Implementation,of,alternative,methods,in,the,health,system,through,evidence-based,medicine

Elizabeta Popova Ramova,Marina Bacanovic

1College for medical cosmetology and physiotherapy,MIT University, Skopje 1000, Republic of North Macedonia.2Head at Alternative Medicine Department,Training implementation center,Bitola 7000,Republic of North Macedonia. 3Institute of Public Health of Republic of North Macedonia,Skopje 1000,Republic of North Macedonia.

Alternative healing methods and non-pharmacological interventions have been used empirically by humans for centuries to reduce pain,improve psyche and socialize. From the point of view of modern medicine and society, where there is a high level of health care,40-65% of patients today still use alternative methods in various regions of the world [1, 2].

The use of such methods is most common when patients are suffering from malignant or other diseases where modern methods of treatment did not give good results,where it was used as an additional therapy with modern therapy, where multi-comorbidity did not allow the use of conventional drugs such as polypharmacy, due to their interactions and side effects. Another reason for using herbal medicines is the existence of resistance to antibiotics and antifungals,as well as the lack of medicines for viruses [3, 4].

Physical medicine and rehabilitation as the oldest and most modern branch of medicine uses multiple forms of physical modalities for non-drug treatment. These are primarily treatment with cold, hot,paraffin packs, water, exercises, massage, electrotherapy,sonotherapy, magnet therapy, light therapy, etc. In the beginning(late 20th and early 21st century), it was difficult to show and prove that these physical modalities had or did not have an effect, so the research presented ranged from vague accounts of positive effects to criticisms of quackery[5, 6].

Researches in the field of PM & Reha went in the direction of seeking quantitative measurable parameters with which we will prove that it has an effect. Statistical calculations were also difficult to perform, making it difficult to publish in highly rated scientific journals. That"s why before doing any examination, we asked ourselves several questions:

1.How is a given disease treated surgically or medically evaluated.

2.Whether the effect of treatment can be demonstrated by available laboratory and other diagnostic procedures.

The first thing we used were the pain assessment scales and most often we used the NAS 0-10 points. During the treatment of the musculoskeletal system, we had the evaluation of muscles strength before and after treatment,the circumstance of the limb with swelling,and the range of motion. In addition, we included the level of bone markers for bone diseases, and for monitoring the effect of treatment in soft tissue diseases, ehosonography and measurement of defects,lengths and thickness of a muscle section. Of course, DEXA and IMR were already available, but in a country like ours with a medium to low economic level, they were not yet available.

In the later period, standard questionnaires were also available to us, with which we measured quality of life and joint function, e.g.such as the Womax index for knee and hip.

When applying the rehabilitation to neurological patients, the situation was somewhat easier, because the Barthel index and the questionnaires for the assessment of the quality of life were already used in the world and since 15 years ago they entered as regular in our health system. Today in Neuro rehabilitation we use all the questionnaires used by neurologists to assess fatigue, balance, quality of life and independence. Our advantage is that their sensitivity is assessed, which we use in interventions that cannot be corrected with any medication, such as, for example, assessment of fatigue and balance. Applying non-pharmacological interventions, and following the recommendations of the WHO, that all alternative methods that are applied should be monitored and their effect evaluated,we started to use methods that are precisely defined as complementary for the benefit of the patients.

In 2013, we published a book analyzing the effect of 32 alternative methods. Some had proven effects others did not. In the period from 2014 to 2019, we worked on several areas of non-pharmacological treatment of diseases such as Multiple Sclerosis, Parkinson"s disease,Breast cancer,sports injuries and aromatherapy.In each of the studied areas, we analyzed the applications of non-pharmacological interventions and how their effect was monitored. There has been visible progress from 2000-2020 in the medical public to show the effects of alternative methods.

The period ahead should enable patients to choose treatment according to personal attitudes,culture and social group,but above all based on the accurately proven effects of methods and regulations from the health system. Here, spears will be broken over who should take the health money, surgical treatment (whether it is necessary or possible without surgery) and non-pharmacological interventions (it has an effect but depends on the personal choice of the patient and the stage of the disease). One thing is clear, whatever to apply the assessment of the quality of life should be with the same questionnaire.

In conclusion, We would say the following: today, medicine has become a business and a field of material gain, far from the Hippocratic Oath. Strict control mechanisms by Health Funds and Insurance Companies can reduce abuses. The application of any medical and alternative method should be regulated by a protocol for effect and quality of life if it is applied in public health, while in the private sector the patient"s choice remains, but multiple opinions should always be requested.