Efficacy and Patient Satisfaction from Homoeopathic Treatment in Gynecological Disorders

Puneet Chopra, Puneeta Ajmera, Sheetal Yadav and Mahavir Singh^*
*Correspondence: Mahavir Singh, Department of Public Health, Amity Medical School, Amity University, Haryana, India, Tel: 9555143143, Email:

Keywords

Homeopathy • Efficacy • Patientsatisfaction • Homeopathictreatment • Gynecologicaldisorders

Introduction

Homeopathy was discovered in the year 1790 by German physician Christian Friedrich Samuel Hahnemann. Homeopathy is based on the principle of "Similia Similibus Currentur” which means ‘likes cures likes’. The homoeopathic medicines are in very small amount and diluted form of natural substance that are tested on healthy human beings to produce signs and symptoms of medicine in its pure form and unmixed with the disease symptoms and is noted down and further when disease patient comes with the similar kinds of signs and symptoms can be given the same medicine for treatment. The homeopathic medicines are mainly derived from natural resources such as animals, minerals or plant kingdom. The process of preparation of homeopathic medicines is known as "Potentization”. It is done in 2 different methods known as “Trituration and Succusion”. Through Potentization the hidden powers of natural substance are aroused by the above 2 methods. Homeopathy is geographically widespread started in Germany and parts of Europe to Asian countries like India, Nepal, Pakistan and many more [1].

There are many types of research and studies which prove the positive effects of homeopathic remedies in various chronic disorders including gynecological disorders such as fibroids, PCOD, Menstrual disorders, PMS, etc. In homeopathic treatments, they use minimal drug dosage and also shorten the average length of disease in many cases There are no side effects and toxic reactions to Homeopathic remedies. Homeopathy has its greatest results in the science of midwifery. Because of the minimal amount of original diluted substances are used in homeopathic treatment, this alternative medicine has no side effects; hence, these medicines can be used confidently during pregnancy under the supervision of a homeopathic practitioner. Many gynecological disorders are treatable by homeopathic remedies. The therapeutic effect of homeopathy is used in treating many diseases such as hemorrhage, cysts, vaginal secretions, during labor and delivery disturbances and gives more appropriate results compared to placebo. There is no such evidence to show the trend of homeopathic researches in the subject of Gynecology; hence this paper aims to evaluate the efficacy and patient satisfaction through homeopathic treatment in the subject of Gynecology for 2 months research around clinics in Faridabad [2].

This is a very complex issue to evaluate the patient’s level of satisfaction with treatment as it is linked to many aspects such as individual expectations, experiences undergone during the illness, and to personal beliefs of what health means. Health sectors have shown great interest in the field of this alternative system of medicine and particularly about the records which shows patient satisfaction from this alternative treatment and information as they influence the compliance to the treatment, and also determining the doctorpatient relationship through follow-ups and positive response from the patient [3].

In the homeopathic system of medicine there is still a controversy going on about the use of public resources in this complementary therapy researchers are working hard to evaluate the patient's choice of treatment by knowing improvement in their conditions and how much they are satisfied with the homeopathic treatment. It is very difficult to assess the complexity of the patient's health or patient's level of satisfaction in few minutes of clinical setting through standardized questionnaires,(Carr-Hill 1992) and in homeopathic treatment, it is even more difficult, because it is an individualized therapy which is based on the distinctive characteristics of every single patient. Since the 1990s, the importance of patient satisfaction has been recognized as a key factor to assess the quality of health services [4].

Aim

• To assess the Efficacy and Patient Satisfaction from Homoeopathic Treatment in Gynecological Disorders.

Objectives

• To evaluate the efficacy of homeopathic treatment in gynecological disorders.

• To evaluate the patients' satisfaction and follow up cases with homeopathic treatment in gynecological treatment.

Statement of the research problem

• What is the percentage of women who show positive results with homeopathic treatment in their gynecological problems?

• What is the percentage of women who came for follow-ups and satisfied with the homeopathic treatment?

• What is the percentage of women who were not satisfied and were drop out cases?

Review of Literature

Mathie and Robinson had conducted a prospective pilot study on “Outcomes and reviews of the patient from homeopathic prescribing" in the year 2006. They conducted a pilot study, in which 15 homeopathic doctors had recorded clinical data over 8 months in their clinical setting. The average age of patients was 39.5 years. During this study, the overall treatment was provided to a total of 1183 individual patients. About 950 cases were recorded with the outcome of two or more homeopathic appointments (follow-ups), 73.9% positive outcome, 6.6% negative outcome, 15.7% no change; 5.8% outcomes were not recorded [5].

Mathie and Farrer had conducted a prospective pilot study on "Outcomes and patient reviews from homeopathic prescribing in gynecological disorders" in the year 2007. They conducted a pilot study, in which 13 homeopathic gynecologists had recorded clinical outcome data throughout 8-month in their clinics and hospitals. The average age of female patients was 44.2 years. During this study, the overall treatment was provided to a total of 736 female patients. About 630 cases were recorded with the outcome of two or more homeopathic appointments (follow-ups), 88.1% with positive outcomes; 2.8% with negative outcomes; 8.4% had no change; 0.7% outcomes were not recorded. Out of 630 patients, about 64 patients had submitted their assessed outcomes before their follow-ups [6].

Subhranil Saha had conducted a prospective pilot study on “The outpatient scenario of Obstetrics and gynecology department of an Indian homeopathic hospital" in the year 2015. The author along with his fellow authors had recorded the prescriptions and case study material in their routine practice to find out or out list the areas of research targeted and evaluate the efficacy of homeopathic medicines in obstetrics and gynecological disorders. The author himself along with 2 homeopathic physicians participated in the data collection method for a period of 4-months in the Obstetrics and gynecology department of The Calcutta Homeopathic Medical College and Hospital, West Bengal, India. In 4 months around 675 females visited the Obstetrics and gynecology department and out of these 456 patients were recorded for the study. 67% of them showed positive results, 17.5% showed negative results, and 13.5% with no change. Chiefly a total of 92.9% chronic conditions were encountered. About 45 varieties of obstetrics and gynecological disorders were reported. The most repeatedly treated conditions were irregularity of menses (43%), dysmenorrhea (30%), menorrhagia (8.5%), and leucorrhea (20.5%). The most positive result of homeopathic medicines was seen in conditions like irregular menses (42.3%), leucorrhea (34.1%), polycystic ovary (33.3%), and dysmenorrhea (27%). A total of 120 medicines were prescribed in the centesimal scale (85.6%), 5o millesimal scale (5.2%) and in some cases placebo and mother tinctures were also used [7].

Richardson had conducted a cross-sectional study on “Surveying patient satisfaction from homeopathic treatment: Liverpool” in the year 2001. The survey was carried over 1 year from 20 July 2000 to 20 July 2001 in Liverpool Regional Department of Homoeopathic Medicine, to check the outcome of patient satisfaction from homeopathic treatment by using Glasgow Homoeopathic Hospital Outcome Score (GHHOS). The surveyed patients showed about 78% positive or satisfactory results in their conditions since they have started taking homeopathic treatment. 55% of patients have benefited in the way that they had reduced their conventional medication for conditions like diabetes, hypertension, and thyroid.

Spence et.al had conducted an observational study on "Treatment of Chronic ailments through non-conventional medication: Homoeopathic treatment" in the year 2005. This study was carried for 6 years in the outpatient department of homeopathic hospitals in the UK. This observational study was conducted throughout 6-years on 6577 follow-up patients, aiming to assess the results from homeopathic treatment in patients with chronic sufferings who were referred to a hospital's OPD. The consecutive follow-ups were seen by a total of 6577 patients. Out of the total number, 71.2% of patients showed positive outcomes and 18.5% recorded with negative changes and rest were with no changes [8].

Carr-Hill RA conducted a study on "To measure the patient satisfaction from homeopathic treatment" in the year 1992. Unaware of the difficulties of the survey the authors participated in the event of exploring the patient satisfaction from homeopathic medicines. This is very difficult to assess patient satisfaction, especially in the homeopathic system because the least interest shown by the patients in this system and rumors among them of homeopathic treatment is on the slower side and takes much time to show results positively. The authors surveyed about 1011 patients around homeopathic hospitals in the UK through questionnaires and about 72% of patients showed satisfaction and great improvement in their conditions with homeopathic treatment, 18% showed dissatisfaction and 10% showed no response regarding homeopathic treatment. This paper more or less tells about what all possible steps the authority should take to improve the health care system and collectively finds patient satisfaction [9].

Mahmoudian and Sadri conducted a study on "Homeopathy satisfaction in Iran" in the year 2014. The study reveals the assessment of the patient satisfaction from homeopathic treatment is an important factor to educate the society or community if the study comes up with positive outcomes and will show as a positive sign for homeopathic growth among community people. This cross-sectional study is descriptive and was conducted in the year 2009 on 150 patients in Isfahan city. The patient selection was done on the special condition as patients who are above the age of 15 years were referred to a homeopathic physician and are on homeopathic medications for at least four times are randomly selected from the above descriptive group and taken for the study. Three main criteria were chosen to assess the patient satisfaction level as (overall health of the patient before and after homeopathic treatment, the performance of the physician and positive outcome in terms of relief of symptoms) by using a standardized questionnaire. At last, the comparison was done with a similar study conducted in the year 2005 on 250 patients. Results: The average score of patient satisfaction from homeopathic therapy was 78.65 out of 100. In 2005 it was 78.32. The positive outcome in terms of relief of symptoms was given the highest level of importance regarding patient satisfaction. The overall health of the patient before and after homeopathic treatment and performance of the physician came next [10].

Guthlin C conducted a study on “Measuring the effects of acupuncture and homoeopathy in general practice: An uncontrolled prospective documentation approach” in the year 2004. The study was done to show increase demands of acupuncture and homoeopathic treatment in Germany. The study was conducted on 7213 samples and it was came up with the results that around 6296 samples go for the acupuncture treatment for their ailments and around 917 samples go for homoeopathic treatment for their ailments. The aim of the project was to study the effects and benefits of acupuncture and/or homoeopathy, and to assess patient satisfaction within a prospective documentation of over 5000 acupuncture and over 900 homoeopathy patients. As data sources, we used the documentation made available by therapists on every individual visit and a standardized quality-of-life questionnaire (MOS SF- 36); these were complemented by questions concerning the patient's medical history and by questions on patient satisfaction. The health insurer provided us with data on work absenteeism. The authors concluded the study with the statement that the both treatment were effective in positive manner and the maximum number of samples were satisfied.

Research Methodology

Inclusion criteria

• Female with age more than 13

• Gynecological disorders

• Females undergoing homeopathic treatment for gynecological disorders

Exclusion criteria

• Female with age less than 13.

• Disorders other than gynecological disorders.

• Females undergoing Allopathic medicine for gynecological disorders.

Material and Methods

Efficacy of homeopathic treatment in gynecological disorders

This is an observational and prospective study and was conducted for a 2-months duration from 20 May 2019 to 19 July 2019. A well-equipped questionnaire was designed and was passed through the tests of validity and reliability and was approved by five experts to make it a standardized one. The study was conducted in the outpatient department of 3 Homoeopathic clinics in Faridabad (NIT). The Homoeopathic physicians in these 3 clinics were ready to share their data for the respective study. The selection of the patient was done on specific criteria as the patients were suffering from gynecological disorders and there age should be at least above 13-years and taking only homeopathic treatment. The 3 of homeopathic physicians were having more than 10-years of experience and running their clinics with full fledge. The details of the patients were recorded on the separate pages of the spreadsheet and recording of each consecutive appointments, row by row were recorded and the following headings as date, patient ID number, age, sex, religion, socioeconomic status, profession, living status, presenting complaints, acute or chronic complaint/ disease, new case or follow-up case with the same complaint, assessment of the complaints by patient in follow-up appointment comparing with the initial homoeopathic treatment.

Patient satisfaction from homeopathic treatment in gynecological disorders

When it comes to evaluating patient satisfaction in the homeopathic system it is a very difficult task to perform because of the myths people had that homeopathic medicines act slowly. The people are unaware of the fact that the homeopathic system has a treatment for midwifery conditions and gynecological disorders. To know about the satisfaction level of the patients who had taken Homoeopathic treatment for gynecological disorders from these 3 respective physicians between 1^st June 2018 to 31^st December 2018 and those who had not come for follow-ups were interviewed on the telephone or through emails using standardized questionnaire(short example in Table 1). After a gap of 7-months when the last patient was seen on the 31st of December the interview was carried in July. The follow-ups appointments were booked either on phone or manually at the clinic’s reception. The telephonic interview was conducted by asking prestructured questions, aiming to evaluate the satisfaction level from the homeopathic treatment and what all are the reasons for not following-up. The telephonic interview includes few questions regarding satisfactory level from the treatment taken and was provided with three straight options [11].

Results

The study was done in the field of gynecological disorders and to check the efficacy of homeopathic treatment in the same and what all feedbacks are received from the patients and what the level of patient satisfaction with homeopathic treatment is. The data was collected from the 3 clinics of Faridabad and all the female patients with gynecological disorders were taken into account for the study. The collected data was further analyzed and came up with the results and presented in the 6 consecutive tables given below which shows the positive results for both efficacy and patient satisfaction from homeopathic treatment. A total of 110 patients were recorded and 110 old patients who didn’t come for the follow-ups were interviewed with the help of a standardized questionnaire.

The study was conducted for 2 months period from 22nd May 2019 to 20th July 2019 and come with the results as follows: the average age of the patient was around 31.2 years and maximum of (75.4%) of the patients were Hindu and rest were Sikhs (19.1%) and Muslims (5.5%). The maximum number of patients were homemakers (55.4%) and the rest were students and service groups with dominating middle socio-economic class around (76.4%); (Table 1). The most leading gynecological disorder among 110 studied cases was Leucorrhea (30.5%), Irregular Menses (23.3%), Dysmenorrhea (18%) and rest were menorrhagias, pruritus vulvae, and infertility shown in (Table 2). The comparison was done with positive outcomes of homeopathic treatment shown by the follow-ups of the patients in the following gynecological disorders such as leucorrhoea cases have the highest number of follow-ups with 31 patients and which shows 80.6% of the positive result even in the first visit, followed by irregular menses with 18 follow-up patients showed 77.7% of the positive result even in the first visit, dysmenorrhoea with 12 follow-up cases showed 58.3% of the positive result even in the first visit and further followed by followup cases in menorrhagia, Pruritus vulvae, PCOD, UTI and many more shown in (Table 3).

Many homeopathic medicines were used which showed positive results in gynecological disorders.The list of medicines are displayed in table and most commendable results and maximum number of prescriptions were of Pulsatilla Nigricans (10%) was recorded and the following medicines which were used are Natrum Muriaticum (8.2%), Medorrhinum (5.5%), Sepia (4.8%), Sulphur (4.6%) and many other drugs used are given in (Table 4). Further, this study was also conducted to evaluate the satisfaction level of patients themselves with the homeopathic treatment in gynecological disorder. The telephonic interview was conducted on 110 patients and those patients were included who had not followed-up since one year and interview was conducted with the help of standardized questionnaire to evaluate their answers for not following up with further treatment and with that to reach the second objective of the study that is patient satisfaction level with homeopathic treatment in gynecological disorders.

The data was recorded with the help of a telephonic interview and analyzed, then came with the following results shown in Around 62(56.4%) patients took the complete treatment for their disease with an answer of that the treatment was effective so the follow-up was necessary, 34(30.9%) patients took incomplete treatment with an answer that the treatment was discontinued due to early improvement and around 14(12.7%) took no treatment which was prescribed to them with an answer that the consultation left a negative impact and it was difficult to have medicine from pharmacy. Further, the patients were asked whether they would take or continue homeopathic treatment for their other disorders around 83.1% of patients answered "YES", 15.7% of patients replied "CANNOT SAY" and 1.2% of people replied "NO" [12].

Through telephonic interview the satisfaction and dissatisfaction level of patient were analyzed on the basis of their responses recorded and which shows about 68.6% patients were satisfied with homoeopathic treatment for their ailments with the following responses that "treatment was very effective" and 31.4% patients were dissatisfied with homeopathic treatment with following responses that "they thought treatment take less time to show positive results, dissatisfied with the consultation and difficulties relating repetition and precautions to be followed with medicines".

Discussion

The 3 centuries had passed since the discovery of an alternative system of medicine "Homoeopathy". It is noticed that very little research work has done in the field of homeopathy. The data analysis indicates that around 1840 papers entitled Homoeopathy indexed in WoS during the study period. The data analysis revealed that only 2.1% of the total published papers were in the subject area of Gynecology and Obstetrics. After showing the remarkable results and effective role of homeopathic treatment in the field of Gynecology and Obstetrics this number of papers seems to be a very needless and small amount of effort. Therefore more attention and willingness are required from the scientists and policymakers of research centers. There is no confusion that many spheres of Gynecology are often over customized, with unnecessary overuse of surgical methods for the treatment. The overuse of contraceptive and hormonal pills is showing bad effects on patients' health and more often the hormonal treatment which shows carcinogenic effects. So, as to overcome and reduce all these side effects of modern medicine the alternative system of treatment "Homoeopathy" was tossed up. It focuses on understanding the initial cause of the disease. Homeopathy is a very beneficial and potent alternative to synthetic hormones. The homeopathic medicines are free from side effects and do not put the patient to a risk of further complications. It is purely based on the principles "like cures like" which means the small number of natural substances in their raw form can produce signs and symptoms in human beings that will treat the same signs and symptoms in similar diseased condition after potentization (a process by which homeopathic remedies are made ).

This well organized and relevant research paper of clinical findings of homeopathic appointments in the 3 clinics of the Faridabad area has found significant and hopeful spheres of future clinical research in the homeopathic field. After many inherent limitations of the study such as selection bias, recall bias, empathy bias, interaction bias, aroused from the use of Likertscale response, etc and through the data analysis, this study would lay the foundation for future research work in the field of homeopathic treatment. On the other hand in the absence of controls these data cannot give the evidence for the effects which the homeopathic intervention provide in the Gynecological disorders, however this study will be very noticeable and valuable in terms of evidence seeking in the field of homeopathic treatment and this study points out probable relationship between treatment and their outcomes [13].

It can be noticed through this study that the most commonly used remedies and gynecological disorders/complaints treated more frequently, helped easily to identify the areas of the efficacy of homeopathic remedies which seems reasonably feasible because the physicians have given a wide range of medicines to be selected from. The outcomes of research progress beyond our expectations and it still takes up with clinical findings in the real community and sets up the homeopathic treatment a worth scope in gynecological disorders. As the study was based on the principles of homeopathy that "individualized prescription" but still many remedies tend to be repeatedly selected and prescribed in specific conditions.

The technique of evaluating the satisfaction level of the patients used was telephonic interview and which showed good results with some drawbacks as of less availability of time and expressions of patients were not seen on telephonic interview. The outcome of satisfaction level was beyond our expectations and overall rate of positive/satisfactory outcome registered in 68.8% patients in this study which is 7.6% more than the previous study conducted on same topic by the students of Calcutta Homoeopathic Medical College and Hospital in the year 2014 by Saha S et.al, “Obstetrics and Gynecological Outpatient Scenario of an Indian Homoeopathic Hospital: A Prospective research-targeted Study” 2014.

In this study, 96.2% of the prescriptions were on the Individualized principle of homeopathy a quite similar finding to different studies in which 100%, 85.6%, and 97.4% were recorded in the Indian Homoeopathic Hospitals. In this study, there was predominantly the use of the centesimal scale was taken into consideration. Hence, data from this small clinical study may be very useful for the researchers to perform well-aimed and controlled research in the future on the effectiveness of homeopathic treatment in gynecological disorders.

Conclusion

The women are the building blogs of any family, community, etc. So their health stands an important role in the community growth. The women related problem that is gynecological disorders which are the major concern in women’s life. The study was conducted to show the effectiveness of homoeopathic medicines in the treatment of gynecological disorders. The homoeopathic system is termed as an alternative system of medicine. It is merely 220 years old and was founded by Dr. Samuel Hahnemann in year 1796. The homoeopathy is getting effected by the myths world had that the medicines take long time for the action and to show positive results and they are not that much effective in treating gynecological disorders. The study was conducted to erase the stigma and myths regarding homoeopathic treatment and to show the factualness about the homoeopathic medicines in gynecological treatment and how much they are effective.

The result of the study showed the positive effectiveness of the homoeopathic medicines in gynecological disorders. The efficacy was around 68.8%. The level of patient satisfaction was also explored through telephonic interview. The medicines were all together effective in both acute and chronic forms of disease. Study showed positive remarks of homoeopathic treatment in various gynecological disorders like Leucorrhea, PCOD, Pruritus valve, Menorrhagia, Dysmenirrhea, etc. More than 100 homoeopathic medicines were prescribed and among them the most effective and commonly prescribed were Pulsatilla Nigricans, Natrum Muriaticum, Medorrhinum, Sepia, Sulphur and many more were prescribed and showed positive effects in treatment of gynecological disorders.

So it was concluded that the alternative system is also as much effective and compatible in treatment of gynecological problems as the modern system (allopathic system) and that were all myths that the homoeopathic medicines are slow to act and are not effective. Hence the patients were satisfied with homoeopathic treatment (68.8%) and are looking forward in future also to go with the homoeopathic treatment for their ailments (83%).

References

1. Carr-Hill, Robert A."The Measurement of Patient Satisfaction." J public health 14 (1992): 236-249.
2. Güthlin, Corina, Oliver Lange and Harald Walach. "Measuring the Effects of Acupuncture And Homoeopathy in General Practice: An Uncontrolled Prospective Documentation Approach." BMC Public Health 4(2004): 6.
3. Hahnemann, Samuel. The Homœopathic Medical Doctrine: Or, Organon ofthe Healing Art. WF Wakeman, (1833).
4. Kleijnen, Jamm. "Clinical Trials of Homoeopathy." Bmj 302 (1991): 316- 323.
5. Mahmoudian, Ahmad and Gholamhosein Sadri. "Homeopathy Satisfaction in Iran." Iranian j nursing midwifery res 19 (2014): 496-502.
6. Mathie, Robert and S. Farrer "Outcomes from Homeopathic Prescribing in Dental Practice: A Prospective, Research-Targeted, Pilot Study." Homeopathy 96 (2007): 74-81.
7. Mathie, Robert. and T. Robinson. "Outcomes from Homeopathic Prescribing in Medical Practice: A Prospective, Research-Targeted, Pilot Study." Homeopathy 95 (2006): 199-205.
8. Mullen, Partricia. D. Compliance Becomes Concordance: Making aChangein Terminology Produce a Change in Behaviour, British Medical Journal Publishing Group, (1997).
9. Richardson, Wing."Patient Benefit Survey: Liverpool Regional Department of Homoeopathic Medicine." British Homeopathic J 90 (2001): 158-162.
10. Saha, Subhranil, Munmun Koley, Shubhamoy Ghosh and Mohan Giri, et al. "Documentation of Prescriptions and Clinical Outcomes in a Homeopathic Hospital Setting in West Bengal, India." J evidence-based complementary alternative medicine 20 (2015): 180-185.
11. Vikram Singh, Rupali Dixit, Deepti Dewan, Alok Mishra, et al. "Randomized Controlled Pilot Study to Compare Homeopathy and Conventional Therapy in Acute Otitis Media." Homeopathy 101 (2012): 5-12.
12. Spence, David. S, Elizabeth Thompson and S.J. Barron. "Homeopathic Treatment for Chronic Disease: A 6-Year, University-Hospital Outpatient Observational Study." J Alternative Complementary Medicine 11 (2005): 793-798.
13. Wright, James G and Nancy L Young. "Outcomes Assessment in Children with Fractures." Skeletal Trauma in Children, (2009).