Health care Medicines in Germeny

Herbal Medicine in Primary Healthcare in Germany

. The WHO has recognized HM as an essential component of primary healthcare. The aim of this study was to explore patients' attitudes towards using HM, their sources of information and the role of costs. Within a qualitative research approach, semi-standardized interviews with 18 patients using HM were conducted and analyzed according to Mayring's content analysis. Patients highlighted their active role and perceived autonomy choosing HM. Most interviewees experienced HM as better, with more sustainable effects and fewer side effects compared to conventional medicine. All media, family, friends, and healthcare professionals were reported as sources of information. Some patients complained that doctors and pharmacists have insufficient knowledge of HM. Most patients expressed their regret that HM is not reimbursed by statutory health insurances but also their general willingness to pay extra for HM. The main challenge for German primary care, besides the reintroduction of reimbursement, is the promotion of knowledge and skill development in HM. This is to ensure patient safety and work in partnership with patients. Appropriate strategies for education must be tailored to the specific needs of health professional groups.

1. Introduction

Herbal medicine (HM) is one of the most widely used Complementary and Alternative Medicine (CAM) therapies used throughout the world. In many countries, HM has a long tradition and the knowledge about local medical plants is ingrained into cultural memory. The WHO estimates that 70–90% of the rural population in developing countries use HM to meet, in part or completely, their health needs [1]. Also, in many developed countries, HM as an element of CAM is highly popular. Therefore, HM is recognized as an essential component of primary healthcare by the WHO [1].

In most developed countries—also in Germany—patients have access to HM via physicians, nonmedical CAM practitioners and on a self-initiated basis. Consequently, diverse healthcare professionals mainly doctors, nurses, pharmacists, and nonmedical CAM practitioners are involved in HM. In Germany, HM is known as one of the five main elements of classic naturopathy (phytotherapy, hydrotherapy, exercise therapy, dietetic therapy, and “life style regulation” therapy) also known as Kneipp therapies. The overall percentage of Germans using HM increased from 52% in 1970 to 70% in 2010 [2].

In 2011, about one billion euro were spent on herbal medicine corresponding to approximately 20% of the total expenditure for over the counter (OTC) drugs in Germany. In addition, herbal medicines are sold in drugstores, via internet, and so forth. About 20% of herbal medicine was sold on a prescription-basis and about 80% were sold over the counter [3]. By far the highest sales are made for the indication of respiratory tract infections, followed by cardiovascular disease and gastrointestinal symptoms. However, sales have slightly decreased since the introduction in 2004 of the Statutory Health Insurance Modernization Act, which excluded several groups of drugs including phytotherapeutics from reimbursement.

German doctors can obtain a postgraduate qualification for “naturopathy,” which includes HM. At the end of the year 2011, 15.949 German doctors had the qualification “naturopathy,” with 70% thereof working in the outpatient sector [4]. However, recent data suggests that far more doctors prescribe or recommend HM to their patients. In a cross-sectional study, more than half of the responding general practitioners (GPs) recommended HM in their day-to-day practice, most of them having no additional qualification for “naturopathy” [5].

Furthermore, HM is often provided by nonmedical CAM practitioners called “Heilpraktiker.” They have to pass an exam on basic medical knowledge to obtain a state license but have no formal training on CAM and HM specifically [6]. While the number of GPs in Germany is decreasing (41.642 GPs in 2011), the number of “Heilpraktiker” has increased over the last years to nearly 32.000 today [4]. Hence, it is clear that Heilpraktikers play a substantial role in Germany for providing patients with HM.

Altogether these developments suggest that, on the one hand, HM has reached mainstream medicine yet on the other hand, studies show that a substantial percentage of patients do not inform their doctors about their use of HM [7, 8]. Furthermore, international studies suggest that doctors and other health professionals are not well prepared to inform their patients about HM [9, 10]. Considering the interactions between HM and conventional drugs this deficit may affect patient safety and, therefore, should be a point for debate and further research.

In view of the above, this study is intended to explore the perspectives and experiences of patients using HM in a primary care context. Using a qualitative approach, we focus particular attention on central patient attitudes and motives for using HM, the methods and needs for information and communication and the role of the costs in choices made.