Complementary and alternative medicine use as health self-management: rural older adults with diabetes

OBJECTIVE: . This study describes complementary and alternative medicine (CAM) use among rural older adults with diabetes, delineates the relationship of health self-management predictors to CAM therapy use, and furthers conceptual development of CAM use within a health self-management framework. Methods. Survey interview data were collected from a random sample of 701 community dwelling African American, Native American, and White elders residing in two rural North Carolina counties. We summarize CAM use for general use and for diabetes care and use multiple logistic modeling to estimate the effects of health self-management predictors on use of CAM therapies. RESULT: . The majority of respondents used some form of CAM for general purpose, whereas far fewer used CAM for diabetes care. The most widely used CAM categories were food home remedies, other home remedies, and vitamins. The following health self-management predictors were related to the use of different categories of CAM therapies: personal characteristics (ethnicity), health status (number of health conditions), personal resources (education), and financial resources (economic status). Discussion. CAM is a widely used component of health self-management among rural among older adults with diabetes. Research on CAM use will benefit from theory that considers the specific behavior and cognitive characteristics of CAM therapies.     

Characteristics of Complementary and Alternative Medicine (CAM) use among older adults with asthma

Objective: A growing number of asthma patients are using Complementary and Alternative Medicine (CAM). Prior studies have not examined CAM use among the older adult population.

Methods: Data from the 2011 Behavioral Risk Factor Surveillance Survey (BRFSS), a national telephone survey, and the Asthma Call-Back survey (ACBS), a survey conducted among BRFSS individuals reporting asthma, were used for the analyses. The study population consisted of 7685 individuals aged 55 years or older with current asthma. The relationship of CAM use with demographic and asthma outcomes was analyzed using logistic regression.

Results: CAM use was reported by 39% (3030). Breathing techniques were the most commonly reported CAM therapy. Demographic factors associated with CAM use include female gender (OR 1.36, p?<?0.002), having at least a college education (OR 1.76, p?<?0.001), cost barrier to healthcare (OR 1.43, p?<?0.001), and living in the West (OR 1.31, p?<?0.01). An inverse relationship was noted between income and CAM use. Those who had received an asthma action plan (OR 1.29, p?<?0.005), current smokers (OR 1.35, p?<?0.02), or impaired asthma control (as defined by symptoms affecting sleep, symptoms limiting activities, and rescue medication use) were more likely to use CAM (OR 1.37, p?<?0.001; OR 1.38, p?<?0.001; and OR 1.2, p?<?0.046, respectively).

Conclusions: A large proportion of asthmatic older adults use CAM. In addition, older adults with asthma who use CAM have decreased asthma control, and further studies are needed to determine a causal role.     

Complementary and alternative medicine for sleep disturbances in older adults

Complementary and alternative medicines (CAM) are frequently used for the treatment of sleep disorders, but in many cases patients do not discuss these therapies directly with their health care provider. There is a growing body of well-designed clinical trials using CAM that have shown the following: (1) Melatonin is an effective agent for the treatment of circadian phase disorders that affect sleep; however, the role of melatonin in the treatment of primary or secondary insomnia is less well established. (2) Valerian has shown a benefit in some, but not all clinical trials. (3) Several other modalities, such as Tai Chi, acupuncture, acupressure, yoga, and meditation have improved sleep parameters in a limited number of early trials. Future work examining CAM has the potential to significantly add to our treatment options for sleep disorders in older adults.     

Self-care dimensions of complementary and alternative medicine use among older adults

BACKGROUND: There is a lack of understanding about the patterns and rates of CAM use among older adults owing to a lack of research on specific types of CAM. OBJECTIVES: This study examines several dimensions of self-care deemed to be associated with CAM. Unmet health care needs, self-care attitudes, and spirituality are interpreted as health belief structures underlying CAM. METHODS: Logistic regression analysis was used to examine use of three groups of practitioner-based CAM: (a) chiropractic; (b) massage, and (c) acupuncture, homeopathy and/or naturopathy use. We analyze a subsample of 4,401 older adults drawn from the 1996/1997 and 1998/1999 waves of the Canadian National Population Health Survey. RESULTS: The logistic regression analyses indicate that self-care attitude and spirituality represent important predictors of practitioner-based CAM use. The associations for unmet health care needs were not supported. The strongest factors associated with CAM use were the illness context variables, which suggest that measures of need are key factors in leading individuals to seek other forms of health care. DISCUSSION: Practitioner-based CAM use among older adults is influenced by self-care attitude and spirituality, in addition to health status, but to varying degrees depending on the type of CAM. Support of these self-care facets suggests that there is a desire on the part of consumers to exercise choice and to participate in health care decisions when considering CAM.     

Complementary and alternative medicine for IBS in adults: mind-body interventions

Standard treatment for IBS focuses on the management or alleviation of the predominant gastrointestinal presenting symptoms, such as diarrhea or constipation, often using pharmacological therapy. For many patients, this approach is unsatisfactory, and patients frequently seek the advice of complementary and alternative medicine (CAM) practitioners in order to explore other treatment options. CAM practices include a broad range of modalities, and mind-body interventions hold particular promise as treatment modalities for IBS because psychological factors could have an important role in IBS symptomatology and quality of life. Psychological stressors are postulated to result in gastrointestinal symptoms through alteration of intestinal function mediated by the autonomic nervous system, hypothalamic-pituitary-adrenal axis and immune system. Hypnotherapy has the strongest supportive evidence as a beneficial mind-body intervention for IBS. Clinical studies of hypnotherapy have uniformly shown improvement of gastrointestinal symptoms, anxiety, depression and quality of life in patients with IBS. Mindfulness meditation remains unstudied for IBS, but is theoretically attractive as a stress-reduction technique. There is a suggestion that relaxation therapy or multimodal therapy (a combination of relaxation therapy, education and psychotherapy) is beneficial for IBS. The most generally accepted psychological mind-body intervention is cognitive behavioral therapy, and clinical trials support the beneficial effects of cognitive behavioral therapy in patients with IBS.     

Complementary and alternative therapies: use in pediatric pulmonary medicine

With increased awareness of complementary/alternative medicine (CAM) and concern of potential adverse effects or limited effectiveness of conventional medications, patients and parents are looking to CAM approaches as either an alternative or as adjunct therapy, especially for chronic diseases such as asthma or cystic fibrosis. It is important that practitioners have adequate information so that patients and parents receive balanced and accurate information, especially regarding safety and potential efficacy. This review provides an overview of some of the more frequently used CAM therapies for children with chronic pulmonary disorders and summarizes the basic principles of each modality, along with efficacy and safety data.     

A comparison of self-report and chart audit in studying resident physician assessment of cardiac risk factors

OBJECTIVE: To examine the relationship between resident physicians’ perceptions of their preventive cardiology practices and a chart audit assessment of their documented services. DESIGN: A criterion standard comparison of two methods used to assess resident physicians’ practices: self-report and chart audit. SETTING: Physician ambulatory care in a residency program. PATIENTS AND OTHER PARTICIPANTS: Coronary artery disease (CAD) risk factor assessment was evaluated by self-report for 72 resident physicians and by chart audit of randomly selected records of 544 of their patients who did not have CAD or a debilitating chronic disease during a one-year period. INTERVENTION: Measurements of the residents’ perceived CAD risk factor assessment practice by self-report, and chart audit assessments of their recorded care. MAIN OUTCOME: The relationship between self-reported and chart audit assessments of CAD risk factors. RESULTS: Chart audit assessment of CAD risk factor management was highly significantly (p<0.01) lower than self-reported behaviors for evaluation of cigarette smoking, diet, physical activity, stress, plasma cholesterol, blood pressure, and body weight/obesity. CONCLUSIONS: Three different interpretations of these findings are apparent. 1) Physician self-report is a poor tool for the measurement of clinical behavior, and therefore research of physician behavior should not rely solely on self-reported data; 2) physicians’ chart recording of their clinical practice is insufficient to reflect actual care; or 3) neither is an accurate measure of actual practice.     

The faulty statistics of complementary alternative medicine (CAM)

The authors illustrate the difficulties involved in obtaining a valid statistical significance in clinical studies especially when the prior probability of the hypothesis under scrutiny is low. Since the prior probability of a research hypothesis is directly related to its scientific plausibility, the commonly used frequentist statistics, which does not take into account this probability, is particularly unsuitable for studies exploring matters in various degree disconnected from science such as complementary alternative medicine (CAM) interventions. Any statistical significance obtained in this field should be considered with great caution and may be better applied to more plausible hypotheses (like placebo effect) than that examined — which usually is the specific efficacy of the intervention.Since achieving meaningful statistical significance is an essential step in the validation of medical interventions, CAM practices, producing only outcomes inherently resistant to statistical validation, appear not to belong to modern evidence-based medicine.     

Correlates of complementary and alternative medicine (CAM) use in Chicago area children with diabetes (DM)

AimsTo correlate complementary and alternative medicine (CAM) use in children with diabetes mellitus (DM) with DM control and other family or disease characteristics.MethodsParents/guardians of children with DM were interviewed about demographics, clinical characteristics, CAM use, health care beliefs, psychosocial variables, and religious beliefs. The child's hemoglobin A1c (HgbA1c) value from the visit was collected. Statistical analyses included χ², Fisher's exact test, and 2-sample t-tests.Results106 families with type 1 DM were interviewed. 33% of children tried CAM in the last year; 75% of parents had ever tried CAM. Children most commonly tried faith healing or prayer; parents most commonly tried faith healing or prayer, chiropractic, massage, and herbal teas. Children were more likely to have used CAM if their parents or siblings used CAM or their family was more religious. They were more likely to have discussed CAM with their providers if they used CAM. Parents of child CAM users reported more problems with DM treatment adherence.ConclusionsChildren with DM used CAM. There were no differences in DM control, demographics, healthcare beliefs, stress, or quality of life between CAM users and non-users. Practitioners should inquire about CAM use to improve DM care for children.     

Complementary and alternative medicine use by patients with inflammatory bowel disease: results from a postal survey

AIMS: Thirty to 50% of north American patients with inflammatory bowel disease (IBD) have been reported to use complementary and alternative medicine (CAM). There is no data in France. The aim of this study was to evaluate the frequency of CAM use and the reasons in a French population of patients with IBD. PATIENTS AND METHODS: An anonymous postal survey was done with a questionnaire mailed to all the patients with IBD, 16 to 79 year-old, followed-up in a public and a private medical centre of Reims, between January 2001 and December 2003. RESULTS: The final sample included 447 patients; 325 (72.7%) filled up the questionnaire: 219 (67.4%) had Crohn's disease, 94 (28.8%) ulcerative colitis and 12 (3.7%) indeterminate colitis. Sixty-nine patients (21.2%) reported CAM use for IBD. The mean number of CAM used simultaneously was 2.9. The most frequently used CAM treatment was homeopathy (40.6%), followed by magnetism (34.8%) and acupuncture (33.3%). The majority of patients (74.8%) never talked about CAM use with their IBD physician. Multivariate analysis showed that the factors significantly associated with CAM use were female gender (odds ratio (OR)=3.5, CI95%: 1.8-6.9), the low level of confidence in their doctor (OR=4.8, CI95%: 1.1-19.8) and the research of informations about their disease (OR=4.6, CI 95%: 2.0-10.7). CONCLUSION: Twenty-one percent of patients with IBD are using CAM, most of the time without talking about it with their physician. The quality of the relationship between the patient and his physician and female sex, more than the perceived severity of the disease, were the main determinants of that use.     

Complementary and alternative medicine use by Canadian patients with inflammatory bowel disease: results from a national survey

OBJECTIVE: Previous studies of complementary and alternative medicine (CAM) use by patients with inflammatory bowel disease (IBD) have relied on samples from specialty clinics. The aim of this study was to determine the prevalence of use and perceived outcomes of CAM in a large, diverse IBD population. METHODS: A postal survey of the members of the Crohn's and Colitis Foundation of Canada gathered data on demographic, disease, and conventional IBD treatment characteristics, and on the use and perceived effects of CAM. Respondents were characterized as not using CAM, as past or present users of CAM for their IBD, or as present users of CAM for other reasons. Comparisons between groups were made with the chi(2) test. RESULTS: The final sample included 2847 IBD patients. Current or past use of CAM for IBD was reported by 1332 patients, of whom 666 continued their use of CAM. Use was lowest in the eastern provinces and highest in the west. Only 15% had used CAM before their IBD diagnosis. Herbal therapies were the most commonly used (41% of CAM users). Improvements in sense of well-being, IBD symptoms, and sense of control over the disease were the most commonly reported benefits. Only 16% of prior CAM users reported any adverse effect of CAM use. A complementary practitioner was consulted by 34%. During the previous year, 46% had spend more than $250 on CAM. CONCLUSIONS: Use of CAM by IBD patients is very common. Most of these patients attribute significant benefits to their CAM use. Few report significant adverse events.     

Complementary alternative medicine in patients with inflammatory bowel disease: use and attitudes

BACKGROUND: A widespread increase in the use of complementary alternative medicine (CAM) by patients with inflammatory bowel disease (IBD) has been recognized. The aim of our study was to evaluate both the extent and the determinants of CAM use by outpatients with IBD. METHODS: Outpatients of the IBD centre at the University Hospital of Berne and patients of two gastroenterology private practices in Olten (Switzerland) completed a mailed self-administrated questionnaire regarding alternative medicine. The questionnaire addressed the following topics: demographic variables; disease-related data; the use of 16 types of complementary medicine; comparison between attitudes towards alternative versus conventional medicine and out-of pocket expenses. RESULTS: Alternative medicine has been used by 47% of the patients. Diagnosis, duration and activity of disease, gender, age, previous surgery were not predictive for the use of CAM. The most commonly used CAM methods were: homeopathy, acupuncture and traditional Chinese medicine. Reasons cited for the use of CAM were: lack of satisfaction with and side effects of conventional therapy and the perceived safety of CAM. Sixty-one percent of patients noted that their IBD had improved with the use of CAM. By contrast, 16% noted a flare during CAM therapies. Forty-seven percent of patients paid more than Euro400 per year for CAM. CONCLUSIONS: Complementary medicine use is common in patients with IBD. Frequently cited reasons for the use of complementary therapies were safety of CAM; dissatisfaction with conventional therapies, including their side effects; and that CAM can be used in addition to conventional therapy.     

Complementary and alternative medicine use by patients with inflammatory bowel disease: An Internet survey.

OBJECTIVES: To determine the degree and determinants of the use of complementary and alternative medicine (CAM) by patients with inflammatory bowel disease (IBD) with the use of the Internet and to compare the results with those found by using a similar survey in patients attending gastroenterology clinics in Calgary, Alberta. SUBJECTS AND METHODS: A cross-sectional survey of 263 patients with IBD with the use of a World Wide Web-based, structured questionnaire was conducted. RESULTS: Complementary therapies had been used by 46% of patients in the previous two years. Current use was reported by 34%. Vitamins, herbal products and natural health practices were the most commonly reported therapies. Side effects and lack of effectiveness of standard therapies were the most commonly cited reasons for seeking complementary medicine. However, despite this, respondents who had previously received surgery, or intravenous or oral steroids were less likely to be current CAM users. Important differences between the determinants of and reasons for CAM use in the present study and those of a similar study of IBD patients in a local tertiary care setting were noted. CONCLUSIONS: Complementary medicine use is common in patients with IBD. Differences in the determinants of and reasons for CAM use noted between the present Internet sample and a gastroenterology clinic sample suggest that conclusions from the present study and from previous studies based only on clinic samples provide a limited view of CAM use by people with IBD. More comprehensive assessments are needed.     

Complementary and alternative medicine use by patients chronically infected with hepatitis C virus.

Complementary and alternative medicine (CAM) is becoming increasingly popular in North America. The use of CAM is also popular in patients with chronic liver disease but is not well documented. The extent of use of CAM in chronic hepatitis C virus (HCV) infected patients was determined, and the demographic and clinical data between users and nonusers of CAM was compared. Seventy-six patients (30% female) with chronic HCV were interviewed. The mean age was 43+/-8 years. Current use of CAM for HCV was reported by 35 of 76 patients (46%). Eighteen of 76 patients within this group used herbal supplements (24%). The most commonly used herb was Silybum marianum (milk thistle), reported by 10 of 76 patients (13.2%). Commonly reported benefits of CAM use included reduction in fatigue, boost in the immune system and improved gastrointestinal function. No adverse effects of CAM use were reported. In the present study, four of 18 patients (22%) with chronic liver disease taking herbal therapies were on herbs that increased bleeding time. The use of CAM in chronic HCV patients is significant. Patients should be asked specifically about their use of CAM. CAM use may have implications affecting conventional treatment and management of HCV.     

Complementary and alternative medicine use among elderly persons: one-year analysis of a Blue Shield Medicare supplement

BACKGROUND: Large scale surveys in the United States and abroad suggest that 35-60% of adults have used some form of complementary/alternative medicine (CAM). However, no studies to date have focused on predictors and patterns of CAM use among elderly persons. METHODS: The population surveyed were Californians enrolled in a Medicare risk product that offers coverage for acupuncture and chiropractic care. Surveys were mailed to 1597 members in 1997 and responses received by 728 (51% response rate). Health risk assessment data were also obtained at baseline and 12-15 months following enrollment in the plan. Multiple logistic regression analyses were carried out to examine predictors of CAM use. RESULTS: Forty-one percent of seniors reported use of CAM. Herbs (24%), chiropractic (20%), massage (15%), and acupuncture (14%) were the most frequently cited therapies. CAM users tended to be younger, more educated, report either arthritis and/or depression/anxiety, not be hypertensive, engage in exercise, practice meditation, and make more frequent physician visits. Use of CAM was not associated with any observed changes in health status. Respondents also expressed considerable interest in receiving third-party coverage for CAM. Although 80% reported that they had received substantial benefit from their use of CAM, the majority (58%) did not discuss the use of these therapies with their medical doctor. CONCLUSIONS: Findings suggest that there is significant interest in and use of complementary/alternative medicine among elderly persons. These results suggest the importance of further research into the use and potential efficacy of these therapies within the senior population.