Patient-Assessed Chronic Illness Care (PACIC) scenario in an Indian homeopathic hospital.

Homeopathy research has focused on chronic conditions; however, the extent to which current homeopathic care is compliant with the Chronic Care Model (CCM) has been sparsely shown. As the Bengali Patient-Assessed Chronic Illness Care (PACIC)-20 was not available, the English questionnaire was translated and evaluated in a government homeopathic hospital in West Bengal, India. The translation was done in six steps, and approved by an expert committee. Face validity was tested by 15 people for comprehension. Test/retest reliability (reproducibility) was tested on 30 patients with chronic conditions. Internal consistency was tested in 377 patients suffering from various chronic conditions. The questionnaire showed acceptable test/retest reliability [intraclass correlation coefficient (ICC) 0.57-0.75; positive to strong positive correlations; p < 0.0001] for all domains and the total score, strong internal consistency (Cronbach's α = 0.86 overall and 0.65-0.82 for individual subscales), and large responsiveness (1.11). The overall mean score percentage seemed to be moderate at 69.5 ± 8.8%. Gender and presence of chronic conditions did not seem to vary significantly with PACIC-20 subscale scores (p > 0.05); however, monthly household income had a significant influence (p < 0.05) on the subscales except for "delivery system or practice design." Overall, chronic illness care appeared to be quite promising and CCM-compliant. The psychometric properties of the Bengali PACIC-20 were satisfactory, rendering it a valid and reliable instrument for assessing chronic illness care among the patients attending a homeopathic hospital.

A validation study of homeopathic prescribing and patient care indicators.

A preliminary version of the homeopathic prescribing and patient care indicators was available. The instrument was modified further in this study with an intention to address formally its validity and reliability, audit prescriptions, identify areas of sub-optimal prescribing, and highlight target areas for improving the quality of practices. A cross-sectional study with record analysis was conducted on systematically sampled 377 patients of Mahesh Bhattacharyya Homeopathic Medical College and Hospital (MBHMC and H), Howrah, West Bengal, India. The outcome measures were homeopathic prescribing indicators (6 items) and patient care indicators (5 items). Individualized homeopathic prescriptions predominated in the encounters. Areas demanding immediate attention were extremely poor labeling of drugs dispensed from the hospital pharmacy, improper record of case history and disease diagnosis, ongoing therapies, and investigational findings in the prescriptions. Internal consistency of the overall instrument was estimated to be good (Cronbach's alpha: Prescribing indicators 0.752 and patient care indicators 0.791). The prescribing indicators, except items 1 and 3, reflected acceptable item-corrected total correlations - Pearson's r from 0.58 (95% CI: 0.52-0.65) to 0.74 (95% CI: 0.69-0.78). The patient care indicators, except item 2, showed acceptable correlations - Pearson's r from 0.40 (95% CI: 0.31-0.48) to 0.82 (95% CI: 0.78-0.85). The instrument also showed high discriminant validity (prescribing indicators P < 0.0001 and patient care indicators P < 0.0001). Improper prescribing practice was quite rampant and corrective measures are warranted. The developed indicators appeared to be validated and reliable; however, they are amendable for further development.

Patient activation measures in a government homeopathic hospital in India.

The American Patient Activation Measure-22 questionnaire (PAM-22) quantifies the knowledge, skills, and confidence essential to manage own health and health care. It is a central concept in chronic illness care models, but studied sparsely in homeopathic hospitals. PAM-22 was translated into Bengali and a cross-sectional study was undertaken in chronically ill 417 patients visiting the outpatient clinic of Mahesh Bhattacharyya Homeopathic Medical College and Hospital, India. Response rate was 90.41%. Data were analyzed using Rasch rating scale model with Winsteps. Activation score was 54.7 ± 8.04 or 62.13% of maximum score. PAM scores differed significantly by age, education, income, and health status (P < .05). The items had good data quality fit statistics and good range of difficulty. The construct unidimensionality was confirmed by good model fits for Rasch model and principal component analysis of residuals found no meaning structure. The questionnaire showed acceptable psychometrics. Patient activation was moderate and needs to be improved.

Access to and utilization of the health services among the patients in a government homeopathic hospital in West Bengal, India: a cross-sectional study.

Accessibility to and utilization of the hospital health services is a complex and multifaceted issue. This study aimed to assess the knowledge of the patients of health services, current level of access to and utilization of services and to identify barriers and socioeconomic disparities in an Indian homeopathic hospital. A cross-sectional survey was conducted in December 2013 on systematically sampled 377 patients. Responses were analyzed using descriptive statistics and univariate logistic regression. Mean knowledge score and perceived mean difficulties in access to and utilization of services were 68.4% and 78.5%, respectively. Knowledge of the services was influenced by age, residence, education, speaking and reading of Bengali language, and income status (P < .05). Difficulty in access to and utilization of the health services were influenced by residence, understanding of Bengali language, and monthly household income (P < .05). Overall, health service access and utilization appeared promising, but needs improvement.

Understanding of biostatistics among the homeopathic fresh graduates and post-graduate trainees in West Bengal, India

Background: A basic understanding of biostatistics is essential, both for designing quality research and evaluating medical literature. We evaluated the understanding of biostatistics and interpretation of research results among homeopathic fresh graduates’ (House Staffs; HSs) and postgraduate trainees’ (PGTs) in West Bengal, India. Methods: A cross-sectional survey of homeopathic HSs and PGTs in the four government homeopathic schools in West Bengal, India, using a pre-tested, valid and reliable biostatistics multiple choice knowledge, confidence and attitude test questionnaire. Results: Internal consistency of the used questionnaires was acceptable (Cronbach’s á = 0.611 – 0.672). Response rate was only 55.6%. Research journal reading habit was seriously lacking. No one had ever taken any research courses or possessed any advanced degrees or diplomas. The overall mean% correct on statistical knowledge was very poor, 1.0% (95% CI 0.1 – 1.9%) vs. 10.0% (95% CI 8.6 – 11.6%) for HSs and PGTs (P < 0.0001). Comparatively, higher knowledge scores were found in respondents from Mahesh Bhattacharyya Homeopathic Medical College and Hospital (P = 0.003). No one could interpret an unadjusted odds ratio, Kaplan-Meier analysis results, and determine strength of evidence for risk factors. Percentages of correct answers for all other knowledge-based questions ranged between only 2.7 – 9.5%. Respondents’ self-assessed confidence in ability to understand biostatistics ranged between 41 – 60%. Positive attitude towards biostatistics was elicited in 16 – 63% respondents. Conclusions: The respondents seriously lacked knowledge in biostatistics needed to interpret research results. Training programs needs to undergo massive and immediate transformation to include more effective biostatistics training in curricula to encourage meaningful research.

Understanding of biostatistics among the homeopathic fresh graduates and post-graduate trainees in West Bengal, India

Background: A basic understanding of biostatistics is essential, both for designing quality research and evaluating medical literature. We evaluated the understanding of biostatistics and interpretation of research results among homeopathic fresh graduates’ (House Staffs; HSs) and postgraduate trainees’ (PGTs) in West Bengal, India. Methods: A cross-sectional survey of homeopathic HSs and PGTs in the four government homeopathic schools in West Bengal, India, using a pre-tested, valid and reliable biostatistics multiple choice knowledge, confidence and attitude test questionnaire. Results: Internal consistency of the used questionnaires was acceptable (Cronbach’s á = 0.611 – 0.672). Response rate was only 55.6%. Research journal reading habit was seriously lacking. No one had ever taken any research courses or possessed any advanced degrees or diplomas. The overall mean% correct on statistical knowledge was very poor, 1.0% (95% CI 0.1 – 1.9%) vs. 10.0% (95% CI 8.6 – 11.6%) for HSs and PGTs (P < 0.0001). Comparatively, higher knowledge scores were found in respondents from Mahesh Bhattacharyya Homeopathic Medical College and Hospital (P = 0.003). No one could interpret an unadjusted odds ratio, Kaplan-Meier analysis results, and determine strength of evidence for risk factors. Percentages of correct answers for all other knowledge-based questions ranged between only 2.7 – 9.5%. Respondents’ self-assessed confidence in ability to understand biostatistics ranged between 41 – 60%. Positive attitude towards biostatistics was elicited in 16 – 63% respondents. Conclusions: The respondents seriously lacked knowledge in biostatistics needed to interpret research results. Training programs needs to undergo massive and immediate transformation to include more effective biostatistics training in curricula to encourage meaningful research.(AU)