Patient questionnaires for use in the integrative medicine primary care setting - a systematic literature review

Introduction: Increasingly, primary care clinics are offering integrative medicine (IM). These clinics, besides treating illness, emphasise holistic health care, health promotion and enhancing well-being. However, very few such clinics are evaluating their services or patient outcomes. Methods: A systematic review was undertaken to identify, appraise and shortlist the best available patient-reported questionnaires to measure outcomes in IM primary care clinics. As well as patient health outcomes, questionnaires measuring proxy outcomes such as lifestyle risk factors, medication use and health services outcomes were included. The internet and Medline, CINAHL and Allied and Complementary Medicine databases were first searched to identify English web-databases listing potential questionnaires. Publication databases were then searched to identify questionnaires measuring underrepresented topics. Potential questionnaires were evaluated using modified guidelines from the Medical Outcomes Trust. Results: Ten web-based databases were identified that cited over 4000 questionnaires. There was a plethora of mental health and quality-of-life questionnaires from which to choose. However, individualised patient-centred questionnaires along with those measuring wellness, holistic health and health promotion/lifestyle activities were lacking. A final shortlist of 71 questionnaires met the inclusion criteria. Conclusions: The majority of the questionnaires had not been tested in the IM primary care setting. The distribution of scores of many popular questionnaires makes them useless when seeking to differentiate or detect changes and improvement in health and wellbeing in healthier populations. Further evaluation is needed to confirm their suitability.