Don't ask, don't tell: parental nondisclosure of complementary and alternative medicine and over-the-counter medication use in children's asthma management

Prevalence and Patterns of Prenatal Alcohol Exposure in Australian Cohort and Cross-Sectional Studies: A Systematic Review of Data Collection Approaches

This study sought to determine data collection approaches in Australian cohort studies and explore the potential impact on reported prenatal alcohol exposure (PAE) prevalence and patterns. Inclusion criteria were that studies related to a general Australian antenatal population where PAE was assessed and reported. Studies were excluded if they were not peer reviewed, examined the prevalence of PAE in pregnancies complicated by alcohol-use disorders, or were published in a language other than English. A systematic search of five electronic databases (PubMed, Embase, CINAHL, Web of Science, and Scopus) was conducted. Risk of bias was assessed using the Effective Public Health Practice Project quality assessment tool. Results were synthesised using MetaXL. Data from 16 separate birth cohorts (n = 78 articles) were included. Included cohorts were either general cohorts that included alcohol as a variable or alcohol-focused cohorts that were designed with a primary focus on PAE. PAE prevalence was estimated as 48% (95% CI: 38 to 57%). When subgroup analysis was performed, estimates of PAE prevalence when self-administered surveys and interviews were used for data collection were 53% (95% CI: 41% to 64%) and 43% (95% CI: 28% to 59%), respectively. Use of trained assessors was an influencing factor of the prevalence estimates when data were collected via interview. Alcohol-focused studies reported higher prevalence of PAE, regardless of method of survey administration. Where interviewer training is not possible, self-administered questionnaires will likely provide the most reliable PAE estimates. No funding sources are relevant to mention. Review was registered with PROSPERO (CRD42020204853).

Understanding Native Hawaiian Caregivers' Beliefs About Pediatric Asthma Management

Native Hawaiian health beliefs and cultural practices may influence how Native Hawaiian caregivers manage their children's asthma. Understanding the use of cultural practices as an asthma management strategy among Native Hawaiian caregivers who have a child with mild persistent, moderate persistent, or severe persistent asthma may inform the development of effective culturally-based asthma management interventions. A qualitative descriptive methodology with medical anthropology framework was used to describe pediatric asthma management strategies, define cultural asthma management practices, and identify cultural practices caregivers were aware of but did not use. Eighteen face-to-face interviews with self-identified Native Hawaiian caregivers of school-aged children between 5 and 12 years with asthma were interviewed. The study found that Native Hawaiian caregivers across all asthma severity types believed that the perceived cause of asthma was hereditary and environmental exposure. Also, standard asthma management strategies were used by caregivers with an emphasis on preventing exposure to known asthma triggers. If asthma symptoms presented themselves, Native Hawaiian caregivers often managed them with alternative practices before using the prescribed medication. Alternative practices included the use of massage and exposure to salt air. Native Hawaiian caregivers readily discussed awareness of cultural practices. However, cultural practices such as lā'au lapa'au (herbal medicine) and lomilomi (massage) were seldom, if ever, used. The study provides healthcare providers with knowledge regarding Native Hawaiian caregivers and their beliefs about the perceived cause of asthma and strategies for managing asthma, including use and awareness of cultural practices.

Complementary and Alternative Medicine Use in Children with a Developmental Disability and Co-occurring Medical Conditions

OBJECTIVE

The primary aim of this study was to evaluate differences in the prevalence of complementary and alternative medicine (CAM) usage among children with and without developmental disabilities (DD). Secondarily, the association between CAM usage and comorbid chronic medical conditions was explored among children with DD.

DESIGN

Data come from the 2012 Child Complementary and Alternative Medicine Supplement of the National Health Interview Survey, a nationally representative sample of children in the United States between the ages of 4 and 17 (n = 10,218).Main outcome measures Multiple logistical regression models provided insight into the relationships between parent-report CAM usage, DD, and chronic medical conditions.

RESULTS

Children with developmental disabilities were more likely to use CAMs compared to their typically developing peers (21% vs 16%). Children with DDs and comorbid chronic medical conditions used CAMs at even higher rates (23% vs 18%).

CONCLUSIONS

Results indicated that children with DD, especially those with a co-occurring chronic medical condition, use CAMs more often that typically developing children. Given scarcity of information on safety and effectiveness, clinical providers need to be alert to which children may be more likely to be exposed to CAMs. Communication between parents and providers needs to include discussion of CAM treatments.

Safety of complementary and alternative medicine in children: A 16-years retrospective analysis of the Italian Phytovigilance system database

BACKGROUND

Dietary supplements and homeopathic medicines are largely used in children as complementary and alternative medicine (CAM) to treat different health conditions. Safety of CAM is unknown when they are marketed. This study analysed suspected CAM-related adverse reaction (AR) in pediatric population.

METHODS

The Italian Phytovigilance system was searched for reports of suspected AR related to CAM use in children (0-18 years) from 2002 to 2018. AR reports were evaluated and information about patient's demographic characteristics, suspected CAM, conventional medications, and ARs were collected. In particular, we evaluated whether patient's and CAM characteristics, and concomitant drugs could be potential predictors of ARs seriousness.

RESULTS

We evaluated 206 pediatric CAM-related AR reports, of which 69 were serious. Patients were mostly treated with only one CAM (n = 193), and 39% of AR reports were related to products containing 2-5 components. Most reported ARs were related to dietary supplements (57.18%), and skin and subcutaneous tissue disorders (40.29%) were the most involved System Organ Class. CAM-related AR reported as serious were higher in subjects exposed to homeopathic medicines (ROR 3.13 [1.88-5.22]), to CAM in presence of concomitant medications (ROR 1.77 [1.01-3.10]), to CAM containing 2-4 components (ROR 2.18 [1.13-4.22]), and to more than three concomitant CAM (ROR 7.81 [1.97-32.69]).

CONCLUSION

We provide new insights on factors that might increase the risk of serious AR associated with CAM use in children: products containing more than two components and simultaneously administered with conventional medications can represent a potential risk in children.

Prevalence of and Factors Associated With Patient Nondisclosure of Medically Relevant Information to Clinicians

IMPORTANCE

Patient failure to disclose medically relevant information to clinicians can undermine patient care or even lead to patient harm.

OBJECTIVE

To examine the frequency of patients failing to disclose to their clinicians information that is relevant to their care and their reasons for doing so.

DESIGN, SETTING, AND PARTICIPANTS

Two national nonprobability samples were recruited to participate in an online survey, one using Amazon's Mechanical Turk (MTurk) from March 16 to 30, 2015 (2096 respondents), followed by one using Survey Sampling International (SSI) from November 6 to 17, 2015 (3011 respondents). Data analysis was conducted from September 28 to October 8, 2018. After dropping respondents meeting the exclusion criteria, the final sample sizes were 2011 (MTurk) and 2499 (SSI).

MAIN OUTCOMES AND MEASURES

The primary outcome measures were self-reported nondisclosure of 7 types of information to their clinician (eg, did not understand instructions, medication use) and reasons for nondisclosure (eg, embarrassment, not wanting to be judged).

RESULTS

There was a total of 4510 overall respondents. Of 2096 respondents, 2013 completed the MTurk survey (96.0% completion rate) and 2011 were included in the analysis. Of 3011 respondents, 2685 completed the SSI survey (89.2% completion rate) and 2499 were included in the analysis. The mean (SD) age of the participants was 36 (12.4) years for MTurk and 61 (7.59) years for SSI. Both samples were predominantly white (MTurk: 1696 [84.3%]; SSI: 1968 [78.8%]). A total of 1630 MTurk participants (81.1%) and 1535 SSI participants (61.4%) avoided disclosing at least 1 type of information. Disagreeing with the clinician's recommendation (MTurk: 918 of 2010 respondents [45.7%]; SSI: 785 of 2497 respondents [31.4%]) and not understanding the clinician's instructions (MTurk: 638 of 2009 respondents [31.8%]; SSI: 607 of 2497 respondents [24.3%]) were the most common occurrences. The most commonly reported reasons for nondisclosure included not wanting to be judged or lectured (MTurk: 81.8% [95% CI, 79.8%-83.9%]; SSI: 64.1% [95% CI, 61.5%-66.7%]), not wanting to hear how harmful the behavior is (MTurk: 75.7% [95% CI, 73.5%-78.0%]; SSI: 61.1% [95% CI, 58.5%-63.8%]), and being embarrassed (MTurk: 60.9% [95% CI, 58.9%-62.9%]; SSI: 49.9% [95% CI, 47.8%-52.1%]). In both samples, participants who were women (MTurk: odds ratio [OR], 1.88 [95% CI, 1.49-2.37]; SSI: OR, 1.38 [95% CI, 1.17-1.64]), younger (MTurk: OR, 0.98 [95% CI, 0.97-0.99]; SSI: OR, 0.98 [95% CI, 0.97-0.99]), and with worse self-rated health (MTurk: OR, 0.87 [95% CI, 0.76-0.99]; SSI: OR, 0.80 [95% CI, 0.72-0.88]) were more likely to report withholding information.

CONCLUSIONS AND RELEVANCE

Many respondents in these surveys intentionally withhold important information from their clinicians and were most likely to do so when they disagreed with or misunderstood their clinician's instructions. A better understanding of how to increase patients' comfort with reporting this information may improve the clinician-patient relationship and patient care.

Integrative Pediatrics: Successful Implementation of Integrative Medicine in a German Hospital Setting-Concept and Realization

Complementary and Alternative Medicine (CAM) has not been systematically institutionalized in pediatric hospital care in Germany so far. For the responsible implementation and systematic evaluation of CAM in pediatric care, a model project was initialized in three different pediatric hospitals in Germany, one of them being the “Kinderkrankenhaus St. Marien” in Landshut, Germany. During this project, a concept of the implementation process was developed based on clinical care, teaching, and scientific evaluation. A project group was formed in St. Marien, which included leaders of the hospital, physicians, nurses, and physiotherapists. Over a period of three years, pediatric treatment modalities of the CAM-spectrum were systematically integrated into routine pediatric care and a new integrative medicine department was established. CAM is now being applied in an inpatient as well as outpatient setting, in addition to conventional medical treatments. The modalities now applied include Traditional Chinese Medicine (TCM), relaxation, hypnosis, reflexology, wraps and poultices, aromatherapy, homeopathy, yoga, and herbal medicine. Studies were initiated in some areas. The process and concept leading up to this successful implementation will be described in this article. We show that with motivated team players and structured proceedings, implementation of integrative medicine in a children’s hospital can be successful.

Use and Nondisclosure of Complementary Health Approaches Among US Children with Developmental Disabilities

OBJECTIVES

Many US children use complementary health approaches (CHAs), including some modalities that may be ineffective, unsafe, and/or costly. Yet, little is known about the prevalence and correlates of CHA use among children with developmental disabilities (DDs), as well as parent nondisclosure of CHAs used for children with DDs to health care providers. We, therefore, aimed to profile the use and nondisclosure of CHAs among US children with DDs.

METHODS

We analyzed data from the 2012 National Health Interview Survey, which included the most recent Child Complementary and Alternative Medicine Supplement. The study sample was comprised of 2141 children with DDs aged 4 to 17 years.

RESULTS

Nearly one-quarter (23%) of US children with DDs used CHAs. Among those with a personal health provider, 42% of parents did not disclose some or all CHAs used to the child's provider. The adjusted odds ratios of using CHAs were greater among those with female sex, higher household income, residences not in the South, difficulty accessing care, or comorbid conditions. CHA was most commonly used because "it is natural." Nondisclosure was associated with female sex, older age, having no functional limitations, less conventional services use, and use of fewer CHAs. The most common reason for nondisclosure was that the child's provider did not ask.

CONCLUSION

Complementary health approach use is prevalent among US children with DDs, and nondisclosure is likely among those who use CHAs. Future intervention targeting education and communication about CHAs for parents of children with DDs and their health care providers may promote disclosure.

Conducting an Integrative Health Interview

Complementary medicine incorporates the use of non-evidence-based complementary modalities into conventional (Western) medicine. Alternative medicines are approaches that are used in place of conventional medicine. Integrative medicine is the synthesis of conventional medical treatments with "evidence-based" complementary medical practices. When complementary approaches are incorporated into mainstream health care, it is called integrative health (IH). Among children and adults, IH is common despite not all therapies being safe and/or effective. Clinicians have suboptimal knowledge of their patients' IH use because, in part, they do not know what questions to ask and/or do not have a standard intake form to collect an IH history, as recently demonstrated by an American Academy of Allergy, Asthma, and Immunology membership survey. To address this unmet need, a group of Complementary and Alternative Practice in Allergy Committee members and interprofessional collaborators reviewed the existing literature to locate IH history forms that could assist in identifying patients' IH use. When none was located, the group created 3 templates for the systematic collection and documentation of IH practices: 2 general screening surveys that could be given to patients to complete before an appointment and a third template that provides the clinician with open-ended questions to help uncover IH practices in culturally diverse patient populations. Specialists, already acknowledged as skillful interviewers, can expand their patient-centered expertise by developing their own IH competencies.

Parent disclosure of complementary health approaches used for children with autism spectrum disorder: Barriers and facilitators

BACKGROUND AND OBJECTIVES

Complementary health approaches (CHA) are widely used among children with autism spectrum disorder (ASD). As part of shared treatment decision-making, healthcare providers are encouraged to discuss CHA with parents of children with ASD. Yet prior research suggests that parents often do not disclose CHA used for children, and their reasons for nondisclosure are poorly understood. We, therefore, aimed to identify barriers and facilitators to parent disclosure of CHA used for children with ASD.

DESIGN AND SETTING

In-depth interviews were conducted with 31 parents who reported that they were currently using CHA for their child's ASD in Denver, Colorado or Portland, Oregon.

RESULTS

We used content analysis to identify six main themes indicating that the following factors play a role in disclosure: parents' drive to optimize their child's health, parent self-efficacy discussing CHA with healthcare providers, parent beliefs about the effectiveness of CHA, parent-provider relationship quality, provider attitudes and knowledge regarding CHA and ASD, and visit characteristics.

CONCLUSIONS

Study findings suggest that family and health system factors, together, influence parent disclosure of CHA used for children with ASD. Multifaceted intervention concurrently targeting the CHA-related knowledge, beliefs, and self-efficacy of parents whose children have been recently diagnosed with ASD, in addition to the CHA-related attitudes and knowledge of their healthcare providers may promote disclosure and shared treatment decision-making about the use of CHA.

Physician perspectives on education, training, and implementation of complementary and alternative medicine

Over recent decades, the demand for complementary and alternative medicine (CAM) has continued to rise in the US. Like the practice of traditional Western medicine, CAM is associated with not only significant health benefits but also significant risks. Unlike traditional Western medicine, however, much of CAM use is less regulated and often occurs unbeknownst to a patient's medical doctor. The use of herbals, dietary supplements, and over-the-counter (OTC) medications can result in adverse effects, and many significant interactions can occur when their use is combined with allopathic medications. Even the more peripheral CAM practices (eg, acupuncture, massage, yoga, and Reiki) have associated risk (eg, adverse effects or worsening of physical injury and conditions). There is, however, impetus for change: both patients and physicians favor increasing physician knowledge of CAM and the synergistic implementation of CAM into routine clinical practice. Although improvement has been achieved from contemporary physician educational efforts, recently published results from patient and physician surveys strongly indicate that additional effort to increase physician knowledge of CAM is needed. Utilizing a 37-item survey and convenience-sampling methodology, we collected detailed information from 114 physicians, fellows, and residents from the Ohio State University Medical Center regarding impediments to increasing physician knowledge of CAM and its implementation in routine clinical practice. The aggregate results of our survey data showed that most physicians 1) desired to increase their knowledge of CAM, 2) believed that less than half of their patients were spontaneously reporting their use of CAM therapies, 3) were not aware of available evidence-based resources on CAM, 4) preferred case-based lectures for learning about CAM, and 5) reported insufficient time during patient encounters as the primary barrier for increasing the implementation of CAM in routine clinical practice.

Complementary and alternative medicines and childhood eczema: a US population-based study

The prevalence of complementary and alternative medicine (CAM) use in US children with eczema is unknown. Furthermore, it is unknown whether CAM use in the United States is associated with higher eczema prevalence. We sought to determine the eczema prevalence in association with CAM usage. We analyzed data from the 2007 National Health Interview Survey that included a nationally representative sample of 9417 children ages 0 to 17 years. Overall, 46.9% (95% confidence interval, 45.6%-48.2%) of children in the United States used 1 or more CAM, of which 0.99% (0.28%-1.71%) used CAM specifically to treat their eczema, including herbal therapy (0.46%), vitamins (0.33%), Ayurveda (0.28%), naturopathy (0.24%), homeopathy (0.20%), and traditional healing (0.12%). Several CAMs used for other purposes were associated with increased eczema prevalence, including herbal therapy (survey logistic regression; adjusted odds ratio [95% confidence interval], 2.07 [1.40-3.06]), vitamins (1.45 [1.21-1.74]), homeopathic therapy (2.94 [1.43-6.00]), movement techniques (3.66 [1.62-8.30]), and diet (2.24 [1.10-4.58]), particularly vegan diet (2.53 [1.17-5.51]). In conclusion, multiple CAMs are commonly used for the treatment of eczema in US children. However, some CAMs may actually be harmful to the skin and be associated with higher eczema prevalence in the United States.

Asthma medications should be available for over-the-counter use: pro

Medications that provide quick relief of symptoms and that control airway inflammation are the mainstays of asthma treatment. However, adherence to these medications is suboptimal. The inconvenience and costs associated with obtaining these prescription-only medications are factors that contribute to poor adherence. The Food and Drug Administration recently requested public comment on a new paradigm whereby specific prescription-only medications could be made available over the counter, provided that conditions for their safe use could be established. Many organizations expressed opposition, including the American Thoracic Society and other societies representing patients with respiratory diseases. These organizations cited unsubstantiated benefits and unnecessary risks as reasons to oppose greater over-the-counter availability of current prescription-only medications. This article examines the rationale for, and potential ramifications of, making asthma medications available for nonprescription use.

Illness representations and cultural practices play a role in patient-centered care in childhood asthma: experiences of Mexican mothers

OBJECTIVE

Patients' cultural health beliefs and behaviors may conflict with biomedical healthcare values and practices potentially leading to non-adherence with asthma treatment regimens. To optimize shared decision-making, healthcare providers should understand and be sensitive to these cultural beliefs and behaviors and negotiate an asthma management plan acceptable to parents. The purpose of this study was to obtain the perspective of Mexican mothers regarding (1) their experiences of living with a child with asthma, (2) their understanding of the nature of asthma, and (3) how their cultural beliefs influence asthma management.

METHODS

A qualitative, phenomenological study design was employed to assess mothers' lived experiences with and perceptions of their child's asthma. Individual in-depth interviews were conducted with a purposeful sample of 20 Mexican mothers of children ages 5-17 years with asthma. An inductive, theory-driven, phenomenological analysis approach was used to elicit thematic findings.

RESULTS

Mothers expressed a symptomatic perception of asthma and limited understanding of the disease. Most believe the disease is present only when their child is symptomatic. Many are surprised and puzzled by the unpredictability of their child's asthma attacks, which they report as sometimes "silent". The inconsistency of triggers also leads to frustration and worry, which may reflect their concerns around daily controller medication use and preference for alternative illness management strategies.

CONCLUSIONS

Our clinical encounters should be refocused to better understand the context of these families' lives and the cultural lens through which they view their child's asthma.

Critical review of complementary and alternative medicine use in menopause: focus on prevalence, motivation, decision-making, and communication

OBJECTIVE

This study aims to undertake the first critical review of complementary and alternative medicine (CAM) use among menopausal women (a term here used to include premenopausal, perimenopausal and postmenopausal women) by focusing on the prevalence of CAM use and CAM users' characteristics, motivation, decision-making, and communication with healthcare providers.

METHODS

A comprehensive search of 2002-2012 international literature in the Medline, CINAHL, AMED, and SCOPUS databases was conducted. The search was confined to peer-reviewed articles published in English with abstracts and reporting new empirical research findings regarding CAM use and menopause.

RESULTS

A considerable level of CAM use was observed among women in menopause. Many menopausal women use CAM concurrently with their conventional medicine. However, communication regarding CAM between menopausal women and healthcare providers seems less than optimal, with a demand for further information on the safety and efficacy of medicines. Existing literature is of variable methodological rigor, often presenting small sample sizes and low-quality data collection. Further rigorous research on this topic-including quantitative and qualitative methods using large national samples, where relevant-is required.

CONCLUSIONS

The findings of this critical review provide insights for those practicing and managing health care in this area of women's health. Healthcare providers should prepare to inform menopausal women about all treatment options, including CAM, and should be aware of the possible adverse effects of CAM and potential interactions between CAM and conventional medicine among women in menopause who are under their care.

Complementary and alternative medicine: A survey of its use in children with chronic respiratory illness

BACKGROUND

The use of complementary and alternative medicine (CAM) has increased in recent years, with especially high prevalence in individuals with chronic illnesses. In the United States, the prevalence of CAM use in pediatric asthma patients is as high as 89%.

OBJECTIVE

To investigate the epidemiology of pediatric CAM use in respiratory subspecialty clinics.

METHODS

A survey was conducted at two hospital-based respiratory clinics in Edmonton (Alberta) and Ottawa (Ontario). Caregivers (most often parents) of children <18 years of age were asked questions regarding child and caregiver use of CAM, including products and practices used, beliefs about CAM, trust in information sources about CAM and characteristics of the respondents themselves.

RESULTS

A total of 202 survey questionnaires were completed (151 from Edmonton and 51 from Ottawa). Pediatric CAM use in Edmonton was 68% compared with 45% in Ottawa, and was associated with caregiver CAM use, poorer health and health insurance coverage for CAM. The majority (67%) of children using CAM had taken prescription drugs concurrently and 58% of caregivers had discussed this with their doctor.

DISCUSSION

Lifetime use of CAM at these pediatric clinics was higher than reported for children who do not have chronic diseases. CAM practices that are popular may be worthy of further research to evaluate their effectiveness and safety profile with regard to drug interactions. Health care providers should be encouraged to discuss CAM use at every visit, and explore their patient's health-related beliefs, behaviours and treatment preferences.

Exploring the decision to disclose the use of natural products among outpatients: a mixed-method study

Background

There is little understanding of the reasons for the limited communication between patients and conventional healthcare professionals regarding patients’ use of complementary and alternative medicine (CAM). The purpose of this study is to explore the predictors of outpatients’ decision to disclose their use of natural products to conventional healthcare professionals.

Methods

A mixed method design was used. Quantitative data were obtained through a survey and qualitative data were obtained from semi-structured interviews. A total of 257 outpatients who fulfilled the criteria of having used natural products prior to the interview were recruited for this study. Subsequently, 39 patients of those who completed the survey were further selected to take part in an in-depth qualitative interview.

Results

Predictors of the decision to disclose the use of natural products to conventional healthcare professionals included age, frequency of clinic visits, knowledge of the natural products and the attitude towards the benefits of CAM use. The themes that emerged from the qualitative data included safeness of the natural products, consulting alternative sources of information, apprehension regarding the development of negative relationships with healthcare professionals and reactions from the healthcare professionals.

Conclusions

Understanding the factors and reasons affecting patients’ decision as to whether to disclose their use of natural products provides an opportunity for conventional healthcare professionals to communicate better with patients. It is important to encourage patients to disclose their use of natural products in order to provide responsible health care as well as increasing patient safety regarding medication usage.

Traditional and complementary approaches to health for children: Modelling the parental decision-making process using Andersen's Sociobehavioural Model

OBJECTIVES

Traditional and complementary approaches to health (TCA) are common for children. Andersen's Sociobehavioural Model (SBM) is often used to explain healthcare decision-making. This study aimed to identify the prevalence and determinants of traditional and complementary approaches to health (TCA) in a multi-ethnic child population, and to explore whether the SBM explained TCA health care decision-making in this population.

DESIGN

Cross-sectional questionnaire survey. NHS ethical approval was given.

SETTING

GP waiting rooms, Northwest London.

MAIN OUTCOME MEASURE AND ANALYSIS

All carers/parents (with children under 16), attending GP appointments on specific days, were asked to complete a questionnaire about TCA use; primary outcome 12-month child TCA use. Forward stepwise logistic regression tested appropriateness of the SBM.

RESULTS

A total of 394 questionnaires were returned, representing 737 children; a quarter White British. Prevalence of 12-month TCA use was 45.4%, mainly food-based herbs/spices for minor illnesses which were used prior to GP consultation. Over half identified that TCA was part of their ethnic/cultural background. Only 29% had discussed TCA with their GP. The strongest predictor of child TCA use in the SBM was carer TCA use, itself influenced by carer gender and ethnicity, and GP advice. Need factors were not influential.

CONCLUSIONS

Child TCA use was common in this multi-ethnic community, particularly the use of food-based remedies for minor illnesses, and carers' experience and background are central in deciding to use TCA for a child. TCA appears practiced as part of cultural background, with implications for GPs to be aware of their role in guiding patients to ensure safe practice.

The Factors Contributing to Expenditures on Over-the-Counter Drugs in South Korea

OBJECTIVES

To determine the factors contributing to the use of over-the-counter (OTC) drugs and to examine the relationship between the purchase of OTC drugs and the utilization of health care services in South Korea.

METHODS

This study used data from the 2008 Korea Health Panel Survey. The respondents were classified according to the purpose of the OTC drug use. The first group (n = 364) included respondents who had purchased OTC drugs for self-medication, and the second group (n = 955) included respondents who had taken OTC drugs for nutrition for more than 3 months. Logistic regression analyses were conducted to identify the factors contributing to the purchase of OTC drugs.

RESULTS

The self-medication group was more likely to be older and to have a chronic disease. In addition, the purchase of OTC drugs was related to the utilization of other health care services. The more outpatient services at clinics were used, the more the respondents tended to purchase OTC drugs for self-medication and nutrition. As hospital outpatient visits increased, however, the purchase of OTC drugs for self-medication decreased and the purchase of OTC drugs for nutrition increased.

CONCLUSIONS

This study shows that age and chronic disease are the major factors related to using OTC drugs for self-medication for long-term periods. Furthermore, this study suggests that the use of outpatient services is one of the factors associated with purchasing OTC drugs. Considering the potential adverse effects of OTC drugs, communication between physicians and patients should be encouraged at outpatient visits.

Heavy metal contaminants in yerberia shop products

Complementary and alternative medications, including the use of herbal medications, have become quite popular in the USA. Yerberias are found throughout the southwest and specialize in selling Hispanic herbal products. The products sold in these stores are not regulated by any governmental agency. Previous reports have found Ayurvedic medications contain high levels of lead, mercury, and arsenic. The primary purpose of this study is to examine the prevalence of heavy metal contaminants sold at Yerberia stores in the southwest. Yerberias in the Phoenix, Arizona area were identified via search of an on-line search engine using the words "Yerberia Phoenix." Every second store was selected, and products were purchased using a standard script. The products were subsequently analyzed for mercury, lead, and arsenic. The main outcome is the prevalence of heavy metal content in over-the-counter "cold" medications purchased at a Yerberia. Twenty-two samples were purchased. One product contained pure camphor (2-camphone) and was subsequently not further analyzed. Of the 21 samples analyzed, lead was found in 4/21 (19.4 %). Arsenic and mercury were in 1/21 (4.8 %) each. Because two samples contained two heavy metals, the total prevalence of heavy metals was 4/21 (19.4). Heavy metal contaminants are commonly encountered in over-the-counter herbal "cold" medications purchased at Yerberias in the southwest.

A systematic review of complementary and alternative medicine for asthma self-management

This article is a systematic review of complementary and alternative medicine use for pediatric and adult asthma self-management. The aim of the review was to summarize the existing body of research regarding the types and patterns of, adverse events and risky behaviors associated with, and patient-provider communication about complementary therapies in asthma. This evidence serves as the basis for a series of recommendations in support of patient-centered care, which addresses both patient preferences for integrated treatment and patient safety.

Completeness, accuracy, and presentation of information on interactions between prescription drugs and alternative medicines: an internet review

BACKGROUND

As the use of the Internet continues to increase across all age groups and education levels, with usage in the US around 78%, consumers are increasingly turning to the Internet for health related information.

OBJECTIVE

To assess the completeness, accuracy, and consumer friendliness of information on the Internet pertaining to drug-Complementary and Alternative Medicine (CAM) interactions with cardiac drugs.

METHODS

A review of online information was performed across three search engines and ten drug-CAM pairs.

RESULTS

Overall, the quality of the drug-CAM interaction information available online to consumers is fairly poor. Only one site contained an interaction checker that provided interaction information for all ten pairs, but with an accuracy rate of 50%. Reading levels ranged from 10.5-23.5, with a mean of 16.7. A value greater than 22 indicates a graduate level reading skill.

CONCLUSION

Web site developers should be cautious in presenting drug-CAM interaction information unless it is comprehensive and regularly maintained. Consumers should also know how to evaluate sites before trusting the content where the consequences are potentially severe.

Integration of complementary and alternative medicine in primary care: what do patients want?

OBJECTIVE

To explore patients' perspectives towards integration of Complementary and Alternative Medicine (CAM) in primary care.

METHODS

A mixed-methods approach was used. This included a survey on use, attitudes and disclosure of CAM, an e-panel consultation and focus group among patients with joint diseases.

RESULTS

A total of 416 patients responded to the survey who suffered from osteoarthritis (51%), rheumatoid arthritis (29%) or fibromyalgia (24%). Prevalence of CAM use was 86%, of which 71% visited a CAM practitioner. Manual therapies, acupuncture and homeopathy were most frequently used. A minority (30%) actively communicated CAM use with their General Practitioner (GP). The majority (92%) preferred a GP who informed about CAM, 70% a GP who referred to CAM, and 42% wanted GPs to collaborate with CAM practitioners. Similar attitudes were found in the focus group and upon e-panel consultation.

CONCLUSIONS

Most patients in primary care want a GP who listens, inquires about CAM and if necessary refers to or collaborates with CAM practitioners.

PRACTICE IMPLICATIONS

To meet needs of patients, primary care disease management would benefit from an active involvement of GPs concerning CAM communication/referral. This study presents a model addressing the role of patients and GPs within such an integrative approach.

The challenges of facilitating primary healthcare discussions on traditional, complementary and alternative medicine for childhood eczema: piloting a computerized template

OBJECTIVE

Healthcare practitioners (HCPs) experience barriers to changing routine consultation practice. Communication and recording of traditional, complementary and alternative medicines (TCAM) is inadequate. This pilot study explored the challenges of implementing a computerized template in primary care to facilitate communication on TCAM for paediatric eczema.

METHODS

A computerized template to record TCAM use, with links to evidence-based TCAM databases, was designed, based on qualitative research with patients and HCPs. Four London general practices implemented the template integrated with usual practice. Twelve focus groups during the 6 month study period explored HCPs' knowledge, communication and information sources regarding TCAM and perceived barriers to template implementation.

RESULTS

HCPs were initially enthusiastic about discussing TCAM, for improving communication and understanding patient's choices, but the template was used in under a third of consultations. HCPs were surprised at low TCAM use (10%) and lack of correlation with eczema or ethnicity. Reported barriers were time and remembering, due to busy, target-driven practice.

CONCLUSION

HCPs recognize the importance of discussing TCAM use for childhood eczema, and potential benefits for HCP-patient communication.

PRACTICE IMPLICATIONS

Future tools to facilitate TCAM discussion should prioritise use of existing IT systems and address barriers to use, especially lack of time.

Complementary and alternative medicine use for headache and migraine: a critical review of the literature

CONTEXTS: An evidence base for complementary and alternative medicine (CAM) consumption within general populations is emerging. However, research data on CAM use for headache disorders remain poorly documented. This paper, constituting the first critical review of literature on this topic, provides a synopsis and evaluation of the research findings on CAM use among patients with headache and migraine.

METHODS

A comprehensive search of literature from 2000 to 2011 in CINAHL, MEDLINE, AMED, and Health Sources was conducted. The search was confined to peer-reviewed articles published in English reporting empirical research findings of CAM use among people with primary headache or migraine.

RESULTS

The review highlights a substantial level of CAM use among people with headache and migraine. There is also evidence of many headache and migraine sufferers using CAM concurrent to their conventional medicine use. Overall, the existing studies have been methodologically weak and there is a need for further rigorous research employing mixed method designs and utilizing large national samples.

DISCUSSION

The critical review highlights the substantial prevalence of CAM use among people with headache and migraine as a significant health care delivery issue, and health care professionals should be prepared to inquire and discuss possible CAM use with their patients during consultations. Health care providers should also pay attention to the possible adverse effects of CAM or interactions between CAM and conventional medical treatments among headache and migraine patients.

Complementary and alternative medicine use and psychosocial outcomes among urban adolescents with asthma

Objective. Many adolescents with asthma use complementary and alternative medicine (CAM) for asthma symptom management. The purpose of this study was to investigate cross-sectional and longitudinal differences in psychosocial health outcomes between high and low CAM users among urban adolescents with asthma. Methods. Adolescents (Time 1: N = 151, Time 2: N = 131) completed self-report measures regarding the use of 10 CAM modalities, mental health, and health-related quality of life (HRQoL) following two clinic visits 1 year apart as part of a larger observational study. Multivariable regression analyses using backward elimination examined relationships between CAM use at Time 1 and outcomes at Time 1 and Time 2, controlling for key covariates and, in longitudinal analyses, Time 1 functioning. Results. Participants (M(age) = 15.8, SD = 1.85) were primarily African-American (n = 129 [85%]) and female (n = 91 [60%]) adolescents with asthma. High and low CAM users differed significantly in terms of several psychosocial health outcomes, both cross-sectionally and longitudinally. In cross-sectional multivariable analyses, greater frequency of praying was associated with better psychosocial HRQoL (R(2) = 0.22). No longitudinal relationships remained significant in multivariable analyses. Conclusions. Specific CAM techniques are differentially associated with psychosocial outcomes, indicating the importance of examining CAM modalities individually. Greater frequency of praying was cross-sectionally associated with better psychosocial HRQoL. When controlling for key covariates, CAM use was not associated with psychosocial outcomes over time. Further research should examine the effects of CAM use in controlled research settings.

Complementary and alternative medicine use and adherence with pediatric asthma treatment

BACKGROUND AND OBJECTIVE

Complementary and alternative medicine (CAM) use for pediatric asthma is increasing. The authors of previous studies linked CAM use with decreased adherence to conventional asthma medicines; however, these studies were limited by cross-sectional design. Our objective was to assess the effect of starting CAM on pediatric adherence with daily asthma medications.

METHODS

We used a retrospective cohort study design. Telephone surveys were administered to caregivers of patients with asthma annually from 2004 to 2007. Dependent variables were percent missed doses per week and a previously validated "Medication Adherence Scale score." Independent variables included demographic factors, caregiver perception of asthma control, and initiation of CAM for asthma. We used multivariate linear regression to assess the relationship between medication adherence and previous initiation of CAM.

RESULTS

From our longitudinal data set of 1322 patients, we focused on 187 children prescribed daily medications for all 3 years of our study. Patients had high rates of adherence. The mean percent missed asthma daily controller medication doses per week was 7.7% (SD = 14.2%). Medication Adherence Scale scores (range: 4-20, with lower scores reflecting higher adherence) had an overall mean of 7.5 (SD = 2.9). In multivariate analyses, controlling for demographic factors and asthma severity, initiation of CAM use was not associated with subsequent adherence (P > .05).

CONCLUSIONS

The data from this study suggest that CAM use is not necessarily "competitive" with conventional asthma therapies; families may incorporate different health belief systems simultaneously in their asthma management. As CAM use becomes more prevalent, it is important for physicians to ask about CAM use in a nonjudgmental fashion.

Complementary and alternative medicine (CAM) use among children with current asthma

OBJECTIVE

To estimate the prevalence of complementary and alternative medicine (CAM) use among children with current asthma.

DESIGN

We analyzed data from the Asthma Call Back Survey (ACBS) 2006-2008. ACBS is a follow-up to the state-based Behavioral Risk Factor Surveillance System (BRFSS) survey that collects information on asthma and related factors including CAM use for asthma. The survey is administered to the parents who report in a subset of BRFSS states that their children have asthma. 5435 children had current asthma and were included in this analysis.

RESULTS

Overall, 26.7% (95% confidence interval [CI]=24.5-29.0) of children with current asthma reported CAM use in the previous 12 months. Among them, the three most commonly used therapies were breathing techniques (58.5%; 95% CI=53.6-63.5), vitamins (27.3%; 95% CI=23.0-31.5), and herbal products (12.8%; 95% CI=9.2-16.4). Multivariate analysis of CAM use revealed higher adjusted odds ratios (aOR) among children who experienced cost barriers to conventional health care compared with children with no cost barrier (aOR=1.8; 95% CI=1.2-2.8). Children with poorly controlled asthma were most likely to use all types of CAM when compared to their counterpart with well-controlled asthma: aOR=2.3 (95% CI=1.6-3.3) for any CAM; aOR=1.7 (95% CI=1.2-2.6) for self-care based CAM; and aOR=4.4 (95% CI=1.6-9.3) for practitioner-based CAM.

CONCLUSIONS

Children with poorly controlled asthma are more likely to use CAM; this likelihood persists after controlling for other factors (including parent's education, barriers to conventional health care, and controller medication use). CAM is also more commonly used by children who experienced cost barriers to conventional asthma care. CAM use could be a marker to identify patients who need patient/family education and support thus facilitate improved asthma control.

Use of complementary and alternative medicine among asthmatic patients in primary care clinics in Malaysia

OBJECTIVES

This study aimed to determine the knowledge about asthma and the prevalence, disclosure and evaluation of the use of complementary and alternative medicine (CAM) among asthmatic patients.

METHODS

This cross-sectional study was conducted on 95 patients diagnosed with asthma in a primary healthcare centre in Kuala Lumpur, Malaysia using a self-administered questionnaire.

RESULTS

Ninety-five patients with a mean age of 47.06 years (±12.8) participated, the majority were female (66.7%), Malay (72.6%). The prevalence of ever-CAM use was 61.1%. The non-ever-CAM users' mean age was 51±13.9 years while the ever-CAM users' mean age was 44.5 ±11.5 years (P = 0.021). Sixty-three females (66.8%) used CAM compared to 14 males (43.8%) (P = 0.014). Thirty-six (62.1%) CAM users had not discussed use of CAM with their doctors. The main reason of non-disclosure was the doctor never asked (55.6%), and the main sources of information about CAM were family and relatives (46.6%). There was no significant difference between use of CAM and knowledge about asthma. The majority of asthmatic patients used rubs (39%), foods (16.9%) and herbs (16.9%). About 76% of asthmatic patients perceived CAM as good for their disease management. On linear multiple regression, Malay race (P = 0.026) and female gender (P = 0.006) were significant predictors of CAM use.

CONCLUSION

Use of CAM among asthmatic patients is relatively high, particularly among females. The majority of asthmatic patients valued the use of CAM. Non-disclosure was high in this study. Health education of asthmatic patients about CAM is highly recommended.

Medication use in children with asthma: not a child size problem

OBJECTIVE

The global burden of pediatric asthma is high. Governments and health-care systems are affected by the increasing costs of childhood asthma--in terms of direct health-care costs and indirect costs due to loss of parental productivity, missed school days, and hospitalizations. Despite the availability of effective treatment, the current use of medications in children with asthma is suboptimal. The purpose of this review is to scope the empirical literature to identify the problems associated with the use of pediatric asthma medications. The findings will help to design interventions aiming to improve the use of asthma medications among children.

METHODS

A literature search using electronic search engines (i.e., Medline, International Pharmaceutical Abstracts (IPA), PubMed, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature (CINAHL)) and the search terms "asthma," "children," and "medicines" (and derivatives of these keywords) was conducted.

RESULTS

The search terms were expanded to include emergent themes arising out of search findings. Content themes relating to parents, children themselves, health-care professionals, organizational systems, and specific medications and devices were found. Within these themes, key issues included a lack of parental knowledge about asthma and asthma medications, lack of information provided to parents, parental beliefs and fears, parental behavioral problems, the high costs of medications and devices, the child's self-image, the need for more child responsibility, physician nonadherence to prescribing guidelines, "off-label" prescribing, poor understanding of teachers, lack of access to educational resources, and specific medications.

CONCLUSION

These key issues should be taken into account when modifying the development of educational tools. These tools should focus on targeting the children themselves, the parent/carers, the health-care professionals, and various organizational systems.

A longitudinal analysis of complementary and alternative medicine use by a representative cohort of young Australian women with asthma, 1996-2006

BACKGROUND

There is evidence of asthma patients using complementary and alternative medicine (CAM). This article reports the findings of the first ever longitudinal study of CAM use among women with asthma from a large nationally representative sample.

METHODS

A longitudinal analysis of questionnaires completed in 1996, 2000, 2003, and 2006 as part of the Australian Longitudinal Study on Women's Health. The cohort began with 14,701 randomly selected young women (aged 18-22 years). CAM use was defined as a consultation with a range of complementary practitioners in the 12 months prior to each survey. Statistical analyses included the use of generalized estimating equations.

RESULTS

Over the 10-year period, approximately 26% of the women were asthmatic. Asthmatic women were significantly more likely to use CAM (19%, 22%, and 36% for surveys 2-4, respectively) than non-asthmatic women (15%, 20%, and 32% for surveys 2-4, respectively). CAM use increased as time since asthma diagnosis increased. However, only the increase in consultations with a naturopath/herbalist remains statistically significant when the CAM modalities are considered individually alongside asthma status. The longitudinal model suggests that women with asthma are 1.13 (95% CI: 1.05-1.21) times more likely to consult with a CAM practitioner (p< .001). The study also shows that CAM users have a higher dissatisfaction with conventional healthcare services and consultations when compared to CAM non-users.

CONCLUSION

These findings suggest that women with asthma may turn to CAM after conventional care fails to adequately address their healthcare needs.

Integrative pediatric care: parents' attitudes toward communication of physicians and CAM practitioners

OBJECTIVE

In this study, we explored parents' perspectives toward complementary and alternative medicine (CAM) use by their children and its impact on parent-doctor and doctor-CAM-practitioner communication.

PATIENTS AND METHODS

We designed a 2-arm study of parents who approached either conventional primary care or CAM clinics with their children to consult physicians or practitioners regarding their child's health.

RESULTS

A total of 599 parents responded to our questionnaire (319 in 5 conventional clinics [83.9% response rate] and 280 in 21 CAM clinics [71.2% response rate]). Parents in conventional clinics reported less use of CAM by their children within the previous year (35.3% vs 73.7%; P < .0001) but used more traditional and homemade remedies (46.4% vs 12.7%; P < .0001). Both parent groups largely supported informing their child's physician regarding CAM use and expected the physician to initiate a CAM-related conversation and to refer their child to a CAM practitioner. The 2 groups' respondents largely supported communication between the child's physician and the CAM practitioner by the use of a referral/medical letter. Compared with respondents in CAM clinics, parents in conventional clinics were more supportive of CAM integration in a pediatric primary care setting and envisioned a more dominant role of physicians regarding CAM referral and a significant role of physicians in providing CAM.

CONCLUSIONS

Parents who are referred to conventional and CAM clinics express distinctive attitudes toward CAM integration in pediatric care. Parents perceive physician-CAM practitioner communication as highly important and instrumental in promoting their children's health and safety.

Validation of the Asthma Illness Representation Scale-Spanish (AIRS-S)

BACKGROUND

To expand knowledge surrounding parental illness representations (IRs) of their children's asthma, it is imperative that culturally appropriate survey instruments are developed and validated for use in clinical and research settings. The Asthma Illness Representation Scale (AIRS) provides a structured assessment of the key components of asthma IRs, allowing the health care provider (HCP) to quickly identify areas of discordance with the professional model of asthma management. The English AIRS was developed and validated among a geographically and ethnically diverse sample. The authors present the validation results of the AIRS-S (Spanish) from a sample of Mexican and Puerto Rican parents.

METHODS

The AIRS was translated and back translated per approved methodologies. Factor analysis, internal reliability, external validity, and 2-week test-retest reliability (on a subsample) were carried out and results compared with the validated English version. Data were obtained from 80 Spanish-speaking Mexican and Puerto Rican parents of children with asthma. The sample was recruited from two school-based health centers and a free medical clinic in Phoenix, Arizona, and a hospital-based asthma clinic in Bronx, New York.

RESULTS

The original Nature of Asthma Symptoms, Facts About Asthma, and Attitudes Towards Medication Use subscales emerged. Remaining factors were a mixture of items with no coherent or theoretical distinction between them. Interpretation of results is limited due to not meeting the minimum requirement of 5 observations/item. Cronbach's alpha coefficients for the total score (alpha = .77) and majority of subscales (alpha range = .53-.77) were acceptable and consistent with the English version. Parental reports of a positive relationship with the HCP significantly predicted AIRS scores congruent with the professional model; longer asthma duration was associated with beliefs aligned with the lay model; and AIRS scores congruent with the professional model were related to lower asthma severity. Stability in AIRS-S scores over 2 weeks was demonstrated.

CONCLUSIONS

The AIRS-S is a culturally appropriate instrument that can be used by HCPs to ascertain Spanish-speaking parents' asthma illness beliefs and assess discordance with the professional model of asthma management. This information can be used by the HCP when discussing parent's asthma management strategies for their children during clinical encounters.

What's new in alternative therapies for asthmatic children?

Nurses require current information about popular complementary and alternative medicine for pediatric asthma. This integrative review searched scientific literature in PubMed and WEB of Science from 2004 to 2009 via key terms: asthma complementary medicine, nursing complementary pediatric asthma, asthma herbal, and herbal pediatric asthma. Nine journal articles met the inclusion criteria of containing data collection and analysis for biologically based therapies for pediatric asthma. Evidenced-based research on this focus topic is still in its initial stages. Two themes of maximizing the diet and augmenting conventional therapy with Traditional Chinese Medicine may serve as conduits of patient education.