Complementary and alternative medicine use in patients with chronic diseases in primary care is associated with perceived quality of care and cultural beliefs

Patterns of complementary and alternative medicine use amongst outpatients in Tokyo, Japan

BACKGROUND

The use of complementary and alternative medicine (CAM) has been increasing rapidly throughout the world during the past decade. The use of CAM in the general Japanese population has been previously reported to be as high as 76%. This study aims to investigate the patterns of CAM use, perceived effectiveness and disclosure of CAM use to orthodox medical practitioners amongst patients attending typical primary and secondary care clinics in a busy district general hospital in Tokyo, Japan.

METHODS

The authors analysed data collected during March 2002 on patients attending general outpatient clinics held at Shiseikai Daini Hospital in Tokyo, Japan. Data was collected by use of self-completed questionnaires distributed to patients in the outpatient clinics waiting area. Statistical analysis was performed using chi-square tests of independence.

RESULTS

515 adults were approached to participate in this study and the overall response rate was 96% (n = 496). 50% of the patients were using or have used at least 1 CAM therapy within the last 12 months. The 5 most commonly used therapies were massage (n = 106, 43%), vitamins (n = 85, 35%), health foods including dietary supplements (n = 56, 23%), acupressure (n = 51, 21%) and kampo (n = 46, 19%). The majority of CAM users (75%, n = 145) found their CAM treatment to be effective (95% CI = 68-81%). Patients who were more likely to use CAM were females (p = 0.003) and those with a high number of medical conditions (p = < 0.0001). Only a small proportion of patients reported their CAM use to their physician (42%, n = 74). There was no significant difference in CAM use for the different age groups (p = 0.85), education level (p = 0.30) and financial status (p = 0.82).

CONCLUSION

Patterns of CAM usage in the sample surveyed was high (50%). Despite this high prevalence rate and presumed acceptance of CAM in Japan, the reporting of CAM use by patients to their physicians was low (42%). It is therefore important that physicians are aware of the possibility that their patients may be using CAM and also increase their knowledge and understanding of these treatments.

Self-care and adherence to medication: a survey in the hypertension outpatient clinic

Background

Self-care practices for patients with hypertension include adherence to medication, use of blood pressure self-monitoring and use of complementary and alternative therapies (CAM) The prevalence of CAM use and blood pressure self-monitoring have not been described in a UK secondary care population of patients with hypertension and their impact on adherence to medication has not been described. Adherence to medication is important for blood pressure control, but poor adherence is common. The study aimed to determine the prevalence of self-care behaviours in patients attending a secondary care hypertension clinic.

Methods

Cross-sectional questionnaire survey. 196 patients attending a secondary care hypertension clinic in a teaching hospital serving a multiethnic population, Birmingham, UK. Main outcome measures: Prevalence of use of CAM, home monitors, adherence to anti-hypertensive medication.

Results

CAM use in previous 12 months was reported by 66 (43.1%) respondents. CAM users did not differ statistically from non-CAM users by age, gender, marital status or education. Vitamins, prayer a dietary supplements were the most commonly used CAM. Nine (12.7%) women reported using herbal CAM compared to one man (1.2%), (p = 0.006). Ten (6.7%) respondents reported ever being asked by a doctor about CAM use. Perfect adherence to anti-hypertensive medication was reported by 26 (44.8%) CAM-users and 46 (60.5%) non-CAM users (p = 0.07). Being female and a CAM user was significantly associated with imperfect adherence to anti-hypertensive medication. Older and white British respondents were significantly more likely to report perfect adherence. Blood pressure monitors were used by 67 (43.8%) respondents, which was not associated with gender, CAM use or adherence to medication.

Conclusion

Hypertensive patients use a variety of self-care methods, including CAM, home blood pressure monitors, and adherence to prescribed medication. This study found the prevalence of CAM use in hypertensive patients was higher than in the UK population. It is important to acknowledge the self-care behaviour of hypertensive patients, in order to assess potential harm, and encourage effective methods of self-care.

Patient-based evaluations of primary care for cardiovascular diseases: a comparison between conventional and complementary medicine

BACKGROUND

Patients with chronic diseases, including cardiovascular conditions, increasingly rely on complementary and alternative medical (CAM) therapies.

OBJECTIVES

The Swiss Program for Complementary Medicine Evaluation offers a unique opportunity to analyse cardiovascular patients' satisfaction with CAM and conventional medical (COM) therapies. The treatment choices of doctors certified in conventional as well as complementary therapies also could be studied.

METHODS

A national observational evaluation on treatment satisfaction of patients consulting COM or CAM doctors. Out of this evaluation project, data related to patients with cardiovascular diseases were specifically analysed for patient satisfaction with treatment and outcome when treated by COM or CAM doctors.

RESULTS

Of 199 included doctors (78 COM, 121 CAM) treating cardiovascular patients, COM doctors treated twice as many cardiovascular patients per doctor than CAM doctors. CAM doctors treated less than 1/3 of their cardiovascular patients solely by CAM, while they treated 42% exclusively by COM therapies. Patients seeing a CAM doctor had a significantly longer consultation and were more likely to be highly satisfied with overall treatment outcome and patient-practitioner communication. Moreover, patients seeing a CAM doctor and being treated solely by a CAM therapy more often report 'complete fulfilment of outcome expectation' and 'high overall satisfaction with treatment', although their symptoms less often disappear totally than those of COM therapy-treated patients.

CONCLUSION

CAM therapies are not the first treatment choice for cardiovascular diseases. However, even though CAM doctors preferentially apply COM therapies, cardiovascular patients treated by CAM doctors are more likely to be satisfied with the overall treatment outcome, possibly because of the longer and better patient-practitioner interaction.

Consumer Decision Factors for Initial and Long-Term Use of Complementary and Alternative Medicine

Guided by the conceptual framework of the consumer decision-making model, the present study compared the factors associated with initial and long-term use of complementary and alternative medicine (CAM) providers. A survey was completed by 239 people recruited from the offices of physicians and CAM practitioners. Conventional medicine clients ( n = 54), new or infrequent clients ( n = 73), and established CAM clients ( n = 112) were compared to identify the decision factors for initial and long-term CAM use. Consistent with the components of this model, we found support for the roles of external influences (age, social recommendations), decision process factors (symptom severity, egalitarian provider preference), and post-decision factors (dissatisfaction with conventional care) depending on whether the pattern of CAM use was new or infrequent or established. Overall, this study provides preliminary support for the utility of the consumer decision-making model as an integrative framework for understanding the roles of correlates of CAM use.

Racial/Ethnic Differences in the Use of Complementary and Alternative Medicine in Patients With Arthritis

OBJECTIVE

To examine use of complementary and alternative medicine (CAM) by individuals with osteoarthritis (OA) from 4 ethnic groups, differences in CAM use among groups, and correlates of CAM use.

METHODS

Data were obtained from individuals from 4 ethnic groups (African, Asian, and Hispanic Americans, and Caucasians) participating in trials assessing celecoxib efficacy. A questionnaire assessing CAMs specifically used to help arthritis was administered at screening. Use of 42 specific therapies within 7 categories-alternative medical systems, mind-body interventions, manipulation and body-based methods, energy therapies, and 3 types of biologically based therapies--was queried.

RESULTS

More than 80% of subjects reported that they used some CAM for arthritis in the past month. In contrast, 50% reported the use of prescription medicines, and 52% reported the use of over-the-counter medicines. Dietary practices were the most common type of CAM (71.5%), followed by mind-body interventions (42.4%), topical agents (38.1%), use of supplements or herbs (32.9%), and manipulation and body-based methods (21.4%). African Americans were more likely to report any CAM use than other groups (89.1% versus 83.1% [Asian], 81.1% [Hispanic], 77.7% [Caucasian]). African and Asian Americans more commonly reported the use of mind-body interventions in general, and prayer in particular. African Americans were also most likely to report the use of topical agents. Asian Americans were most likely to report use of alternative medical systems, manipulation methods, and supplements. Caucasians were least likely to report use of dietary practices.

CONCLUSION

Individuals with OA commonly use CAM. Use of these therapies varies by racial/ethnic group. Some CAMs may be effective for symptom relief, while others may interact with prescription medications, suggesting that routine queries by physicians concerning CAM use would be beneficial.

Complementary and alternative medicine therapies in acne, psoriasis, and atopic eczema: results of a qualitative study of patients' experiences and perceptions

OBJECTIVES

The aim of this study was to explore the use of complementary and alternative medicine (CAM) therapies in patients with acne, psoriasis, or atopic eczema and the attitudes about CAM of these patients.

DESIGN

This was a qualitative study, utilizing semistructured interviews and thematic analysis.

SETTING

Patients were recruited from the practices of dermatologists and general practitioners in a noncapital Australian city.

RESULTS

Twenty-six (26) interviews were conducted with patients with acne, 29 with psoriasis, and 7 with atopic eczema. Use of CAM therapies was common. Participants tended to value CAM over orthodox therapies because of their preference for natural approaches to their skin diseases and the perceived lesser potential for adverse effects of CAM therapies. Respondents with acne were more confident about the efficacy of CAM than were those with psoriasis or eczema. The resulting sense of control attenuated psychologic sequelae of acne. This was not apparent in psoriasis or eczema.

CONCLUSIONS

Practitioners should be cognizant of the likely use of CAM and its implications (including the potential for attenuation of psychologic morbidity) in their patients who have skin diseases.

Use of Complementary and Alternative Medicine Among Adults with Chronic Diseases: United States 2002

BACKGROUND

Use of Complementary and Alternative Medicine (CAM) has increased in recent years.

OBJECTIVE

The aim of this study was to determine the use of CAM among people with diagnosed chronic diseases.

DESIGN

Cross-sectional analysis was used.

SETTING

The 2002 National Health Interview Survey was the setting.

PATIENTS

Participants were representative of the noninstitutionalized U.S. population 18 years and older.

MEASUREMENTS

Respondents answered questions about use of CAM and physician-diagnosed arthritis, cancer, cardiovascular disease, diabetes, and lung disease.

RESULTS

Adults with diagnosed chronic diseases are more likely to use CAM compared to adults with none of the reported chronic diseases. Adults with arthritis alone were most likely to report ever use of CAM (59.6%) followed by adults with cancer or lung disease alone or two or more chronic diseases (55%), adults with cardiovascular disease (46.4%), and adults with no chronic diseases (43.6%) and diabetes alone (41.4%). Adults with chronic diseases were also more likely to report use of CAM in the past 12 months (32% to 43.3%), followed by adults with none of these chronic diseases (32%), and adults with diabetes alone (26.2%). Less than 30% of CAM users in the past 12 months reported talking to their healthcare professional about CAM use.

LIMITATIONS

Information about CAM use is based on self-report.

CONCLUSIONS

Use of CAM, particularly biologically based CAM therapies, is common and is more likely to be used by those with chronic diseases.

Does trust in health care influence the use of complementary and alternative medicine by chronically ill people?

BACKGROUND

People's trust in health care and health care professionals is essential for the effectiveness of health care, especially for chronically ill people, since chronic diseases are by definition (partly) incurable. Therefore, it may be understandable that chronically ill people turn to complementary and alternative medicine (CAM), often in addition to regular care. Chronically ill people use CAM two to five times more often than non-chronically ill people. The trust of chronically ill people in health care and health care professionals and the relationship of this with CAM use have not been reported until now. In this study, we examine the influence of chronically ill people's trust in health care and health care professionals on CAM use.

METHODS

The present sample comprises respondents of the 'Panel of Patients with Chronic Diseases' (PPCD). Patients (>or=25 years) were selected by GPs. A total of 1,625 chronically ill people were included. Trust and CAM use was measured by a written questionnaire. Statistical analyses were t tests for independent samples, Chi-square and one-way analysis of variance, and logistic regression analysis.

RESULTS

Chronically ill people have a relatively low level of trust in future health care. They trust certified alternative practitioners less than regular health care professionals, and non-certified alternative practitioners less still. The less trust patients have in future health care, the more they will be inclined to use CAM, when controlling for socio-demographic and disease characteristics.

CONCLUSION

Trust in future health care is a significant predictor of CAM use. Chronically ill people's use of CAM may increase in the near future. Health policy makers should, therefore, be alert to the quality of practising alternative practitioners, for example by insisting on professional certification. Equally, good quality may increase people's trust in public health care.

The behaviors of seeking a second opinion from other health-care professionals and the utilization of complementary and alternative medicine in gynecologic cancer patients

GOALS OF WORK

The aim of the study is to determine the predictors for seeking a second opinion and the utilization of complementary and alternative medicine (CAM) among gynecologic cancer patients.

PATIENTS AND METHODS

Patients attending a gynecologic cancer clinic of a tertiary referral center were recruited over a period of 1 year. A survey was conducted for all the participants in a one-on-one basis.

MAIN RESULTS

One hundred ninety-one patients were recruited. Eighty patients (41.9%) had consulted other health-care professionals (HCP) for a second opinion after they were diagnosed to have cancer and 89 (46.6%) had utilized CAM. In multivariate analysis, late-stage disease (OR=2.65, 95% CI 1.26-5.58), treatment with radiotherapy (OR=2.27, 95% CI 1.19-4.33) and tertiary education (OR=11.28, 95% CI 3.06-41.54) were independent predictors for seeking a second opinion from other HCP and utilization of CAM. Patients who sought a second opinion from other HCP were more likely to utilize CAM (OR=6.12, 95% CI 3.24-11.54). Eighty percent of the patients did not inform their usual caregiver their utilization of CAM.

CONCLUSIONS

Seeking a second opinion from other HCP is common in gynecologic cancer patients. Patients who seek a second opinion are more likely to utilize CAM.