Use of conventional care and complementary/alternative medicine among US adults with arthritis

Does Patient Race Affect Physical Therapy Treatment Recommendations?

BACKGROUND

Racial disparities in the medical treatment of adults with arthritis are well-documented. Disparities with physical therapy treatment have yet to be thoroughly evaluated.

OBJECTIVE

To investigate the association of patient's race with physical therapy treatment recommendations for patients with arthritis.

DESIGN

Online survey.

METHODS

Physical therapists, physical therapist assistants, student physical therapists, and student physical therapist assistants within a Southern California county completed an online survey that presented a case vignette with a randomly assigned photograph of a White or Black woman. Recommendations for the plan of care included frequency of visits and number of exercises in the home exercise program (HEP), referrals to other healthcare professionals, and explicit ranking of how patient characteristics impacted the treatment planning were compared between respondents who viewed the Black or White patient.

RESULTS

Eighty-three participants completed the survey, and all participants reported that the patient was appropriate for physical therapy. Most participants (66.3%) reported that they would recommend a frequency of therapy of 2-3 times weekly. All participants recommended including a HEP. There were no statistically significant differences by patient race in recommendations for treatment frequency or referrals to other healthcare team members. HEP prescription was a median of four exercises, but participants who viewed the Black patient were more likely to recommend fewer exercises than those who viewed the White patient (p = 0.03). Explicitly, 96.1% of participants reported that race did not impact their treatment recommendations.

CONCLUSIONS

In most aspects of treatment planning, the patient's race did not impact recommendations by physical therapy professionals. The lower exercise prescription assigned to the Black patient may represent a disparity that merits further attention.

A National Survey of Complementary and Alternative Medicine Use for Treatment Among Asian-Americans

Asian Americans (AAs) are more likely to use complementary and alternative medicine (CAM) compared to other race/ethnicities, yet previous studies have conflicting results. The 2012 National Health Interview Survey data was analyzed to investigate AA's (n = 2214) CAM use for treatment. AAs were divided into four subgroups: Chinese, Asian Indian, Filipino, and Other Asian. Only 9% of AAs reported using CAM for treatment, with 6% indicating CAM use specifically for chronic conditions. This could be a form of medical pluralism, a mixture of Eastern and Western health approaches. The "Other Asian" subgroup reported highest use of CAM for treatment. Significant predictors included age (≥ 65 years) and high educational attainment (≥ college degree). Sociodemographic factors were also significant predictors within Asian subgroups. Further investigation of this and other forms of medical pluralism among AAs are needed to explore potential cofounders and risks like underreporting, CAM schedules/dosages, cultural influences, and CAM's impact on one's health.

Examining racial and ethnic trends and differences in annual healthcare expenditures among a nationally representative sample of adults with arthritis from 2008 to 2016

BACKGROUND

Disparities in health care utilization and outcomes for racial and ethnic minorities with arthritis are well-established. However, there is a paucity of research on racial and ethnic differences in healthcare expenditures and if this relationship has changed over time. Our objectives were to: 1) examine trends in annual healthcare expenditures for adults with arthritis by race and ethnicity, and 2) determine if racial and ethnic differences in annual healthcare expenditures were independent of other factors such as healthcare access and functional disability.

METHODS

We used the Medical Expenditures Panel Survey (2008-2016) to examine trends in annual healthcare expenditures within and between racial and ethnic groups with arthritis (n = 227,663). A two-part model was used to estimate the marginal differences in expenditures by race and ethnicity after adjusting for relevant covariates, including the impact of healthcare access.

RESULTS

Between 2008 and 2016, there were no significant changes in unadjusted healthcare expenditures within any of the racial and ethnic groups, but the trend among non-Hispanic whites did differ significantly from Hispanics and Other. In fully adjusted analysis, mean annual expenditures for non-Hispanic whites was $946, $939, and $1178 more than non-Hispanic blacks, Hispanics, and Other, respectively (p < .001). Healthcare access also independently explained expenditure differences in this population with adults who delayed care spending significantly more ($2629) versus those who went without care spending significantly less (-$1591).

CONCLUSIONS

Race and ethnicity are independent drivers of healthcare expenditures among adults with arthritis independent of healthcare access and functional disability. This underscores the need for ongoing research on the factors that influence persistent racial and ethnic differences in this population.

A scoping review of network meta-analyses assessing the efficacy and safety of complementary and alternative medicine interventions

BACKGROUND

Network meta-analysis (NMA) has rapidly grown in use during the past decade for the comparison of healthcare interventions. While its general use in the comparison of conventional medicines has been studied previously, to our awareness, its use to assess complementary and alternative medicines (CAM) has not been studied. A scoping review of the literature was performed to identify systematic reviews incorporating NMAs involving one or more CAM interventions.

METHODS

An information specialist executed a multi-database search (e.g., MEDLINE, Embase, Cochrane), and two reviewers performed study selection and data collection. Information on publication characteristics, diseases studied, interventions compared, reporting transparency, outcomes assessed, and other parameters were extracted from each review.

RESULTS

A total of 89 SR/NMAs were included. The largest number of NMAs was conducted in China (39.3%), followed by the United Kingdom (12.4%) and the United States (9.0%). Reviews were published between 2010 and 2018, with the majority published between 2015 and 2018. More than 90 different CAM therapies appeared at least once, and the median number per NMA was 2 (IQR 1-4); 20.2% of reviews consisted of only CAM therapies. Dietary supplements (51.1%) and vitamins and minerals (42.2%) were the most commonly studied therapies, followed by electrical stimulation (31.1%), herbal medicines (24.4%), and acupuncture and related treatments (22.2%). A diverse set of conditions was identified, the most common being various forms of cancer (11.1%), osteoarthritis of the hip/knee (7.8%), and depression (5.9%). Most reviews adequately addressed a majority of the PRISMA NMA extension items; however, there were limitations in indication of an existing review protocol, exploration of network geometry, and exploration of risk of bias across studies, such as publication bias.

CONCLUSION

The use of NMA to assess the effectiveness of CAM interventions is growing rapidly. Efforts to identify priority topics for future CAM-related NMAs and to enhance methods for CAM comparisons with conventional medicine are needed. SYSTEMATIC REVIEW REGISTRATION: https://ruor.uottawa.ca/handle/10393/35658.

Complementary medicine use in rheumatology: A review

Complementary and alternative medicine (CAM) use is increasing worldwide; specifically it appears that these treatment modalities are popular among rheumatology patients. The most commonly reported CAM therapies are herbal medicines, homeopathy, chiropractic, acupuncture and reflexology. Despite high reported rates of CAM use, the number of patients disclosing use to their rheumatologists remains low. This review highlights rates of current CAM use in rheumatology in studies performed worldwide, and discusses potential reasons for nondisclosure of CAM use to clinicians.

Dietary Supplement Use in Patients With Celiac Disease in the United States

BACKGROUND

There has been increasing interest in the use of complementary and alternative medicine (CAM) in the general population. Little is known about CAM use in patients with celiac disease (CD).

GOALS

We aimed to determine the demographics and clinical characteristics of patients with biopsy-proven CD who use dietary supplements to treat their symptoms.

STUDY

CD patients completed a questionnaire on demographics, types of dietary supplement use, attitudes toward CAM, and 3 validated scales: CD-related Quality Of Life (CD-QOL), the CD Symptoms Index (CSI), and the CD Adherence Test (CDAT).

RESULTS

Of 423 patients, 100 (23.6%) used dietary supplements to treat CD symptoms. The most frequently used supplement was probiotics (n=59). Supplement users had a higher CD-QOL score (75.06 vs. 71.43, P=0.04) but had more symptoms based on CSI (35.64 vs. 32.05, P=0.0032). On multivariable analysis, adjusting for age, sex, education, symptom improvement following a gluten-free diet, and where the survey was completed, patients presenting with classic symptoms (OR, 2.56; 95% CI, 1.01-6.44) or nonclassic symptoms (OR, 2.75; 95% CI, 1.04-7.24) were significantly more likely to use supplements than those with asymptomatic/screen-detected CD.

CONCLUSIONS

Patients with biopsy-proven CD who have symptoms at diagnosis tend to use dietary supplements more than those that are screen detected. Those using supplements report persistent symptoms, but a higher quality of life. The contribution of the gluten-free diet and supplement use to quality of life in the symptomatic CD patient needs to be determined.

To Tell or Not to Tell: Shared Decision Making, CAM Use and Disclosure Among Underserved Patients with Rheumatic Diseases

The purpose of this analysis was to assess the impact of perceived shared decision-making (SDM) on complementary and alternative medicine (CAM) use and disclosure in a sample of urban, underserved minority patients (n = 109) with rheumatic diseases. Nearly three quarters of the patients (71.6%) reported CAM use. Of these, 59% disclosed CAM use to their provider. Logistic regression models were created. In model 1 SDM significantly predicted CAM use; however, the overall model fit was not significant. In model 2, gender, ethnicity, and SDM predicted CAM disclosure with 73.2% correctly classified. Females were more likely and Hispanics were less likely to disclose CAM use. Those with higher SDM scores were more likely to disclose CAM use. SDM played a role in whether patients used CAM and disclosed CAM use to their providers. Improving SDM strategies may be especially important among patients who are least likely to disclose CAM use.

Racial differences in symptom management approaches among persons with radiographic knee osteoarthritis

Background

The extent to which racial differences exist in use of treatments for osteoarthritis (OA) is debatable. The purpose of this study was to describe the differences between African Americans (AA) and Caucasian Americans (CA) in using treatment approaches to manage symptoms among individuals with radiographic-confirmed knee OA.

Methods

A cross-sectional study was conducted. Using data from the Osteoarthritis Initiative, we identified 508 AA and 2,075 CA with radiographic tibiofemoral OA in at least one knee. Trained interviewers asked questions relating to current OA treatments including seven CAM therapy categories—alternative medical systems, mind-body interventions, manipulation and body-based methods, energy therapies, and three types of biologically based therapies, as well as conventional medications. We categorized participants as: conventional medication only users, CAM only users, users of both and users of neither. Multinomial logistic regression models adjusting for sociodemographics and clinical/functional factors provided estimates of the association between race and treatment use.

Results

Overall, 16.5% of AA and 24.2% of CA exclusively used CAM to treat OA, 25.0% of AA and 23.8% of CA used CAM in conjunction with conventional medications, and 24.8% of AA and 14.6% of CA exclusively used conventional medications. After control for sociodemographic and clinical factors, AA were less likely than CA to use CAM therapies alone (adjusted odds ratio (OR) of using CAM alone relative to no CAM or conventional treatments: 0.68, 95% confidence interval (CI): 0.48–0.96) or with conventional medications (adjusted OR relative to no CAM or conventional treatments: 0.59, 95%CI: 0.42–0.83). However, no differences in use of conventional medications alone were observed after adjustment of covariates.

Conclusion

CAM use is common among people with knee OA, but is less likely to be used by AA relative to CA. For effective CAM therapies, targeted outreach to underserved populations including education about benefits of various CAM treatments and providing accessible care may attenuate observed disparities in effective CAM use by race.