Health care utilization among complementary and alternative medicine users in a large military cohort

Background  

Complementary and Alternative Medicine use and how it impacts health care utilization in the United States Military is not well documented. Using data from the Millennium Cohort Study we describe the characteristics of CAM users in a large military population and document their health care needs over a 12-month period. The aim of this study was to determine if CAM users are requiring more physician-based medical services than users of conventional medicine.     

Use of complementary and alternative medical therapies among racial and ethnic minority adults: results from the 2002 National Health Interview Survey

PURPOSE: Complementary and alternative medicine (CAM) use among ethnic minority populations is poorly understood. We sought to examine CAM use in Hispanics, non-Hispanic blacks and non-Hispanic whites. METHODS: We analyzed data from the Alternative Health Supplement to the 2002 National Health Interview Survey (NHIS), including information on 19 different CAM therapies used in the past 12 months. RESULTS: An estimated 34% of Hispanic, non-Hispanic black and non-Hispanic white adults in the United States used at least one CAM therapy (excluding prayer) during the prior 12 months (2002). CAM use was highest for non-Hispanic whites (36%), followed by Hispanics (27%) and non-Hispanic blacks (26%). Non-Hispanic whites were more likely to use herbal medicine, relaxation techniques and chiropractic more frequently than Hispanics and non-Hispanic blacks. After controlling for other sociodemographic factors, Hispanic and non-Hispanic black races/ethnicities were associated with less CAM use, with adjusted odds ratios (95% confidence intervals) of 0.78 (0.70, 0.87) and 0.71 (0.65, 0.78), respectively. Hispanics cited using CAM because conventional medical treatments were too expensive more frequently than non-Hispanic blacks or whites. Hispanics had the highest provider nondisclosure rates (68.5%), followed by non-Hispanic blacks (65.1%) and non-Hispanic whites (58.1%). CONCLUSIONS: Excluding prayer, Hispanics and non-Hispanic blacks used CAM less frequently than non-Hispanic whites and were less likely to disclose their use to their healthcare provider. Further research is needed to improve our understanding of the disparities in CAM use.     

Health locus of control and use of conventional and alternative care: a cohort study.

BACKGROUND: Health locus of control influences health-related behaviour, but its association with healthcare use is unclear. AIM: To investigate the association between individuals' health locus of control and the use of conventional and alternative health care. DESIGN OF STUDY: Prospective cohort study. SETTING: A nationally representative random sample of community-dwelling adult households in Japan. METHOD: Health locus of control, symptom-related visits to physicians, and the use of dietary and physical complementary and alternative medicine (CAM) was measured. Dietary CAM included supplements, such as herbs and vitamins. Physical CAM included manipulations, such as acupuncture and acupressure. RESULTS: Of the 2453 adult participants studied, 2103 (86%; 95% CI [confidence interval] = 84 to 88%) developed at least one symptom during the 31-day study period. Of these symptomatic adults, 639 visited physicians (30%; 95% CI = 28 to 32%), 480 used dietary CAM (23%; 95% CI = 21 to 25%), and 156 (7%; 95% CI = 6 to 9%) used physical CAM. The likelihood of visiting a physician was not related significantly to individuals' health locus of control. Increased use of dietary CAM was weakly associated with control by spiritual powers (P = 0.028), internal control (P = 0.013), and less control by professionals (P = 0.020). Increased use of physical CAM was significantly associated with control by spiritual powers (P = 0.009) indicating a belief that supernatural forces control individuals' health status. CONCLUSION: The likelihood of visiting a physician is not affected by individuals' health locus of control. Control by spiritual powers is involved with increased CAM use. Internal control is weakly associated with greater use of dietary CAM; professional control is weakly associated with less use of dietary CAM.     

Rationales for CAM Education in Health Professions Training Programs.

The authors review the use of complementary and alternative medicine (CAM) in the United States. They then present and discuss the rationales used by the 15 National Center for Complementary and Alternative Medicine CAM educational grantees in their original proposals for incorporating CAM content into conventional health professions training programs. Fourteen of the grantees were from major U.S. medical and nursing schools, and one was from a medical student foundation. Awards were for five-year periods (with the exception of one three-year grant) from 2000 to 2008. Rationales for developing educational programs about CAM for conventional health professionals included (1) the prevalence and growth of CAM in the United States, (2) response to governmental, legislative, and other mandates, (3) need for enhanced communication between conventional providers and patients using CAM, (4) need to enhance safety of CAM use and interactions with conventional care, (5) CAM education's positive impact on broadening core competencies for conventional health care professionals, (6) positive impact on enhancing cultural competency, (7) need for better communication between conventional and CAM providers, (8) potential for improving health care coordination, (9) potential impact on increasing CAM research quality and capacity, and (10) potential for enhancing quality of care through informed CAM use. Integration of CAM with conventional health care requires educational venues that prepare conventionally trained caregivers with a sufficient knowledge base for assessing beneficial and detrimental interactions between CAM and conventional care approaches; development of criteria for making informed referrals to CAM practitioners; and enhanced research capacity.     

Complementary and conventional medicine: a concept map

Background

Despite the substantive literature from survey research that has accumulated on complementary and alternative medicine (CAM) in the United States and elsewhere, very little research has been done to assess conceptual domains that CAM and conventional providers would emphasize in CAM survey studies. The objective of this study is to describe and interpret the results of concept mapping with conventional and CAM practitioners from a variety of backgrounds on the topic of CAM.

Methods

Concept mapping, including free sorts, ratings, and multidimensional scaling was used to organize conceptual domains relevant to CAM into a visual "cluster map." The panel consisted of CAM providers, conventional providers, and university faculty, and was convened to help formulate conceptual domains to guide the development of a CAM survey for use with United States military veterans.

Results

Eight conceptual clusters were identified: 1) Self-assessment, Self-care, and Quality of Life; 2) Health Status, Health Behaviors; 3) Self-assessment of Health; 4) Practical/Economic/ Environmental Concerns; 5) Needs Assessment; 6) CAM vs. Conventional Medicine; 7) Knowledge of CAM; and 8) Experience with CAM. The clusters suggest panelists saw interactions between CAM and conventional medicine as a critical component of the current medical landscape.

Conclusions

Concept mapping provided insight into how CAM and conventional providers view the domain of health care, and was shown to be a useful tool in the formulation of CAM-related conceptual domains.

     

Suicidal ideation among college students in the United States

This study analyzed data from the 1995 National College Health Risk Behavior Survey (NCHRBS) to assess the prevalence of suicidal ideation among college students in the United States and to examine the association between suicidal ideation and substance use in this population. The NCHRBS used a mail questionnaire to assess health-risk behaviors in a nationally representative sample of undergraduate students. During the 12 months preceding the survey, 10% of the students had seriously considered attempting suicide. When controlling for demographic characteristics, the analysis showed that students who had considered suicide were at increased odds of using tobacco, alcohol, and illegal drugs. These results suggest that colleges and universities should establish suicide prevention programs that also address the related problem of substance use.     

Barriers to treatment seeking in primary insomnia in the United Kingdom: a cross-sectional perspective

STUDY OBJECTIVES: To examine the most commonly perceived barriers to treatment seeking among individuals in the United Kingdom diagnosed with primary insomnia. Although there are effective treatments, the rate of insomnia in the United Kingdom is 22%, which is substantially higher than in other parts of Europe and in the United States. DESIGN: Cross-sectional. SETTING: Treatment and research clinic at a university department of psychiatry. PARTICIPANTS: Fifty-six women and 29 men who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-TR criteria for primary insomnia who had (n = 48) or had not (n = 37) sought treatment. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Endorsement of reasons for not seeking treatment on the Barriers to Treatment Questionnaire. The most commonly endorsed reasons for not seeking treatment were the perception of insomnia as benign, trivial, or a problem that one should be able to cope with alone. Other commonly endorsed barriers to treatment related to lack of awareness of treatment options and to perception of the available treatment options as ineffective and unattractive. CONCLUSIONS: Given the chronicity and serious adverse consequences of insomnia, this study suggests that programs of public health awareness designed to reduce the perception of insomnia as trivial and to increase awareness of the effective treatments available may be important for reducing the prevalence of insomnia in the United Kingdom.     

The care of HIV-infected adults in rural areas of the United States.

OBJECTIVE: This study describes the population of HIV-infected adults receiving care in rural areas of the United States and compares HIV care received in rural and urban areas. METHODS: Interviews were conducted with a nationally representative sample of 367 HIV-infected adults receiving health care in rural areas and 2806 HIV-infected adults receiving health care in urban areas of the contiguous United States. RESULTS: We estimate that 4800 HIV-infected persons received medical care in rural areas during the first half of 1996. Patients in rural HIV care were more likely than patients in urban HIV care to receive care from providers seeing few (<10) HIV-infected patients (38% vs. 3%; p <.001). Rural care patients were less likely than urban care patients to have taken highly active antiretroviral agents (57% vs. 73%; p <.001) or Pneumocystis carinii pneumonia prophylactic medication when indicated (60% vs. 75%; p =.006). CONCLUSIONS: Few American adults received HIV care in rural areas of the United States. Our findings suggest ongoing disparities between urban and rural areas in access to high-quality HIV care.     

Use of selected complementary and alternative medicine (CAM) treatments in veterans with cancer or chronic pain: a cross-sectional survey

Background  

Complementary and alternative medicine (CAM) is emerging as an important form of care in the United States. We sought to measure the prevalence of selected CAM use among veterans attending oncology and chronic pain clinics and to describe the characteristics of CAM use in this population.     

Prevalence and correlates of illness worry in the general population

The prevalence and correlates of illness worry in the general population were investigated in a representative sample. The authors screened residents of the United States by telephone, and more detailed interviews were conducted with 123 respondents who reported at least 1 month of worry about serious illness in the past 12 months and an equal number of randomly selected persons without such worry. Data on demographic characteristics, medical and psychiatric conditions, functional impairment, and health care utilization were collected. At least 1 month of worry was endorsed by 13.1% of the screened population. Correlates of worry included a cluster of psychiatric conditions (major depressive episode, panic attacks, and generalized anxiety disorder) and three clusters of physical conditions (heart disease, cancer, and other diseases). Worry about serious illness was associated with functional impairment and health care utilization.     

US women desire greater professional guidance on hormone and alternative therapies for menopause symptom management

OBJECTIVE: Women increasingly use alternative therapies for menopause symptom relief. We examined 1) current use and perceptions of hormone and alternative therapies for symptom relief among US women, and 2) healthcare provider involvement in women's decision making. DESIGN: An online survey was completed by a national sample of 781 US women aged 40 to 60 years (72% survey completion rate) drawn from the Knowledge Networks panel in June 2004. Nationally representative estimates of women's use and perceptions of hormone and alternative therapies were made by accounting for sampling weights and survey design. RESULTS: Hormone therapy was reported among 263 or 37% of this largely symptomatic sample, of whom 59% had stopped primarily due to concern about its potential risks. Herbal products and soy supplements separately were used among 31% and 13% of symptomatic women, of whom 41% and 67% were current users. Forty-four percent of herb users considered these products helpful with symptom relief. Sampled women generally felt ill informed about proper doses and usage of herbal products. Also, 58% of the sampled women expressed at least some concerns about these products, whereas proven safety was the most important factor when women consider such products. Despite considering healthcare providers the most reliable source of information, sampled women expressed low confidence in their ability to give sufficient information about treatment options for menopause symptoms. CONCLUSIONS: Alternative therapies have become increasing popular and are quickly approaching hormone therapy in frequency as therapies for symptom relief among menopause-age women in the United States. However, large gaps exist between patient expectations and provider preparedness to guide patient decision making.     

What should students learn about complementary and alternative medicine?

With thousands of complementary and alternative medicine (CAM) treatments currently being used in the United States today, it is challenging to design a concise body of CAM content which will fit into already overly full curricula for health care students. The purpose of this article is to outline key principles which 15 National Center for Complementary and Alternative Medicine-funded education programs found useful when developing CAM course-work and selecting CAM content. Three key guiding principles are discussed: teach foundational CAM competencies to give students a framework for learning about CAM; choose specific content on the basis of evidence, demographics and condition (what conditions are most appropriate for CAM therapies?); and finally, provide students with skills for future learning, including where to find reliable information about CAM and how to search the scientific literature and assess the results of CAM research. Most of the programs developed evidence-based guides to help students find reliable CAM resources. The cumulative experiences of the 15 programs have been compiled, and an annotated table outlining the most highly recommended resources about CAM is presented.     

Family history of insomnia in a population-based sample

STUDY OBJECTIVES: To examine the rates of family history of insomnia in a population-based sample composed of self-defined good sleepers and individuals with insomnia and compare individuals with and without family history of insomnia on several characteristics presumably associated with insomnia. DESIGN: Cross-sectional comparisons of self-defined good sleepers and individuals with insomnia selected from a larger epidemiologic study using a randomly selected sample of 2001 adults of the province of Quebec in Canada. PARTICIPANTS: Nine hundred fifty-three adults (60.3% women; mean age = 43.9 years) completed several postal questionnaires, including a survey of past and current history of insomnia/sleep disorders for self and first-degree relatives. Participants were classified as good sleepers, individuals with insomnia symptoms, or individuals with an insomnia syndrome. INTERVENTIONS: N/A. RESULTS: Of the total sample, 34.9% reported at least 1 first-degree relative with past or current insomnia. The mother was the most frequently afflicted first-degree relative with insomnia (19.7%). Family history rates of insomnia were not significantly different when individuals with current insomnia symptoms or syndrome were compared with self-defined good sleepers. However, significant group differences emerged when good sleepers were subdivided according to the presence or absence of past personal history of insomnia. Individuals with past or current insomnia were significantly more likely to report a family history of insomnia than were good sleepers who had never experienced insomnia in the past (39.1% vs 29.0%). Participants with a family history of insomnia endorsed higher scores on measures of insomnia severity, anxiety symptomatology, and arousal predisposition. CONCLUSIONS: These findings provide additional evidence about the potential role of both family and personal history of insomnia as predisposing factors to insomnia. Longitudinal family studies are needed to further examine the relative contribution of genetic and environmental factors in the genesis and heritability of insomnia.     

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.     

Complementary and alternative medical therapy utilization by people with chronic fatiguing illnesses in the United States

Background  

Chronic fatiguing illnesses, including chronic fatigue syndrome (CFS), pose a diagnostic and therapeutic challenge. Previous clinical reports addressed the utilization of health care provided to patients with CFS by a variety of practitioners with other than allopathic training, but did not examine the spectrum of complementary and alternative medicine (CAM) therapies used. This study was designed to measure CAM therapy use by persons with fatiguing illnesses in the United States population.     

Dietary supplements and natural products as psychotherapeutic agents.

Alternative therapies are widely used by consumers. A number of herbs and dietary supplements have demonstrable effects on mood, memory, and insomnia. There is a significant amount of evidence supporting the use of Hypericum perforatum (St. John's wort) for depression and Ginkgo biloba for dementia. Results of randomized, controlled trials also support the use of kava for anxiety and valerian for insomnia. Although evidence for the use of vitamins and amino acids as sole agents for psychiatric symptoms is not strong, there is intriguing preliminary evidence for the use of folate, tryptophan, and phenylalanine as adjuncts to enhance the effectiveness of conventional antidepressants. S-adenosylmethionine seems to have antidepressant effects, and omega-3 polyunsaturated fatty acids, particularly docosahexaenoic acid, may have mood-stabilizing effects. More research should be conducted on these and other natural products for the prevention and treatment of various psychiatric disorders.     

Use of complementary and alternative medicine among the patients in primary health care

OBJECTIVE: Use of complementary and alternative medicine (CAM) is widespread in western countries despite its unconfirmed effectiveness. The aim of the study was to show the use of CAM by patients in primary health care. PATIENTS AND METHODS: Cross-sectional method was used in a sample of 941 patients attending fourteen primary care practices from six Croatian cities who visited their family physician for whatever reason and filled in an anonymous questionnaire. On data analysis, distribution of frequencies and chi2-test were used. A probability value of p (two-tailed) indicated a statistically significant difference. RESULTS: The response rate was 70%. At least once in their lifetime CAM was utilized by 46% and in previous year by 32% of patients. Most frequent users were persons in the 46-55 age group years and those with higher education. A statistically significant difference was established between CAM utilization and age, education, employment and relaxation/stress reducing techniques. The most frequently used methods were herbalism (38%), homeopathy (15.6%) and acupuncture (13.1%). In 53.5% of subjects CAM was used together with conventional medicine. CAM was most often used for musculoskeletal diseases, gastrointestinal diseases, and for prevention. Chiropractic was most commonly used for musculoskeletal disorders, and herbalism and homeopathy for respiratory disorders. Supplements, natural healing products and homeopathic medicines were used by 80.1% of study subjects. Patients decide on the use of CAM because they believe it will help them (27%), conventional medicine failed to alleviate their complaints (19.7%) and they were afraid of side effects of drugs (13.3%). Satisfaction with CAM treatment was reported by 45.5% of study subjects. More than half of the patients notified their physician on the use of CAM (59.6%) and the majority (81.7%) of all subjects would like to discuss the use of CAM in their treatment with their family physician. DISCUSSION: In this study, the use of CAM was consistent with literature data. Frequent use of herbal method may lead to potential risks due to possible herb-drug interactions. The reason for the use of CAM is rarely dissatisfaction with their physician but often dissatisfaction with the results and side effects of conventional treatment. Doctors will require additional education on CAM methods, their effectiveness, safety, indications and contraindications in order to be well informed and able to discuss CAM use with their patients. CONCLUSION: The use of CAM is common among patients attending primary health care. Sociodemographic factors are important predictors of its use. Doctors should openly ask their patients about the use of CAM and receive proper education to be able to discuss the potential benefits versus possible risks of its use in individual cases.     

Complementary and alternative medicine use and substitution for conventional therapy by HIV-infected patients

BACKGROUND: HIV-infected patients commonly use complementary and alternative medicine (CAM), but it is not known how often CAM is used as a complement or as a substitute for conventional HIV therapy. OBJECTIVES: To evaluate the prevalence and factors associated with CAM use with potential for adverse effects and CAM substitution for conventional HIV medication. DESIGN AND PARTICIPANTS: Cross-sectional survey of U.S. national probability sample of HIV-infected patients (2,466 adults) in care from December 1996 to July 1997. MAIN OUTCOME VARIABLES: Any CAM use, CAM use with potential for adverse effects, and use of CAM as a substitute for conventional HIV therapy. Substitution was defined as replacement of some or all conventional HIV medications with CAM. RESULTS: Fifty-three percent of patients had recently used at least one type of CAM. One quarter of patients used CAM with the potential for adverse effects, and one-third had not discussed such use with their health care provider. Patients with a greater desire for medical information and involvement in medical decision making and with a negative attitude toward antiretrovirals were more likely to use CAM. Three percent of patients substituted CAM for conventional HIV therapy. They were more likely to desire involvement in medical decision-making (odds ratio, 1.8; 95% confidence interval, 1.0-3.2) and to have a negative attitude toward antiretrovirals (odds ratio, 7.8; 95% confidence interval, 3.0-19.0). CONCLUSIONS: Physicians should openly ask HIV-infected patients about CAM use to prevent adverse effects and to identify CAM substitution for conventional HIV therapy.     

Prevalence of sexual and drug-related HIV risk behaviors in the U.S. adult population: results of the 1996 National Household Survey on Drug Abuse.

CONTEXT: Data on the prevalence of HIV risk behavior that are representative of the general population are needed to help evaluate the effectiveness of prevention programs. OBJECTIVE: To use data from a large national interview survey to make estimates of the prevalence of sexual and drug-related HIV risk behaviors in the adult population of the United States. DESIGN: Nationally representative cross-sectional survey with in-person interviews collecting information on drug use and sexual behavior. SETTING AND PARTICIPANTS: 12,381 U.S. adults aged between 18 and 59 who were respondents to the 1996 National Household Survey on Drug Abuse, as part of sample of the noninstitutionalized population. Interviews took place in respondents homes using face-to-face interviewer-administered and self-administered questionnaires. RESULTS: In total, 2.8% of respondents were classified as having increased risk for HIV through sexual behavior; this represents 3.9 million persons. 1.7% reported some degree of risk through drug-related behaviors, representing 1.2 million persons. 3.5% of adults (5 million persons) were found to have some degree of HIV risk from sexual or drug-related behavior. Persons who were at risk through drug behavior were much more likely than others to be at risk through sexual behavior. Condom use was not related to HIV risk, although having a recent HIV test was found to be. Among those who reported some behaviors that placed them at increased risk for HIV infection, only 22% used a condom the last time they had sex with a regular partner. CONCLUSIONS: The high rate of sexual risk behavior on the part of drug users suggests increasing condom use for this group should be a priority goal for programs, especially condom use with main partners. Survey work needs to be continued and improved to make it possible to assess the impact of successful local prevention efforts on national rates of HIV risk behavior.     

The CAM Education Program of the National Center for Complementary and Alternative Medicine: an overview.

The authors provide a historical context and overview of the experience of education projects at 14 health professions schools in the United States and the American Medical Students Association that were funded by the National Center for Complementary and Alternative Medicine at the National Institutes of Health in cohorts of five per year in 2000, 2001, and 2002-2003. These 15 projects were designed to incorporate CAM information into the curricula of conventional health professions schools. A longer-term goal was to accelerate the integration of CAM and conventional medicine.The overall program started in 2000 at a time when discussions about the definition, goals, and value of integrative medicine were already well underway. The efforts specific to each project, as well as the shared challenges, accomplishments, and collaborative efforts of all 15 projects, can provide guidance for the education of conventional health care providers about CAM in an integrative medicine environment.Challenging issues that must be faced include (1) the need to develop successful strategies to incorporate information about CAM into already dense health professions school curricula, (2) the need for conventional health professionals to have authoritative resources to provide their patients information about risks and benefits of CAM practices, and (3) the need to identify appropriate roles for CAM practitioners in educating conventional health professionals about CAM therapies. The authors discuss these issues and others and present some recommendations.