CAMbrella Final Report

Work package 5:

CAM use – the providers' perspective

Leading beneficiary: University of Bern (UNIBE)

Objectives:
WP5 sought to identify the different models of CAM provided by registered physicians and CAM practitioners (including non-medical providers with no academic background) by country within European public health systems. It aimed to:

review literature addressing the providers' perspective of CAM use in Europe, find out how many providers offer CAM and which different CAM methods are provided
identify the health problems for which CAM is utilised (in cooperation with WP4)
explore how CAM research and the relevant evidence base are integrated into CAM practice
describe the impact of research results on health care practice.

Description of work:
There are only few peer reviewed publications that deal with this topic and present reliable data. For physicians, registration bodies enable data sampling in a more or less reliable manner through internet searches, whereas non-medical practitioners are rarely organised and thus much less accessible through the internet. With decreasing 'levels' of professional organisation the precision and accuracy of the available data diminishes.

As regards physicians, four of the five most provided CAM therapies were clearly identified: acupuncture, manual therapies, homeopathy, and herbal medicine are represented in almost all EU27+12 countries. A population based ranking of the next 5 to 15 therapies demonstrates decreasing accuracy with decreasing order due to lack of reliable data, mostly in the new EU member states and some of associated countries. For some of the professionally organised non-medical practitioners, web-derived data of varying reliability are available. However, even for some western EU countries, including France, Germany, Italy, Portugal and Spain, this data must be collected from the “yellow pages”. In summary, there is a North to South and West to East decline concerning the reliability of data for both medical and non-medical CAM providers.

WP5 tested various forms of communication and meeting formats to understand and develop appropriate research methods, and to identify the national approaches to medicine and health care barriers. Research was restricted to registered CAM practitioners, both medical and non-medical, and further contributions from NGOs were included in the final deliverable. Together with WP4, WP5 identified the health problems for which CAM is used and contacted national registration bodies for information to allow cross-referencing of data for physicians and non-medical practitioners. The data obtained were displayed in tables and country and discipline specific maps. As regards education and training, three levels of qualification and certification were identified:

medically trained professionals like dentists, pharmacists, physicians (MD) veterinarians and sometimes midwifes, fully trained in both, conventional medicine and CAM, according to national (MD) and international CAM standards with national diploma and registration, continuous medical education (CME) and repeated certifications
non-medical practitioners with full CAM training of various levels according to national or international standards (e. g. ECCH83 diploma), and
MDs and non-medically trained practitioners who receive a lower level of education within their chosen CAM discipline.

No specific data were obtained for impact of research on education and practice, but we assume no differences compared to conventional medicine, where scarce data is available. WP5 also identified a lack of information regarding CAM products. Hence, the European Coalition on Homeopathic and Anthroposophic Medicinal Products (ECHAMP) and the Association of Natural Medicine in Europe (ANME) were asked for their specific and, where available, general data concerning the market for CAM products.

Findings:
CAM provision in Europe comprises health care practitioners and physicians with different healing attitudes, medical background, training, certification, and practice. Data are only available if they are registered in any specific body open to the public, and are therefore scarce, scientific publications are almost lacking completely. Both medical and non-medical practitioners play an important role in the provision of CAM within the healthcare system in Europe.

CAM provision in the EU27+12 is maintained by more than 150,000 registered medical doctors (MDs) with additional CAM certification and more than 180,000 registered and certified non-medical CAM practitioners. This suggests up to 65 CAM providers (35 non-medical practitioners and 30 physicians) per 100,000 inhabitants, compared to the EU figures of 95 general medical practitioners per 100,000 inhabitants.

Acupuncture is the most frequently provided method (53% of all practitioners) with 80,000 physicians and 16,000 non-medical practitioners trained in the therapy, followed by homeopathy (27% - 45,000 and 4,500, respectively). These two disciplines are both dominated by physicians. Herbal medicine and manual therapies are almost exclusively provided by non-medical practitioners. Naturopathy, on the other hand, is dominated by 15,000 (mostly German) physicians, as is 83 European anthroposophic medicine (4,500) and neural therapy (1,500). For more details see (von Ammon K et al. Complementary and Alternative Medicine provision in Europe – First results approaching reality in an unclear field of practices. Forsch Komplementmed 2012;19(suppl 2):37-43). (84)

CAM provision in Europe has not yet gained governmental interest at large; state funded research based knowledge is mainly available for Denmark, Germany, Norway, Switzerland, and the UK. This calls for more research in this field throughout the EU and associated countries. Public demand can be noted:

for transparent harmonisation of CAM training, medical education and certification
that standards of regulation and registration bodies are open to the public for both therapists and products.