjective effects, and side effects of CAM use, reasons for CAM use, characteristics of CAM users compared to those of nonusers, and patients' expectations of doctors regarding their CAM use among Korean cancer patients at a single cancer center. METHODS: From April to August, 2003, we interviewed 186 cancer patients hospitalized in the Korea Cancer Center Hospital using a structured questionnaire, and analyzed the data. RESULTS: 78.5% of experimental subjects (146 patients) had been treated with at least one type of CAM, in addition to conventional Western treatment, with a mean monthly cost of 1, 380, 000 Won/person (approximately, 1, 100 U.S. dollars on July, 2004). The most prevalent types of CAM used by these patients included medicinal mushrooms (67.1%), herbs (54.1%), vegetable diets (50.6%), and ginseng (46.5%). The main reported reasons for the use of CAM in addition to conventional medicine were nutritional support (19.1%) and physical strengthening (17.8%). 5% of CAM users experienced side effects. The younger and more educated the patients were, the more likely they were to employ CAM. 66% of CAM users wanted to discuss CAM techniques with their doctors. CONCLUSION: More than two-thirds of cancer patients used various kinds of CAM, incurring considerable costs. Therefore, in order to help patients make informed decisions, medical society should be open to communication with patients. Not only the scientific aspects, but also the economic aspects of CAM usage should be examined more thoroughly, in order to ensure proper distribution of medical resources.

Alternative medicine: old ideas with new interests?

The use of complementary or alternative medicine has greatly increased in developed countries during the last few years. In such countries, laws have been passed and regulations made to protect both the public and the practitioners. There are a growing number of research units in universities, journals, and associations of practitioners of complementary medicine. In Jamaica, too, there is increasing recognition, if not acceptance, of the popular interest in complementary medicine. In preparation for the next century we will need to address some of the legal, educational and scientific issues raised.