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Patient–provider interactions may affect GERD symptoms
Certain aspects of the interactions between patients with GERD and complementary and integrative medicine providers may improve patient symptoms, according to the results of a pilot randomized controlled trial.
“Our findings suggest that the type of patient–provider interaction that occurs in some complementary and integrative provider visits may significantly improve GERD symptoms beyond that of a high-quality, empathic conventional medical visit,” Michelle Dossett, MD, PhD, MPH, of the Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital, said in a press release. “While previous studies have suggested that patient–provider interactions can affect a wide range of symptoms, most of them compared high-quality conventional visits with those in which the providers intentionally limited their interactions. No previous studies have looked at the effects on GERD-related symptoms, and there is little data comparing conventional visits with those of complementary and integrative providers.”
The aim of the study was to determine the safety and feasibility of a 2 x 2 factorial design study evaluating the effects of two different patient–provider interactions, as well as the effects of over-the-counter, homeopathic Acidil (abies nigra, carbo vegetabilis, nux vomica, robinia pseudoacacia; Boiron) on symptoms and health-related quality of life among patients with GERD.
Dossett and colleagues enrolled and followed 24 patients with GERD symptoms from June 2013 to April 2014, and randomly assigned them to a standard visit based on an empathic conventional primary care evaluation (median visit length, 18 minutes [range, 11-32 minutes]) or an expanded visit based on a complementary and integrative medicine (CIM) consultation (median visit length, 42 minutes [range, 23-74 minutes]), as well as either 2 weeks of Acidil or placebo. The physician visit was single-masked, the Acidil randomization was double-masked, and participants completed a variety of questionnaires throughout the study period to assess symptoms, quality of life and other factors.
The investigators found GERD symptom severity was comparable between the Acidil and placebo groups, but patients in the expanded visit group more often reported a 50% or greater improvement in severity of symptoms compared with the standard visit group (P = .01). No associations with treatment outcomes were observed for the length of the consultation, perceived empathy or beliefs in CIM at baseline.
“The results of this study provide unique preliminary data on the importance of the patient–physician relationship, an ingredient in health care that is often overlooked,” Gloria Yeh, MD, MPH, of the Beth Israel Deaconess Department of Medicine, said in the press release.
“Since all of the visits in this study were performed by a single provider, a next step will be to determine whether other providers trained in the expanded visit model can achieve similar results and whether these results will last long term,” Dossett said. “Identifying the elements of the expanded visit that are responsible for symptom improvement may help us develop ways to incorporate those aspects into conventional medical practice.” – by Adam Leitenberger
Disclosures: Dossett reports she has served as a consultant to TJL Enterprises. Yeh reports no relevant financial disclosures. Please see the full study for a list of all other researchers’ relevant financial disclosures.