Clinical Review ABC of complementary medicine

Complementary medicine in conventional practice

BMJ 1999; 319 doi: http://dx.doi.org/10.1136/bmj.319.7214.901 (Published 02 October 1999) Cite this as: BMJ 1999;319:901
  1. Catherine Zollman,
  2. Andrew Vickers

    The past 10 years has seen a significant increase in the amount of complementary medicine being accessed through the NHS. These services are not evenly distributed, and many different delivery mechanisms are used, some of which (such as homoeopathic hospitals) predate the inception of the NHS. Others depend on more recent NHS reorganisations, like general practice fundholding and health commission contracting, or have been set up as evaluated pilot projects.

    Complementary therapies have been available in the NHS since its inception

    Integrating complementary medicine into conventional settings

    Successful integration is more likely with
    • Demand from patients

    • Commitment from high level staff in the conventional organisation

    • Protected time for education and communication

    • Ongoing evaluation of service (may help to defend service in the face of financial threat)

    • Links with other conventional establishments integrating complementary medicine

    • Realism and good will from all parties

    • Jointly agreed guidelines or protocols between complementary and conventional practitioners

    • Support from senior management or health authority

    • Careful selection and supervision of complementary practitioners

    • Funding from charitable or voluntary sector

    Problems are likely with
    • Financial insecurity

    • Time pressure

    • Lack of appropriate premises

    • Unrealistic expectations

    • Overwhelming demand

    • Inappropriate referrals

    • Unresolved differences in perspective between complementary and conventional practitioners

    • Real or perceived lack of evidence of effectiveness

    • Lack of resources and time for reflection and evaluation

    List adapted from the report of the Delivery Mechanisms Working Party of the Foundation for Integrated Medicine

    In general, development of these services has been demand led rather than evidence led. A few have published formal evaluations or audit reports. Some of these show benefits associated with complementary therapy—high patient satisfaction, significant improvements on validated health questionnaires compared with waiting list controls, and suggestions of reduced prescribing and referrals. However, data from other services are less clear, and many have not been formally evaluated These pilot projects have also identified various factors that influence the integration of complementary medicine practitioners within …

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