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 referred
Condition % referrals
Atopic eczema 18%
Hair loss 14%
51% Acne 11%
Psoriasis 9%
76% Rosacea 8%
Seborrhoeic eczema 7%
Vitiligo 6%
Urticaria 4%
Pain and tenderness of the skin 3%
Warts 2%
Skin other 17%
Non-skin 2%
 Reasons for referral
• Conventional treatment not working
• Conventional treatment not suitable
Main

• Patient requested alternative treatment

• Other patients reported improvements
• Patient wants HM + conventional
treatment
• No conventional treatment
 Patient reported problems
Type 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 wellbe

DESCRIPTIONS DATES OF CONSULTAT

first

Enter consultation dates ⇒

CURRENT PROBLEM(S) that you want treatment for SCORES FOR EACH VISIT
P1
P2
P3
P4
P5
ACTIVITIES (things that are painful/difficult to do) SCORES FOR EACH VISIT
A1
A2
A3
A4
WELLBEING SCORES FOR EACH VISIT
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
First Last Change Std. Significance
N (mean) (mean) (mean) Deviation (2-tailed)
Problem 1 152 4.08 3.03 1.07 1.557 0.000
Problem 2 119 3.94 2.92 1.04 1.895 0.000
Problem 3 79 3.65 2.97 0.71 1.580 0.000
Problem 4 45 3.51 2.76 0.76 1.540 0.003
Problem 5 21 3.57 2.95 0.50 2.013 0.281
Activity 1 67 4.61 3.32 1.26 1.744 0.000
Activity 2 28 4.32 2.93 1.41 1.782 0.000
Activity 3 9 4.11 3.11 1.00 1.323 0.039
Activity 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 conditions
Mean Std.
N change Deviation
Eczema 31 1.0323 1.68293
Hair loss/ baldness 18 0.5556 1.61690
Rosacea 12 2.0833 1.50504
Psorasis 11 1.0909 1.75810
Acne 10 1.0000 0.94281
Urticaria 8 0.3750 1.40789
Seborrhoeic eczema 6 1.0000 1.67332
Vitiligo 6 0.5000 2.07364
Pruritis 3 -0.3333 0.57735
Other skin problems 17 1.1765 1.70423
Not 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