A Dutch Anthroposophic Primary Health Centre

How to deal with complexity and uncertainty in this kind of

integrative medicine?

Slides of the presentation held at the WONCA Congress for family

medicine in Basel at the 18th of September 2009

by Marco Ephraïm, GP and GP-trainer

• 75 GP’s (solo, group or PHC-practice)• 34 Primary Health Center’s (mostly called:

‘Therapeuticum ……….’)• > 125.000 patients• well integrated in conventional medicine

Integration of Anthroposophic Medicine in General Medicine in the Netherlands:

Amsterdam

• 115.000 inhabitants• 60 GP’s, of which: • 4 anthroposophic GP’s for ca. 7000 people

• Zoetermeer:

Leiden

The Hague

Rotterdam

Utrecht

www.therapeuticumaurum.nl

Primary Health Centre ‘THERAPEUTICUM AURUM’

Thanks to a patients initiative it started 29 years ago in Zoetermeer in a small garage…:

Team of ‘Aurum’ (september 2009)

• 4 GP’s (partnership) + 2 GP’s in training• 7 receptionists-’plus’ • 2 practice nurses (DM, COPD; org./fin.)• 6 physiotherapists (mass, training ther, MT)• 1 psychotherapist, 3 counsellors • 2 midwifes (weekly); • 2 dietitians• Baby and Child Health Centre (doctor and nurse, weekly)• 2 nurses for bathing therapy/oil application• 2 creative therapists (painting, modelling)• 1 eurythmy therapist (anthr. moving therapy)• 1 music therapist; 1 speech therapist• 1 internist (monthly, a transmural project) // 38 co-workers

3 of the 4 GP’s and2 ‘aios’(GP’s in training)

A weekly team meeting about complex patients

physiotherapy wing physicians wing

Aims and restrictions of AM

• Balance of Body - Vitality– Soul - Spirit• Main aim AM is to support the self-healing

forces and the autonomy of the patients (‘salutogenesis’, Antonowsky)

• AM can function the most safe if integrated in primary care, and done or referred by doctors

Medications

• The balanced use of both natural and conventional medicines plays an important role

• Example: upper respiratory diseases, anthroposophical and conventional treatment compared:

Anthroposophic vs. Conventional Anthroposophic vs. Conventional therapy therapy

of acute respiratory and ear of acute respiratory and ear infections: infections:

a prospective outcomes study, a prospective outcomes study, 20052005

Antibiotics were given to 5,5% of the anthroposophically Antibiotics were given to 5,5% of the anthroposophically (A) treated patients and to 33,6% of the conventional (A) treated patients and to 33,6% of the conventional (C) treated patients(C) treated patients

Less side effects in the A-groupLess side effects in the A-group More patient satisfaction in the A-groupMore patient satisfaction in the A-group

See summary of abstracts, available at the deskSee summary of abstracts, available at the desk

Hamre, H.J. et al.,Hamre, H.J. et al., Anthroposophic vs. Conventional Anthroposophic vs. Conventional therapy of acute respiratory and ear infections: a therapy of acute respiratory and ear infections: a prospective outcomes study, Wiener Klinische prospective outcomes study, Wiener Klinische Wochenschrift, 2005Wochenschrift, 2005

TherapiesEurythmy therapy

Art therapy

Other related items to mention:• Network in the town: GP’s, pharmacies, hospital,

others• Participation in out-of-hours acute service (‘HAP’ =

huisartsenpost) • HIS: Medicom • Costs: feedback of health insurance (anthr. practices

are slighly cheaper than conventional practices)• GP-training (first and third year, Leiden)• Anthr.Med.-training (via www.nvaa.nl)

Complex and uncertain? AM:

• new concepts and tools to meet patients with e.g. psychosomatic and somatisation problems

• reduces the use of conventional medicines (like antibiotics) in a safe way with less costs, in this patient population

• gives inspiration for cohesiv teamwork and a good working climate

Anyway a challenge requiring further research!

Thank you for your attention!

and

Be welcome to visit our health center!

Marco Ephraim, GP GP-trainer in liaison to Leiden University

Teacher in international anthroposophic medical training Primary Health Centre ‘Therapeuticum Aurum’

Frits de Zwerverhove 1 NL – 2717TP Zoetermeer T: 0031 79 3211811 / 3212368

E: marco.ephraim@gmail.comW: www.therapeuticumaurum.nl

More information: www.nvaa.nl International: www.ivaa.info