Health outcomes of the consultation- Elements of consultations in general practice and homeopathy that facilitates selfmanagement and coping of chronic illness.: A qualitative study
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Background: One key-element to achieve good health in the future is to make patients cope better with their health-problems on their own. In general practice the consultation is the basic tool, and this tool has changed and evolved over the years. The public healthsystem in Norway provides each inhabitant a general practitioner (GP), but there are many other health providers who offer advises when it comes to achieving good health, and how to cope with health problems. In a study from 2008, 12,6% of the population in central Norway report one or more visits to a practitioner of complementary and alternative medicine (CAM) during the last year. In classical homeopathy the consultation is a cornerstone for treating the patient in an individual way. To find which elements in the consultations that contributes to better health for patients with chronic illnesses, we can in a better way understand the needs of our patients and create a better intercommunication, which in turn could lead to more selfmanagement. Aim: The aim of this study is to explore what patients with chronic illness who have had consultations with GPs and homeopaths perceive to be the helpful elements in the consultations facilitating self-management and coping with their health-problems in everyday life. Participants and methods: We have preformed a qualitative study based on semi-structured interviews with 12adult patients with a chronic illness, who have visited both a homeopath and a general practitioner. The patients where recruited by homeopath practices in Central Norway, since most of the adult population that visit CAM-practitioner have already been to ageneral practitioner. They had to have consulted a homeopath and a physician at least twice. We got help to recruit patients from two different homeopathy centers to exclude the way one specific practitioner is working, which could be affecting our results. The interviews where taped, transcribed, and translated to English. Results: The patients are overall satisfied with both their GP and homeopath, but use them in a supplementary way. Visiting GPs makes the patients confident that more is done for optimizing their health. To get a diagnosis leads to better coping, but patients seek something beyond this; they want to be encouraged to cope with their health-problem on a daily basis. When it comes to chronic illness they find the CAM treatment supportive and helpful by providing everyday advices, explaining physical and psychological reactions and gives the patient a logical explanation of their problems. Being listened to and seen in an individual way makes the patients feel comfortable and taken care of, this is among other aspects the aim in the patient-centered methodin conventional therapy (CT) and in the holistic approach used in homeopathy. Conclusion: When it comes to chronic illness patients needs to work through a process with accepting, adjusting and coping with their situation. Successful coping depends on self-management, support, getting everyday advices and information about their illness from professional health-care providers and others. Through this they preserve identity, play an active role when it comes to their own health and gets hope for the future. The consultation needs to be long enough, the relation between patient and healthcare provider should be characterized by trust, openness, and responsibility by both parts.