Care Situation in Homeopathic Practice

Emergency management

In acute and emergency management in homeopathic practice, it is also of particular interest to draw up an overview of the more common acute treatment and consultation issues that actually occur in homeopathic practice.

This also includes the separate differentiation of primary diagnosis by the homeopathic physician or alternative practitioner himself, as well as the accompanying treatment of acute exacerbations of chronic diseases.

The ICD-10 codes are given, as a rapid classification of a suspected diagnosis is necessary in emergency management. The possibility of concomitant homeopathic treatment depends on the diagnosis and is examined on a case-by-case basis.

Common acute concerns in the homeopathic practice.

This includes concerns where the homeopathic practice is the first point of contact for the patient. The survey shows that overall this is rare: more than 1 time a month, 15% of respondents reported treating emergencies. In individual cases this is the case for 45% of the practices. Approximately 40% indicated that they do not treat emergencies at all.

Frequency distribution of individual concerns

Common concerns (42%):

Table 1: Common concerns (42%):	Diagnosis Code
Insect bites with suspected allergic reactions.	Depending on the severity, for example ICD-10 T63.4 - Venom of other arthropods ICD-10 T78.4 - Allergic reaction ICD-10 T78.2 - Anaphylactic shock, unspecified
Circulatory weakness with dizziness, tendency to faint, usually with hormonal dysregulation in younger women, and anxiety	The respective diagnosis codes for dizziness are based on the main complaints, e.g: ICD-10 R42 Dizziness and staggering, excl. ICD-10 H81.- Disorders of vestibular function ICD-10 F41.- Anxiety disorders
Mild nosebleeds in children, advice and acute remedies when tamponade is not needed	ICD-10 R04.0
Care for minor wounds, dressing changes, spontaneous injuries (e.g., sprains)	The diagnosis code depends on the respective localisation of the wound/injury, see: ICD-10 S00-T98: Injuries, poisoning and certain other consequences of external causes.

Less common concerns (18%):

Table 2: Less common concerns (18%):	Diagnosis Code
Acute chest pain, usually thoracic ribs, or rib joint pain	ICD-10 R07.1-R07.4 ICD-10 R07.1 Chest pain during breathing ICD-10 R07.2 Precordial pain ICD-10 R07.3 Other chest pain ICD-10 R07.4 Chest pain, unspecified
Palpitations, tachycardia, usually as a symptom of anxiety	ICD-10 R00.0 - Tachycardia, unspecified ICD-10 F41.- Anxiety disorders
Hearing loss, co-treatment after specialist diagnosis	ICD-10 H91.2
Whiplash, after specialist diagnosis for accelerated regeneration	ICD-10 S13.4
Mild burns, grade I - II in peripheral regions (hand, fingers)	ICD-10 T23.0 -T23.2

Rarely occurring emergencies (5%):

All other concerns together account for around 5% of mentions for all practices surveyed. The concerns were co-treatment for:

Table 3: Overview of rarely occurring emergencies (5%)

Frequency in practice:	Frequent >10x/ year	Data in %	Only few individual cases	Data in %	not yet treated	Data in %	ICD-10
Severe asthma attack	34	8,70%	203	51,92%	154	39,39%	J46
Hyperventilation syndrome	17	4,35%	170	43,48%	204	52,17%	F45.3 Somatoform disorders
Seizures	25	6,39%	192	49,10%	174	44,50%	R56.- Convulsions, not elsewhere classified G40. - Epilepsy
Suspicion of apoplexy	1	0,26%	138	35,29%	252	64,45%	I64
States of confusion and agitation	41	10,49%	202	51,66%	148	37,85%	F05 Delirium not induced by alcohol and other psychoactive substances
Acute suspicion of suicide	5	1,28%	153	39,13%	233	59,59%	R45.8 Other symptoms and signs involving emotional state
Onset of eclampsia	3	0,77%	71	18,16%	317	81,07%	O15
Acute urinary retention	11	2,81%	123	31,46%	257	65,73%	R33
Epiglottitis	11	2,81%	82	20,97%	298	76,21%	J05.1
Mild traumatic brain injury	45	11,51%	206	52,69%	140	35,81%	S06.0 Commotio cerebri
Blunt trauma to chest and abdomen	30	7,67%	188	48,08%	173	44,25%	S20-S29 (depending on specific localisation)
Hypothermia, frostbite	11	2,81%	108	27,62%	272	69,57%	T33-T35 (depending on severity)

The analysis shows that regular emergency care of these concerns (> 1x/mon) occurs in less than 10% of practices.

Individual mentions of rarely occurring emergencies:

The following concerns are individual mentions and without percentages:

Table 4: Individual mentions of rarely occurring emergencies:	Diagnosis Code
Fractures	The diagnosis code depends on the respective localisation of the wound/injury, see: ICD-10 S00-T98: Injuries, poisoning and certain other consequences of external causes.
Suspected appendicitis	ICD-10 K35.-
Severe sunburn (> 20% of body surface area)	ICD-10 L55.1 Sunburn of second degree ICD-10 L55.2 Sunburn of third degree
Hypertensive crises	ICD-10 I10-I15 – Essential (primary) hypertension -0 Without indication of a hypertensive crisis -1 With indication of a hypertensive crisis
Retinal detachment (after ophthalmic care)	ICD-10 H33.-

Primary diagnosis of acute concerns in the homeopathic practice

Here we deal with acute situations of patients who are already undergoing treatment and for this reason consult their "trusted practitioner" as the first point of contact. The underlying disease is usually known. In about 5% of the practices surveyed, this occurs more than once a month, in 32% only in individual cases, and 63% state that they do not perform primary diagnostics in emergencies.

Single cases

Total accumulations

1655 / 9 = 184

47%

• Insect bites - allergic reactions
• Tachycardia, paroxsysmal
• Suspected thrombosis
• Acute chest wall pain
• Bang trauma, hearing loss
• Craniocerebral trauma CCT I-II
• Whiplash
• Minor wounds

Individual nomination

• Lacerations,
• Suspected cerebral hemorrhages,
• esp. tendon and ligament ruptures,
• Contusions and dislocations, esp. fractures,
• acute biliary colic,
• Ascitis suspicion,
• minor burns and scalds in everyday life,
• high fever with dizziness

Comment

The emergency situations identified in the survey usually require a differentiated interview over the phone to decide the urgency and the question of an inpatient emergency department.

In which chronic diseases are acute crises treated as well?

Crises of neurological diseases

Table 5: Crises of neurological diseases

	frequent (>10x/year)	individual cases	not yet treated
Multiple Sclerosis (MS)	7%	48%	45%
Stroke, consequences of	5%	48%	47%
Epilepsy	4%	40%	56%
Brain tumors	2%	24%	74%
Meningioma	1%	12%	87%
Astrocytoma	0,50%	11%	88,5%
Glioblastoma	0,25%	18%	81,75%

Comment

Crises are only accompanied by a few colleagues more often, in individual cases with ample expertise also ask:

• MS patients in relapses (48%),
• relatives of stroke patients (48%) and parents of children in
• parents of children in epilepsy crisis (40%) for an accompanying homeopathic treatment, in acute seizures despite anticonvulsant medication,

In acute cerebral edema, mostly in patients with brain tumors, these are in any case isolated cases (11-18%), mostly relatives who consult a homeopath while the patient is being treated as an inpatient or has been discharged home shortly after stabilization and no one really knows what to do next.

Crises in cardiovascular diseases

Table 6: Crises in cardiovascular diseases

	frequent (>10x/year)	individual cases	not yet treated
Arterial hypertension	23%	47%	30%
Chronic venous insufficiency, varicosis	10%	42%	48%
Heart weakness, insufficiency	8%	48%	44%
Coronary heart disease (CHD)	6%	38%	56%
Myocarditis/ pericarditis, consequences of	3%	27%	70%
Arterial occlusive disease	2%	21%	77%

Comment

Hypertensive crises clearly stand out by frequency in crisis intervention, with about 1/5 of respondents treating them more frequently.

Exactly 10% also more frequently treat acute venous complaints based on varicosis in pain or thrombophlebitis.

The concomitant treatment of acute complaints in heart failure, angina pectoris and pain in Arterial occlusive disease are isolated cases with a clearly decreasing frequency.

The majority of respondents are not consulted for acute pain in the cardiac region (56%) and for Arterial occlusive disease (77%) in crises.

The consequences of inflammation of the heart muscle (27%) and the pericardium (21%) are also requested homeopathically in acute debilitating episodes in individual cases by patients.

Acute crises in internal diseases

Internal diseases - Co-treatment in crises

Table 7: Acute crises in internal diseases

	frequent (>10x/year)	individual cases	not yet treated
Chronic recurrent gastritis	21%	56%	23%
Hyperuricemia, gout	12%	53%	35%
Diabetes mellitus	10%	40%	50%
COPD	7%	39%	54%
Celiac disease	7%	35%	58%
Sarcoidosis	0%	21%	79%
Urinary tract disorders	1%	21%	78%
Dialysis patients	0,25%	14%	86%
Cystic fibrosis	0%	12%	88%

Comment

Acute gastritis (21% more frequent, 56% in single cases) and gout attacks (frequent 12% single cases 53%) in patients under chronic treatment are treated homeopathically.

Hyperglycemic fluctuations in diabetes, when this is not easily adjustable, take a middle position.

Likewise, in individual cases, homeopathic treatment is more frequently requested for:

• acute exacerbations of chronic obstructive bronchitis (COPD),
• acute diarrhea crises in celiac disease and
• respiratory distress in sarcoidosis.

Patients with infections of the urinary tract, such as the kidneys, are also treated in individual cases by about 1/5 of the respondents.

Treatments of dialysis patients and inflammatory crises in cystic fibrosis are not requested by 80-90% of the practitioners and therefore represent rarities in an outpatient homeopathic practice.

Crises in autoimmune diseases

Autoimmune diseases - Co-treatment in crises

Table 8: Crises in autoimmune diseases

	frequent (>10x/year)	individual cases	not yet treated
Rheumatoid arthritis	21%	56%	23%
Hashimoto's thyroiditis	18%	52%	30%
Crohn's disease	13%	50%	37%
Ulcerative colitis	12%	50%	38%
Graves' disease	4%	36%	60%
Collagenoses	1,5%	25,5%	73%

Comment

Inflammatory and painful phases of rheumatism, as well as acute inflammatory episodes of Hashimoto's thyroiditis, are treated more frequently by one fifth of respondents and in individual cases by slightly more than half at the patient's request.

Acute intestinal inflammations, in connection with M. Chron and Colitis Ulzerosa, are co-treated by only 1/10 of the interviewees more frequently, in individual cases however also by up to 50% of the interviewees.

Crises in Graves' disease are treated in individual cases by about one third of the colleagues interviewed, despite the use of thyrostatic drugs.

The majority of patients with collagenosis (especially lupus erythematosus) do not turn to homeopaths in crises.

Acute crises in oncological diseases

Oncological diseases - co-treatment in crises

Tabelle 9: Acute crises in oncological diseases

	frequent (>10x/year)	individual cases	not yet treated
Breast cancer	7%	45%	48%
Colorectal cancer	4%	35%	61%
Lymphoma	3%	22%	75%
Prostate cancer	2%	30%	68%
Lung cancer	2%	20%	78%
Leukemia	1%	25%	74%
Stomach cancer	1%	22%	77%
Pancreatic cancer	1%	18%	80%
Kidney-cancer	0,5%	12,5%	87%

Comment

Acute complaints and crises are homeopathically co-treated in patients with breast cancer up to 7% more frequently and in individual cases up to 45%.

The rate is even lower for colorectal cancer: 4% more frequently and 35% in individual cases.

The majority of all other cancers are not treated in acute crises.

General statistics

Table 10: Co-treatment of crises during chronic diseases

frequent (>1x/month)	individual cases	not yet treated
6%	32%	62%

Comment

If all acute crises are considered together, it can be seen that:

• 6% of colleagues regularly co-treating crises homeopathically in chronic diseases,
• 32% do so in individual cases, while
• 62% do not perform such treatments, or are not requested to do so.

The low numbers of frequent use indicate that only a few colleagues have a corresponding expertise or offer it at all, which is also perceived by patients.

Acute crisis management consultation

Table 12: Acute crisis management consultation

Daily	32,5%
By telephone arrangement	52%
Rather not	15,5%

Evaluation

A good 2/3 of survey participants report offering emergency consultation only by prior arrangement (52%) or not at all (15.5%). A comparison with the practice structure shows the correlation:

Emergency management requires a comprehensive full-time presence, which from the structure of a usual one-man practice (with and without secretariat) requires a high time budget. This is only provided by 20% of the practices participating in the survey, and 7% of them excessively (60 hours per week).

What situations occur in the telephone consultation?

Table 13: Evaluation situations in the telephone consultation hour

	frequent >10x/week	rare up to 10x/week	very rare only isolated cases
Checking the agent reaction	42%	36%	22%
Calming and de-scaring	32%	37%	31%
Calling in for diagnosise	15%	41%	44%
Forwarding to specialist diagnostics	8%	44%	48%
Immediate hospitalization	1%	7%	92%

Evaluation

Based on the frequency of telephone patient contacts, three groups of emergency management can be distinguished:

• Group A: more than 10 contacts a week,
• Group B: up to 10 contacts and
• Group C: very infrequent telephone contacts, mostly by telephone arrangement.

Group A - frequent telephone contacts: The most frequent contact here is to check the drug reaction, followed by reassuring advice, only every 6th-7th case is immediately referred to a doctor for further diagnostics, only about every hundredth case is immediately sent to the clinic.

Group B - few but regular telephone contacts: Checking of the remedy reaction and a reassuring consultation are more or less balanced, just under half of the patients are called in for diagnostics or referred to a specialist, about every fourteenth patient is sent to the clinic for safety.

Group C - Irregular and infrequent telephone contacts: The most common action is sending emergency cases on to the clinic or referring them to a specialist, or the patient is called in for review. Telephone consultation follows, with telephone review of drug response occurring least frequently in this group.

Comment

The evaluation shows: The fewer patient contacts in the practice, the more likely it is that a referral is made immediately to a specialist in emergency situations, or that the patient is called in for a drug reaction check.

A potential danger to patients or a behavior of inexperienced practitioners, as a result of which medical treatments would be omitted in emergencies, cannot be deduced from this.

Rather, the opposite seems to be the case. The uncertainty of not being able to assess a case correctly increases disproportionately with a lack of clinical experience, which is shown by the high willingness of less experienced patients to be admitted to hospital.

In the supplementary individual responses, about 10% of the respondents stated that there were no emergencies in the telephone consultation hours.

Basic knowledge of emergency medicine

Basic emergency medical knowledge is asked in the first aid self-assessment questions.

Life-saving immediate measures for adults

Table 14: Life-saving immediate measures for adults

	certain	uncertain
Initiation of the rescue chain	89%	11%
Correct positioning	83%	17%
mouth-to-mouth resuscitation	67%	13%
Cardiac massage and circulation control	71%	29%

Evaluation

The overall high % figures for initiation of the lifesaving chain and positioning (80-90%) with a drop in ventilation and chest compressions (certainly in 2/3 of respondents) indicate that the majority of survey participants:in regularly attend first aid courses.

The drop of about 10% for the life-saving measures ventilation and cardiac massage shows that due to lack of experience and frequency in everyday practice, the courses are attended more regularly in order to become more familiar with the lack of practice and to reduce their own uncertainty. The high total number speaks for an intrinsic motivation of the respondents.

Immediate life-saving measures for children

Table 15: Immediate life-saving measures for children

	certain	uncertain
mouth-to-mouth resuscitation in children	33%	67%
Pulse control in children	45%	55%
Cardiac massage in children	30%	70%

Evaluation

45% of the respondents were confident that they could safely determine a pulse in children, while only just under a third were confident in administering breaths and chest compressions.

The difference to adult emergency aid shows that the first aid training offered here is inadequate and that there is a real need for further training. It also indicates that survey participants honestly downgrade their self-assessment of their competence.

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References

The sources mentioned served as a basis for the creation of the survey for structuring the question blocks. They can also be found as source references at individual points in the overall document on the supply situation in homeopathic practice.

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