The use of risk sharing tools for post adoption surveillance of a non pharmacological technology in routine practice: results after one year.

BACKGROUND: To report results obtained by combining risk sharing tools with post-adoption surveillance mechanisms in order to control quality of care and implement a value-based reimbursement scheme for Neuro-reflexotherapy (NRT), a non-pharmacological treatment proven effective for neck pain (NP), thoracic pain (TP) and low back pain (LBP). METHODS: Pre-post prospective cohort study in routine clinical practice, carried out in primary care centers in the Spanish National Health Service in the Balearic Islands (Ib-Salut). Eight-hundred and seventy-one subacute and chronic NP, TP and LBP patients treated in Ib-Salut, who underwent NRT during 2011. A shared risk contract (SRC) was developed, where payments for NRT were linked to results on patients' clinical evolution, reduction in medication and proportion of patients undergoing spinal surgery. Main outcome measures were local pain (NP, TP or LBP), referred pain, LBP-related disability and NP-related disability, measured using previously validated instruments at referral and 3 months later, use of medication assessed at referral and discharge, and rates of spinal surgery prescription after undergoing NRT. RESULTS: Median improvements at discharge corresponded to 57.1% of baseline value for local pain, 75.0% for referred pain, 53.8% for LBP-related disability and 45.0% for NP-related disability. Patients taking medication at discharge represented 29.0% of those taking it at referral. The proportion of patients in whom spinal surgery was prescribed after undergoing NRT was 0%. These results were consistent with those from previous randomised controlled trials (RCTs) and studies in routine practice, and complied with the standards set in the SRC. CONCLUSIONS: It is feasible and effective to enhance post adoption surveillance methods with risk sharing tools to improve quality control and support value-based reimbursement decisions for NRT. The feasibility of generalising this approach to other settings and to other non-pharmacological treatments should be explored.

[Place of reflexotherapy and some other methods of alternative medicine in modern medical practice].

Assessment of the role and place of nontraditional methods of treatment and reflexotherapy, widely applied in hospitals is presented in the article. Besides, we become alerted regarding not serious approach of some scientists and health service managers to reflexotherapy as a whole and to one of its methods--acupuncture. An analysis of the situation developed in the legislation concerning training of reflexotherapy specialists for last 15-20 years not only in Ukraine, but also abroad was done. The article presents a historical parallel between the use of medicamentous and nonmedicamentous methods of treatment.

Variables of stimulation and placebo in acupuncture reflexotherapy.

Placebo can be defined as "the idea of recovery." It represents the natural impulse toward recovery that is catalyzed by treatment or even simply by the idea of treatment. Therefore, placebo is not an "active" treatment; it is used in scientific research to discriminate between the actual effect of a drug or therapeutic technique and the result of chance or the will to recover. Even though it is only an idea, placebo can cause improvement and recovery in approximately 30% of the subjects treated with any therapeutic program and for very different pathologies. Acute pathologies are more sensitive to placebo than chronic ones; functional disorders respond better than organic alterations, and so on. The main controversial issues in the methodology of acupuncture research are: placebo, double-blinding, and the intensity of stimulation of needles. The most used placebo method is sham acupuncture, which is the insertion of the needles outside acupuncture points. It is argued that this methodologically incorrect choice leads to studying the importance of the acupuncture point, rather than that of acupuncture as a transdermic stimulation technique.