CPP Seminar 2 April 2009

Phytotherapy Outcome:

using MYMOP in a hospital setting

Krishna Ramamurthy & Alex Laird

Medical Herbalists

Whipps Cross University Hospital

• First clinic began in Sept 2000, CoP paid for placements, followed by UEL and UoW

• 3 clinic days a month

• Referrals mainly via consultants & nurses

• 293 patients seen from Sept 00-Jun 07

• Modified MYMOP from 2002 via UoW

Conditions referredCondition % referrals

Atopic eczema 18% Hair loss 14% Acne 11% Psoriasis 9% Rosacea 8% Seborrhoeic eczema 7% Vitiligo 6% Urticaria 4% Pain and tenderness of the skin 3% Warts 2% Skin other 17%

Non-skin 2%

51%

76%

Reasons for referral

• Conventional treatment not working

• Conventional treatment not suitable

• Patient requested alternative treatment

• Other patients reported improvements

• Patient wants HM + conventional treatment

• No conventional treatment

Mai

n

Patient reported problemsType of problem

(main occurrences in brackets) % patients

Skin 28%

Digestive (bowel problems) 16% Psychological (sleep problems, anxiety, depression) 15%

Respiratory (asthma, hayfever) 11%

Female genital (menstrual problems) 8%

General and unspecified (fatigue) 5%

Musculoskeletal 5%

Endocrine/metabolic and nutritional 4%

Neurological 4%

Cardiovascular 3% Other 1%

Choose one or two symptoms (physical or mental) which bother you the most. Write them on the lines. Now consider how bad each symptom is, over the last week, and score it by circling your chosen number.

Now choose one activity (physical, social or mental) that is important to you, and that your problem makes difficult or prevents you doing. Score how bad it has been in the last week.

How would you rate your general feeling of wellbeing during the last week?

How long have you had symptom 1, either all the time or on and off?

If an important new symptom has appeared please describe it and mark how bad it is below

The treatment you are receiving may not be the only thing affecting your problem. If there is anything else that you think is important, such as changes you have made yourself, or other things happening in our life, please write it here.

FIRST APPOINTMENT: score how bad you think the problems are FOLLOWING APPOINTMENTS score how you have felt on average since the last treatment. Score between 0 (problem has disappeared) and 6 (as bad as it could be) for each problem, activity and for wellbeing.

DESCRIPTIONS DATES OF CONSULTATIONS

Enter consultation dates

first

CURRENT PROBLEM(S) that you want treatment for SCORES FOR EACH VISIT (0 – 6)

P 1

P 2

P 3

P 4

P 5

ACTIVITIES (things that are painful/difficult to do) SCORES FOR EACH VISIT (0 – 6)

A 1

A 2

A 3

A 4

WELLBEING SCORES FOR EACH VISIT (0 – 6)

WB How you feel generally (0 perfect – 6 worst possible)

MYMOP: Key benefits

• Quick and easy to fill in

• Identifying patients’ key concerns

• Helps monitoring of changes– by herbalist– by patient

• Aids evaluation of service

Limitations

• Problem specific– Patient needs to be able to identify most

important problem in terms of symptoms– Patient’s concerns may not match the

referrer’s– Treatment effects for unidentified problems

not measured

• Modified MYMOP not validated

Length of treatment

• 74% between one and six months

• 16% 6 to 12 months

• 10 % more than one year

Changes in MYMOP score

NFirst

(mean)Last

(mean)Change (mean)

Std. Deviation

Significance (2-tailed)

Problem 1 152 4.08 3.03 1.07 1.557 0.000Problem 2 119 3.94 2.92 1.04 1.895 0.000Problem 3 79 3.65 2.97 0.71 1.580 0.000Problem 4 45 3.51 2.76 0.76 1.540 0.003Problem 5 21 3.57 2.95 0.50 2.013 0.281Activity 1 67 4.61 3.32 1.26 1.744 0.000Activity 2 28 4.32 2.93 1.41 1.782 0.000Activity 3 9 4.11 3.11 1.00 1.323 0.039Activity 4 1 3.00 4.00 -1.00 .Wellbeing 142 3.02 2.38 0.65 1.644 0.000

0.05 or less is statistically significant

Change in P1 Skin conditionsN

Mean change

Std. Deviation

Eczema 31 1.0323 1.68293Hair loss/ baldness 18 0.5556 1.61690Rosacea 12 2.0833 1.50504Psorasis 11 1.0909 1.75810Acne 10 1.0000 0.94281Urticaria 8 0.3750 1.40789Seborrhoeic eczema 6 1.0000 1.67332Vitiligo 6 0.5000 2.07364Pruritis 3 -0.3333 0.57735Other skin problems 17 1.1765 1.70423Not skin 23 1.5217 1.27456

0.5 and over is likely to be clinically significant

Problem 1 analysis

• 55% recorded improvement

• 35% recorded improvement of >1 point

• 36% noted no change in score

• 8% noted deterioration

What this means

• Statistically significant improvement in self-reported patient health

Limitations

• MYMOP – great for monitoring overall change in health, but patient-defined problems may not match the referral diagnosis.

• May need an additional monitoring tool

With thanks to:

• Dr Anthony Bewley, Consultant Dermatologist, Whipps Cross University Hospital

• Dr Nicola Gale, Research Fellow, iCAM Unit, University of Westminster

• Peter Davies, School of Integrated Health, UoW