Perceived Benefits of Using Complementary and Alternative Medicine by Race/Ethnicity Among Midlife and Older Adults in the United States

Qualitative Assessment CIH Institutions' Engagement With Underserved Communities to Enhance Healthcare Access and Utilization

Background

In North America, there is a notable underutilization of complementary and integrative health approaches (CIH) among non-White and marginalized communities.

Objectives

This study sought to understand how CIH educational instutitions are proactively working to redress this disparity in access and utilization among these communities.

Methods

We conducted interviews with 26 key informants, including presidents, clinicians, and research deans across 13 CIH educational institutions across the US and Canada. Thematic analysis included deductive codes based on the interview guide during interview scripts review.

Results

Six themes were identified: (1) CIH institutions often had a long and varied history of community engaged care through partnerships to increase access and utilization; (2) CIH institutions' long-standing community outreach had been intentionally designed; (3) CIH institutions provided an array of services to a wide range of demographics and communities; (4) addressing healthcare access and utilization through community partnerships had a strong positive impact; (5) funding, staffing and COVID-19 were significant challenges that impeded efforts to increase CIH access through community engaged work; (6) identified gaps in community partnerships and services to increase access and utilization were recognized.

Conclusion

These findings underscore significant efforts made to enhance healthcare access and utilization among marginalized, underserved, and racial and ethnic communities. However, barriers such as funding constraints, resource allocation, and the need for proper measurement and accountability hinder proactive initiatives aimed at redressing disparities in CIH utilization within these communities.

Unique characteristics of patients who choose an intensive lifestyle medicine program to address chronic musculoskeletal pain

INTRODUCTION

Factors that motivate musculoskeletal patients to pursue an intensive, lifestyle medicine-based approach to care are poorly understood.

OBJECTIVE

To determine whether, compared to patients seeking musculoskeletal care through traditional pathways, patients who choose an intensive lifestyle medicine program for musculoskeletal pain endorse greater physical dysfunction, worse psychological health, and/or more biopsychosocial comorbidities.

DESIGN

Cross-sectional analysis of existing medical records from 2018 to 2021.

SETTING

Orthopedic department of one academic medical center.

PATIENTS

Fifty consecutive patients who enrolled in an intensive lifestyle medicine program to address a musculoskeletal condition. Comparison groups were the following: (1) 100 patients who presented for standard nonoperative musculoskeletal care, and (2) 100 patients who presented for operative evaluation by an orthopedic surgeon and qualified for joint arthroplasty.

INTERVENTION

Not applicable.

MAIN OUTCOME MEASURES

Primary outcomes were age-adjusted, between-group differences in Patient-Reported Outcomes Measurement Information System (PROMIS) physical and psychological health measures. Secondary outcomes were between-group differences in sociodemographic and medical history characteristics.

RESULTS

Patients who enrolled in the intensive lifestyle medicine program were more racially diverse (non-White race: lifestyle cohort 34% vs. comparison cohorts 16%-18%, p ≤ .029) and had a higher prevalence of obesity and diabetes than both comparison groups (mean body mass index: lifestyle cohort 37.6 kg/m2 vs. comparison cohorts 29.3-32.0, p < .001; diabetes prevalence: lifestyle cohort 32% vs. comparison cohorts 12%-16%, p ≤ .024). Compared to standard nonoperative patients, there were no clear between-group differences in PROMIS physical or psychological health scores. Compared to standard operative evaluation patients, patients in the lifestyle program reported worse anxiety but less pain interference (PROMIS Anxiety: B = 3.8 points [95% confidence interval, 0.1 to 7.4], p = .041; Pain interference: B = -3.6 [-6.0 to -1.2], p = .004).

CONCLUSIONS

Compared to musculoskeletal patients who sought care through traditional pathways, patients who chose an intensive lifestyle medicine pathway had a higher prevalence of metabolic comorbidities, but there was substantial overlap in patients' physical, psychological, and sociodemographic characteristics.

Disparities in chiropractic utilization by race, ethnicity and socioeconomic status: A scoping review of the literature

BACKGROUND

Chiropractic is the largest complementary and alternative medicine profession in the United States, with increasing global growth. A preliminary literature review suggests a lack of widespread diversity of chiropractic patient profiles.

OBJECTIVE

There have been no prior studies to comprehensively integrate the literature on chiropractic utilization rates by race, ethnicity, and socioeconomic status. The purpose of this scoping review is to identify and describe the current state of knowledge of chiropractic utilization by race, ethnicity, education level, employment status, and income and poverty level.

SEARCH STRATEGY

Systematic searches were conducted in PubMed, Ovid MEDLINE, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Cochrane Database of Systematic Reviews, and Index to Chiropractic Literature from inception to May 2021.

INCLUSION CRITERIA

Articles that reported race or ethnicity, education level, employment status, income or poverty level variables and chiropractic utilization rates for adults (≥18 years of age) were eligible for this review.

DATA EXTRACTION AND ANALYSIS

Data extracted from articles were citation information, patient characteristics, race and ethnicity, education level, employment status, income and poverty level, and chiropractic utilization rate. A descriptive numerical summary of included studies is provided. This study provides a qualitative thematic narrative of chiropractic utilization with attention to race and ethnicity, education level, income and poverty level, and employment status.

RESULTS

A total of 69 articles were eligible for review. Most articles were published since 2003 and reported data from study populations in the United States. Of the race, ethnicity and socioeconomic categories that were most commonly reported, chiropractic utilization was the highest for individuals identifying as European American/White/non-Hispanic White/Caucasian (median 20.00%; interquartile range 2.70%-64.60%), those with employment as a main income source (median utilization 78.50%; interquartile range 77.90%-79.10%), individuals with an individual or household/family annual income between $40,001 and $60,000 (median utilization 29.40%; interquartile range 25.15%-33.65%), and individuals with less than or equal to (12 years) high school diploma/general educational development certificate completion (median utilization 30.70%; interquartile range 15.10%-37.00%).

CONCLUSION

This comprehensive review of the literature on chiropractic utilization by race, ethnicity and socioeconomic status indicates differences in chiropractic utilization across diverse racial and ethnic and socioeconomic populations. Heterogeneity existed among definitions of key variables, including race, ethnicity, education level, employment status, and income and poverty level in the included studies, reducing clarity in rates of chiropractic utilization for these populations. Please cite this article as: Gliedt JA, Spector AL, Schneider MJ, Williams J, Young S. Disparities in chiropractic utilization by race, ethnicity and socioeconomic status: a scoping review of the literature. J Integr Med. 2023; Epub ahead of print.

Use of home remedies for the treatment and prevention of coronavirus disease: An integrative review

Background and Aims

Home remedies are understood to mean medications or tonics prepared at home to treat certain ailments without any prescription or professional supervision. Reliance on home remedies increased during coronavirus disease 2019 (COVID-19). The aim of this integrative review was to identify home remedies used to treat and prevent COVID-19 and discuss implications for nursing practice and health related to the safety and efficacy of home remedies.

Methods

Cooper's integrative review method guided this study to identify home remedies used to prevent and treat COVID-19. Google Scholar, BMC, EBSCOhost, Medline, Academic Search Ultimate, Web of Science Core Collections, Science Direct and Global Health were used to search for relevant information on the use of COVID-19 home remedies from 2019 to 2022. The Critical Appraisal Skills Program (CASP) checklist was used to select studies that had to be included. The eligibility criteria included studies on home remedies, written in English from 2019 to 2022. Findings of qualitative, quantitative and mixed-methods research were extracted, and narrative thematic data synthesis was applied.

Results

Eleven articles which met the inclusion criteria were found in nine countries: Ghana (1), South Africa (1), Tanzania (1), Togo (1) and Zimbabwe (1), Bangladesh (1), Hong Kong (1), India (2), Iran (1), and Pakistan (1). Findings showed that home remedies are used for the prevention of COVID-19 infection, treatment of COVID-19, and boosting immunity.

Conclusions

Home remedies have been found to be more pronounced across all sectors and social strata. More research is needed on the use of home remedies for life-threatening outbreaks. Policymakers and healthcare workers are challenged to encourage the use of home remedies in the prevention of other ailments and epidemics that might occur in the future.

Status of traditional Chinese medicine healthcare services in nursing homes across China

This study aimed to elucidate the status of traditional Chinese medicine (TCM) healthcare services provided in nursing homes across China. We investigated 484 nursing homes using self-compiled questionnaires with a convenient sampling method. Chi-squared and Wilcoxon rank-sum tests were used for univariate analysis and binary logistic regression for multi-factor analysis. Of the 443 nursing homes finally included, 215 (48.5%) provided TCM healthcare services. Nursing home leaders majored in integrated TCM and Western medicine, leaders with a better understanding of TCM and government policies, nursing homes charging over 5,000 CNY/month, and those with ≥500 beds were more likely to provide improved TCM healthcare services. Massage, moxibustion, cupping or scraping, plaster therapy, decocting pieces, and acupuncture were the most prevalent and popular TCM services. Lack of professionals, financial investment, and policy support were the most common factors limiting the provision of TCM healthcare services in Chinese nursing homes.

Use of Complementary and Alternative Therapy for Knee Osteoarthritis: Race and Gender Variations

Objective

To evaluate race and gender variations in complementary and alternative medicine (CAM) use for knee osteoarthritis (OA) (unadjusted and adjusted for demographic and clinical factors).

Methods

A secondary analysis of cross‐sectional data was conducted. The sample included Veterans Affairs patients 50 years of age or older with symptomatic knee OA. Current use of various CAM therapies was assessed at baseline. Logistic regression models were used to compare race and gender differences in the use of specific CAMs.

Results

The sample included 517 participants (52.2% identified as African American [AA]; 27.1% identified as female). After adjusting for demographic and clinical factors, AA participants, compared with white participants, were less likely to use joint supplements (odds ratio [OR]: 0.53; 95% confidence interval [CI], 0.31‐0.90]); yoga, tai chi, or pilates (OR: 0.39; 95% CI: 0.19‐0.77); and chiropractic care (OR: 0.51; 95% CI: 0.26‐1.00). However, they were more likely to participate in spiritual activities (OR: 2.02; 95% CI: 1.39‐2.94). Women, compared with men, were more likely to use herbs (OR: 2.42; 95% CI: 1.41‐4.14); yoga, tai chi, or pilates (OR: 2.09; 95% CI: 1.04‐4.19); acupuncture, acupressure, or massage (OR: 2.45; 95% CI: 1.28‐4.67); and spiritual activities (OR: 1.68; 95% CI: 1.09‐2.60). The interactive effects of race and gender were significant in the use of herbs (P = 0.008); yoga, tai chi, or pilates (P = 0.011); acupuncture, acupressure or massage (P = 0.038); and spiritual activities (P < 0.001).

Conclusion

There are race and gender differences in the use of various CAMs for OA. As benefits and limitations of CAM therapies vary, clinicians must be aware of these differences.

Older people's perspectives on use of complementary and alternative medicine and acupressure: A qualitative study

OBJECTIVE

This study explored older people's knowledge, experience and perception of complementary and alternative medicine (CAM) and acupressure, and their willingness to accept acupressure.

METHOD

This qualitative descriptive study, using semi-structured interviews, was conducted at two residential aged care facilities. Thematic analysis was used to analyse the data.

RESULTS

Fifteen older people participated. Participants had limited knowledge about CAM and acupressure. Many of them had positive views on CAM, and were willing to accept acupressure. There were five major themes: knowledge and understanding about CAM, experience of using CAM, general views on use of CAM, reasons for not using CAM, and willingness to accept acupressure.

CONCLUSION

The findings show the diverse views on CAM and acupressure from the perspectives of the older people in this study. There is a need for further research investigating the usefulness of CAM and acupressure in aged care settings.

Immigrant Usage Patterns of Natural Health Products: Role in Pharmacoeconomics

Background:

Understanding patterns and drivers for natural health product (NHP) usage among immigrants is essential in the provision of appropriate health care; many studies have elucidated NHP utilization among immigrants; however, few have considered impacts of concurrent NHP and prescription medication usage.

Objective:

The study aims to determine new immigrant NHP usage patterns (including concurrent usage with prescription medications) and to discern economic impacts driving concurrent usage.

Methods:

A survey questionnaire was administered to local new immigrants during English Language Training classes.

Results:

Most participants understood the NHP definition and would take an NHP for the same disease or condition they would normally take a prescription medication for. Many participants agreed that NHPs are not safe however were unable to provide robust examples of unsafe NHP usage. With regard to purchases of medicines for short and long term illnesses, a high percentage of participants would purchase the prescription medication for a short term illness over the NHP; however this percentage decreases in the event of a long term illness, with more participants relying on NHPs to remedy their long term illness symptoms.

Conclusion:

Pharmacoeconomics tends to be a major driver for immigrant utilization of NHPs, and is a stronger influencer of use compared to ethnicity or parenteral usage of such products. This pharmacoeconomic correlation in the preference to use NHPs over prescription medications tends to be more observable for chronic and long term conditions (compared to short term illnesses).

Toxicity Assessment of Chinese Herbal Medicine Cynomorium songaricum Rupr

Cynomorium songaricum Rupr, known as Suo Yang, is most commonly used to treat fatigue, protect the liver, and invigorate kidneys in Northwest China. Given the wide medicinal utilisation and lack of safety evaluation, this work evaluated the acute toxicity, genetic toxicity, and 90-day repeated oral toxicity of Suo Yang. Twenty Kunming mice were orally given Suo Yang once and observed for 14 days in the acute toxicity test. The genetic toxicity of Suo Yang was tested using in vivo and vitro assays (bacterial reverse mutation test, mouse bone marrow micronucleus assay, and spermatocyte chromosomal aberration assay). In the 90-day repeated oral toxicity study, 80 SD rats were randomly divided into 4 groups and then orally given Suo Yang at different concentrations (1.04, 2.08 or 4.16 g/kg), while the control group was given sterile water. In the acute toxicity test, no abnormal behaviour or mortality was found in mice. The results suggest that the maximum tolerable dose of Suo Yang is greater than 15 g/kg. In the genotoxicity studies, no revertant colonies were produced in vitro. In the in vivo assays, no increased frequencies of micronuclei or structural abnormalities of spermatocyte chromosomes were found. In the 90-day repeated oral toxicity study, no significant toxicological manifestations were observed in haematological parameters or clinical and pathological examinations. In summary, these results suggest that Suo Yang at the given doses does not cause adverse effects in animals. Thus, Suo Yang can reasonably be considered a safe herbal medicine.