Alternative/complementary medicine: wider usage than generally appreciated

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.

Applications of Pueraria lobata in treating diabetics and reducing alcohol drinking

Pueraria lobata is one of the most important medicinal herbs used traditionally in China. According to Shanghan Lun (Treatise on Exogenous Febrile Disease), it has been used traditionally to relieve body heat, eye soring, dry mouth, headache associated with high blood pressure, and stiff neck problems. Modern studies in the 1970s revealed that isoflavonoids extracted from P. lobata were the bioactive components of an herbal remedy namely Yufeng Ningxin Tablets for the treatment of patients after stroke. This article reviews recent application of P. lobota in the treatment of diabetics and in reducing alcohol drinking. In view of its low toxicity profile, P. lobota stands an excellent chance to be developed as a phytomedicine for treating human diseases.

Predictive factors of complementary and alternative medicine use in the general population in Europe: A systematic review

AIM

To identify predictive factors of CAM use in the general population in Europe.

METHODS

We performed a systematic review to summarize and analyse the published data on factors predictive of CAM use by the general population in Europe. The Cumulative Index to Nursing and Allied Health Literature, Google Scholar, PsycInfo, PubMed and the Web of Science databases were systematically searched up to August 2, 2018. We selected observational studies (case-control, cohort and cross-sectional) of adults conducted in Europe. Risk of bias was determined using the ROBINS-I tool recommended by the Cochrane Group.

RESULTS

Over six thousand articles were identified of which 49 met our inclusion criteria. Twenty three studies investigated the consultation of CAM practitioners, five looked at the use of CAM products, one concerned CAM practices and twenty studied combinations of these. Female gender and self-reported chronic disease are predictive factors of CAM practitioner use. In contrast, marital status is not a predictive factor for consulting a CAM practitioner. Female gender is also a predictive factor of CAM product use. For all other factors investigated, no clear conclusions could be drawn.

CONCLUSION

We found no clear specificity of the use of CAM practitioners versus conventional health practitioners. Other directions of public health research should be explored, rather than assuming that there is specificity.

What low back pain is and why we need to pay attention

Low back pain is a very common symptom. It occurs in high-income, middle-income, and low-income countries and all age groups from children to the elderly population. Globally, years lived with disability caused by low back pain increased by 54% between 1990 and 2015, mainly because of population increase and ageing, with the biggest increase seen in low-income and middle-income countries. Low back pain is now the leading cause of disability worldwide. For nearly all people with low back pain, it is not possible to identify a specific nociceptive cause. Only a small proportion of people have a well understood pathological cause-eg, a vertebral fracture, malignancy, or infection. People with physically demanding jobs, physical and mental comorbidities, smokers, and obese individuals are at greatest risk of reporting low back pain. Disabling low back pain is over-represented among people with low socioeconomic status. Most people with new episodes of low back pain recover quickly; however, recurrence is common and in a small proportion of people, low back pain becomes persistent and disabling. Initial high pain intensity, psychological distress, and accompanying pain at multiple body sites increases the risk of persistent disabling low back pain. Increasing evidence shows that central pain-modulating mechanisms and pain cognitions have important roles in the development of persistent disabling low back pain. Cost, health-care use, and disability from low back pain vary substantially between countries and are influenced by local culture and social systems, as well as by beliefs about cause and effect. Disability and costs attributed to low back pain are projected to increase in coming decades, in particular in low-income and middle-income countries, where health and other systems are often fragile and not equipped to cope with this growing burden. Intensified research efforts and global initiatives are clearly needed to address the burden of low back pain as a public health problem.

Renal biochemical and histopathological alterations of diabetic rats under treatment with hydro alcoholic Morus nigra extrac

Introduction: Morus nigra fruit is known to have antioxidant effects and used to control the blood sugar level in traditional medicine.

Objectives: This study was conducted to investigate the biochemical and histopathological changes in the serum and kidneys of diabetic rats treated with hydroalcoholic M. nigra extract.

Materials and Methods: In this study, 60 male Wistar rats were divided into five groups of 12 each. After induction of diabetes with alloxan, the diabetic rats were treated with hydroalcoholic extract of M. nigra at different concentrations. Then, the animals were anesthetized and the serum levels of glucose, creatinine, and urea as well as kidney tissue catalase level measured. The kidney tissue was also histopathologically examined.

Results: Milder glomerular damage was seen in the group treated with 800 mg/kg of the M. nigra extract compared with diabetic and positive controls, and no difference in the expansion of mesenchymal tissue into renal glomerular vessels observed between the group treated with 800 mg/kg of M. nigra extract and diabetic and positive controls. Furthermore, creatinine levels were significantly higher and urea levels significantly lower in the group treated with 800 mg/kg of M. nigra extract than healthy and positive control groups (P<0.05).

Conclusion: Administration of M. nigra extract at 800 mg/kg can prevent kidney tissue damage in diabetic rats and this fruit seems to be beneficial to patients with diabetes.

Determinants of the Use of Four Categories of Complementary and Alternative Medicine

The purpose of this research is to assess the social and health determinants of the use of four separate and distinct categories of complementary and alternative medical therapies: biologically based, mind-body, manipulative, and whole CAM medical systems. The behavioral model of health services use, which holds that health service use is a function of predisposing, enabling, and need characteristics, is used as the theoretical framework for linking specific determinants with the four categories of CAM use. Data are taken from a statewide interview survey of Kansas adults ( N = 2,166) conducted in 2001. Results from multivariate analyses demonstrate that there is variation in the determinants of the use of different categories of CAM therapies. Overall, the results indicate that future research on the determinants of CAM must delineate between various CAM therapies to gain an accurate portrayal of the factors contributing to CAM use.

Doctor-Shopping Behaviors among Traditional Chinese Medicine Users in Taiwan

Doctor-shopping has caused an increase in medical expense, potential to receive duplicate medications, and suffer adverse drug reactions. We carried out a population-based retrospective study aimed at examining the user patterns of traditional Chinese medicine (TCM) ambulatory care in Taiwan. We retrieved complete TCM ambulatory visit datasets for the year 2007 from the National Health Insurance database in Taiwan. We defined the patients whose distribution of TCM physician numbers scored more than 97.5 percent (more than, or equal to, five TCM physicians) within one year as TCM doctor-shoppers. In total, 6,596,814 subjects (28.9%) paid TCM visits during that year. All 177,728 subjects (2.69%) who visited more than five (including) TCM physicians were classified as TCM shoppers. The most prevalent diagnostic grouping was upper respiratory infections (44.7%) and sprains and strains (44.0%). Men had a lower odds ratio (OR) among TCM shoppers than women (OR = 0.94, 95% confidence interval (CI) = 0.93-0.96). Younger people were less likely to be TCM shoppers than other people were. The ORs of TCM shoppers were higher among veterans and low-income patients (OR = 1.29 (1.23-1.35), and 1.33 (1.27-1.41)). In conclusion, health education on the potential of drug interactions and iatrogenic health risks incurred from doctor-shopping should be addressed to those high-risk patients.

Therapeutic values, chemical constituents and toxicity of Taiwanese Dysosma pleiantha--a review

Dysosma pleiantha (Hance) Woodson also called as Bajiaolian belongs to the family Berberidaceae, is widely used in Taiwan as traditional Chinese herbal medicine for more than thousands of years. It is usually recommended by various traditional Chinese medical doctors and herbal pharmacies for general remedies including postpartum recovery, treatment of weakness, neck mass, acne, hepatoma, lumbago, snakebite, tumor growth and dysmenorrhea. In the textbooks of traditional Chinese medicine, there is limited information about the toxicity of Bajiaolian. Podophyllotoxin, a lignan is the main toxic ingredient of Bajiaolian rhizome. Therefore, Bajiaolian is documented as the fifth highest cause of poisoning among the herbal medicine in Taiwan. Since the therapeutic and toxic doses are very close, Bajiaolian poisoning cases are frequently reported in Taiwan. Moreover, Dysosma poisoning cases are difficult to diagnosis because physicians are unfamiliar with this medicine's multiple clinical presentations in different stages of intoxication. Therefore, the objective of this review is to represent the collective information available in literatures regarding D. pleiantha, a cytotoxic lignan containing medicinal plant. Specifically, the literatures have been reviewed for articles pertaining to chemical constituents, properties, therapeutical benefits, toxicity, poisoning symptoms, toxic as well as therapeutic dose and medical management.

Psychosocial factors that predict why people use complementary and alternative medicine and continue with its use: a population based study

Studies have explored the predictors of CAM use but fewer data explain the psychosocial factors associated with this and why people continue with CAM.

AIMS

To examine the psychosocial factors that predict CAM use; to explore the predictors of continuing with CAM.

DESIGN

A cross sectional survey.

METHODS

1256 adults were interviewed as part of 2012 Queensland Social Survey. We included questions about CAM, perceived control, cognitive style, spirituality and openness. Relationships were explored using bivariate and multiple logistic regression.

RESULTS

79% of people had used CAM in the last 12 months. Socio-demographics, health behaviours, spirituality, openness and prescribing sources were the strongest predictors of CAM use. General health, chronic illness and prescribing sources predicted continued CAM use.

CONCLUSION

There was high CAM use in Queensland, Australia. Personal characteristics and psychosocial factors need to be considered as part of the individual's holistic assessment and on-going care.

Focused suggestion with somatic anchoring technique: rapid self-hypnosis for pain management

This article details a self-hypnosis technique designed to teach patients how to manage acute or chronic pain through directed focus. The focused suggestion with somatic anchoring technique has been used with various types of pain, including somatic pain (arthritis, post-injury pain from bone breaks, or muscle tears), visceral pain (related to irritable bowel disease), and neuropathic pain (related to multiple sclerosis). This technique combines cognitive restructuring and mindfulness meditation with indirect and direct suggestions during hypnosis. The case examples demonstrate how the focused suggestion with somatic anchoring technique is used with both acute and chronic pain conditions when use of long-term medication has been relatively ineffective.

Alternative health care consultations in Ontario, Canada: A geographic and socio-demographic analysis

BACKGROUND

An important but understudied component of Canada's health system is alternative care. The objective of this paper is to examine the geographic and socio-demographic characteristics of alternative care consultation in Ontario, Canada's largest province.

METHODS

Data is drawn from the Canadian Community Health Survey (CCHS Cycle 3.1, 2005) for people aged 18 or over (n = 32,598) who had a consultation with an alternative health care provider. Four groups of consultations are examined: (1) all consultations (2) massage therapy (3) acupuncture, and (4) homeopath/naturopath. Descriptive statistics, mapping and logistic regression modeling are employed to analyze the data and to compare modalities of alternative health care use.

RESULTS

In 2005, more than 1.2 million adults aged 18 or over consulted an alternative health care provider, representing about 13% of the total population of Ontario. The analysis revealed a varied geographic pattern of consultations across the province. Consultations were fairly even across the urban to rural continuum and rural residents were just as likely to consult a provider as their urban counterparts. From a health perspective, people with a chronic condition, lower health status and self-perceived unmet health care needs were more likely to see an alternative health provider. Women with chronic conditions such as fibromyalgia, high blood pressure, chronic fatigue syndrome and chemical sensitivities were more likely to see an alternative provider if they felt their health care needs were not being met.

CONCLUSIONS

The analysis revealed that geography is not a factor in determining alternative health care consultations in Ontario. By contrast, there is a strong association between these consultations and socio-demographic characteristics particularly age, sex, education, health and self-perceived unmet health care needs. The results underscore the importance of women's health needs as related to alternative care use. The paper concludes that there is a need for more place-specific research that explores the reasons why people use specific types of alternative health care as tied to socio-economic status, health, place of residence, and knowledge of these treatments.

Use of complementary and alternative medicine and self-rated health status: results from a national survey

BACKGROUND

Despite the absence of conclusive evidence of effectiveness, complementary and alternative medicine (CAM) is used by 4 of 10 adults in the US; little is known about the association between CAM use and health status.

OBJECTIVE

To determine the relation between CAM use and self-reported health status and health improvement over time.

DESIGN AND PARTICIPANTS

We performed a secondary database analysis using data from the 2007 National Health Interview Survey of non-institutionalized US residents conducted by the National Center of Health Statistics of the Center for Disease Control. We identified CAM users and compared them to non-users. We used multivariable logistic regression to model the health status of respondents. We controlled for confounders including socio-demographic, clinical, and behavioral factors. The models were evaluated for discrimination and calibration.

MAIN MEASURES

The likelihood of respondents to report 'Excellent' current health and 'Better' health than in the prior year.

KEY RESULTS

Based on 23,393 respondents, we found 37% of U.S. adults used complementary and alternative medicine and 63% did not use any CAM. Compared to those who did not use CAM, CAM users were more likely to rate their health as 'Excellent' (adjusted-odds ratio (AOR) = 1.14, 95% CI = [1.03,1.26]). Similarly, CAM users were more likely to report their health as 'Better' than in the prior year (AOR = 1.64, 95% CI = [1.49,1.83]). The c-statistics for the two models were 0.755 and 0.616, respectively.

CONCLUSION

We found a significant association between CAM use and self-rated excellent health and health improvement over the prior year. Prospective trials are required to determine whether CAM use is causally related to excellent health status and better health than in the prior year.

Who Are the Users of Vitamin–Mineral and Herbal Preparations among Community-Living Older Adults?

Information on the characteristics of seniors who use supplements is lacking. A convenience sample of community-living seniors (n= 128) was recruited from 10 sites to identify factors associated with supplement use (vitamin-mineral and/or herbal preparations). Data on nutritional variables, health history, and supplement use were collected with an interview-administered questionnaire. APropensity to Use Supplementsscale was developed and was associated with increased use of herbal supplements. At the bivariate level, few characteristics distinguished users and non-users. Multivariate modelling revealed the Propensity scale and a low Body Mass Index to be factors related to the total number of supplements used. When individual scale items were examined at the bivariate level, food supply concerns, health beliefs, and a proactive role in one's own health were associated with increased supplement use. Initial results suggest seniors' attitudes towards supplements may be an important factor contributing to their decision to use supplements. Further work is required in a more diverse, randomly selected, older Canadian population.

Domiciliary medication reviews by fourth year pharmacy students in Western Australia

Objective

The principal aim of this study was to assess the potential value of final-year undergraduate pharmacy students in domiciliary medication review (DMR).

Method

Students attended workshops on communication skills, complementary medicines and medication review. Each student contacted 5–10 patients by telephone and asked them to identify from memory all current medications. The student later conducted a DMR in the patient's home and prepared a report for the pharmacist preceptor and the patient's medical practitioner (GP) to review.

Results

The students recruited 189 patients, 80% of whom were over 60 years of age. The mean number of medications recalled by patients (5.8±2.9) was significantly lower than the number of medications that patients were actually taking (8.5 ± 3.5; P &lt;0.001). Overall, 39% of patients gave incorrect/unknown indications for at least one medication and 17% had expired medicines. Students identified an average of 2.1 ± 1.7 actual or potential medication problems per patient. The mean number of problems endorsed by the pharmacist and GP were 1.1 and 0.9, and an additional 0.4 and 0.2 problems were identified, respectively. Nineteen patients (10%) required changes in therapy. Pharmacists and GPs thought it was appropriate for students to conduct DMRs under supervision and to include DMR as part of the students' training.

Conclusion

Final-year pharmacy students were capable of collecting and collating medication information for DMRs in the community setting. The programme was acceptable to patients, GPs and pharmacist preceptors. Experience in DMRs should be included in the education of pharmacy students and pre-registration trainees.

Bajiaolian poisoning-a poisoning with high misdiagnostic rate

BACKGROUND

One of the oldest Chinese herbal medicine, bajiaolian is widely used in traditional therapy. In Taiwan, bajiaolian is the fifth highest cause of poisoning among herbal medicines. The diagnosis is difficult because physicians are unfamiliar with this medicine's multiple presentations in different stages of intoxication.

PROCEDURES

The records of 4 major poison centers in Taiwan were searched for all bajiaolian intoxication from July 1985 (the opening of first poison center) to March 2003. Two emergency physicians with toxicologic training reviewed the admission charts and visited case patients for follow-up.

FINDINGS

Seventeen patients were identified, of which 15 (88.2%) had been misdiagnosed initially. In the beginning of their medical care, 14 cases were diagnosed as acute gastroenteritis.

CONCLUSION

Bajiaolian intoxication is probably misdiagnosed because of early gastrointestinal symptoms followed by neurologic symptoms. A detailed patient history should be taken, and symptoms should be reviewed systemically to improve diagnostic accuracy.

Preventive screening of women who use complementary and alternative medicine providers

BACKGROUND

Many women use complementary and alternative medicine (CAM). Although CAM use has been associated with reductions in conventionally recommended pediatric preventive care (e.g., vaccination), little is known about associations between CAM use and receipt of recommended preventive screening in women.

METHODS

Using Washington State insurance data from 2000 to 2003, the authors generated clustered logistic regression models, examining associations between provider-based CAM use and receipt of screening tests for Chlamydia trachomatis, breast cancer, and cervical cancer: (1) contrasting women who used CAM providers only (alternative use) and women who used both conventional and CAM providers (complementary use) with women who used conventional care only and (2) testing associations between screening and use of four specific CAM provider types-naturopathic physicians, chiropractors, massage therapists, and acupuncturists.

RESULTS

Both alternative and complementary use was associated with reduced Chlamydia screening. Cancer screening increased with complementary use but decreased with alternative use of CAM. Use of naturopathy was associated with decreased mammography, whereas all four CAM therapies were positively associated with Papanicolaou testing.

CONCLUSIONS

When used in conjunction with conventional care, use of provider-based CAM may signal high interest in various types of health-promoting behavior, including cancer screening. Negative associations between CAM and Chlamydia screening and between naturopathy and mammography require additional study. Interventions with CAM providers and their patients, aimed at improving rates of conventionally recommended screening, might encourage greater focus on preventive care, an important task when CAM providers serve as women's only contact with the healthcare system.

Toward a sociological understanding of complementary and alternative medicine use

BACKGROUND AND OBJECTIVES

The wide array of treatments and modalities comprising complementary and alternative medicine (CAM) represent a growing option for many individuals. Seeking to better understand this, much research has centered on identifying sociodemographic (e.g., age, gender, race) or social-psychologic (e.g., absorption, depression, coping) correlates of using CAM therapies. In contrast, sociological perspectives recognize the influence of larger-scale, external forces on individuals' motivations to seek alternative or complementary care.

AIM

This paper, then, illustrates current and potential sociological approaches to understanding CAM use, and the importance of social forces that influence persons' decisions to utilize (or not) "unconventional" medical care.

A Survey of Hospices Use of Complementary Therapy

As people live longer with chronic illnesses, the need for hospice services will increase. Complementary therapies have been shown to increase ease, relieve pain, and improve quality of life; all relevant for people with chronic illness at the end of their lives. The first aim of this study was to identify complementary therapy services available to, and provided for, clients receiving hospice care in Nevada and Montana. The second aim was to identify differences in those therapies for urban and rural hospice clients. Using a descriptive survey design, data were collected from surveys sent to all hospice administrators in Nevada and Montana (N=54). A 50% (n=27) response rate was obtained. Most (70.4%, n=19) of the participating hospices offered complementary therapy; slightly more than half (52.9%, n=9) provided the services for less than 25% of their clients. No significant differences were found between rural and urban hospices.

Patients' motives for choosing a physician: comparison between conventional and complementary medicine in Swiss primary care

Background

The study is part of a nationwide evaluation of complementary and alternative medicine (CAM) in primary care in Switzerland. The Objective was to identify patients' expectations and reasons governing the choice of complementary medicine compared with conventional primary care (CONV).

Methods

The data were derived from the PEK study (Programm Evaluation Komplementärmedizin), which was conducted in 2002–2003 with 7879 adult patients and parents of 1291 underage patients, seeking either complementary (CAM) or conventional (CONV) primary care. The study was performed as a cross-sectional survey. The respondents were asked to document their (or their children's) self-perceived health status, reasons governing their choice, and treatment expectations. Physicians were practicing conventional medicine and/or complementary methods (homeopathy, anthroposophic medicine, neural therapy, and traditional Chinese medicine). Reasons governing the choice of physician were evaluated on the basis of a three-part classification (physician-related, procedure-related, and pragmatic/other reasons)

Results and Discussion

Patients seeing CAM physicians tend to be younger and more often female. CAM patients referred to procedure-related reasons more frequently, whereas pragmatic reasons dominated among CONV patients. CAM respondents expected fewer adverse side effects compared to conventional care patients.

Conclusion

The majority of alternative medicine users appear to have chosen CAM mainly because they wish to undergo a certain procedure; additional reasons include desire for more comprehensive treatment, and expectation of fewer side-effects.

The use of CAM and conventional treatments among primary care consulters with chronic musculoskeletal pain

Background

Chronic musculoskeletal pain is the single most cited reason for use of complementary and alternative medicine (CAM). Primary care is the most frequent conventional medical service used by patients with pain in the UK. We are unaware, however, of a direct evidence of the extent of CAM use by primary care patients, and how successful they perceive it to be.

Methods

Aims and objectives

To determine CAM use among patients with chronic musculoskeletal pain who have consulted about their pain in primary care.

Study design

Face-to-face interview-based survey.

Setting

Three general practices in North Staffordshire.

Participants

Respondents to a population pain survey who had reported having musculoskeletal pain in the survey and who had consulted about their pain in primary care in the previous 12 months as well as consenting to further research and agreeing to an interview. Information was gathered about their pain and the use of all treatments for pain, including CAM, in the previous year.

Results

138 interviews were completed. 116 participants (84%) had used at least one CAM treatment for pain in the previous year. 65% were current users of CAM. The ratio of over-the-counter CAM use to care from a CAM provider was 3:2. 111 participants (80%) had used conventional treatment. 95 (69%) were using a combination of CAM and conventional treatment. Glucosamine and fish oil were the most commonly used CAM treatments (38%, 35% respectively). Most CAM treatments were scored on average as being helpful, and users indicated that they intended to use again 87% of the CAM treatments they had already used.

Conclusion

We provide direct evidence that most primary care consulters with chronic musculoskeletal pain have used CAM in the previous year, usually in combination with conventional treatments. The high prevalence and wide range of users experiences of benefit and harm from CAM strengthen the argument for more research into this type of medicine to quantify benefit and assess safety. The observation that most users of conventional medicine also used CAM suggests a continuing need for more investigation of effective pain management in primary care.

Use frequency of traditional Chinese medicine in Taiwan

Background

Use of Traditional Chinese medicine (TCM), an important category of complementary and alternative medicine (CAM), has increased substantially in Western countries during the past decade. Use of TCM is also widespread in the Chinese population. However, few informative data have been obtained to date by large-scale investigations of TCM use in the Chinese population. This study was aimed at elucidating the demographics and patterns of TCM use in Taiwan.

Methods

We employed the complete datasets of TCM outpatient reimbursement claims from 1996 to 2001, including the use of Chinese herbal remedies, acupuncture and traumatology manipulative therapy, to analyse use frequencies, the characteristics of TCM users, and the disease categories that were treated by TCM in Taiwan.

Results

At the end of 2001, 6,142,829 (28.4%) among the 21,653,555 valid beneficiaries of the National Health Insurance in Taiwan had used TCM during the year. However, 13,536,266 subjects (62.5%) had used TCM at least once during the whole 6-year period from 1996 to 2001, with a total of 156,224,266 visits (mean 11.5 visits per user). The mean number of TCM users per annum was 5,733,602, with a mean increment of 1,671,476 (29.2%) of new users yearly. Among TCM users, female was higher than male (female:male = 1.13:1), and the age distribution displayed a peak at around the 30s, followed by the 20s and 40s. Chinese herbal remedies (85.9%) were the most common TCM modality used by this population, followed by acupuncture (11.0%) and traumatology manipulative therapies (3.1%). Private TCM clinics provided most of the TCM care (82.6%), followed by private TCM hospitals (12.0%). The top ten major disease categories for TCM visits were diseases of the respiratory system, musculoskeletal system and connective tissue; symptoms, signs and ill-defined conditions; injury and poisoning; diseases of the digestive system, genitourinary system, skin and subcutaneous tissue, nervous system and sense organs, circulatory and endocrine system; nutritional and metabolic diseases; and immunological disorders.

Conclusion

TCM was popular among the Chinese population in Taiwan during the period studied. More than 60% of all subjects had used TCM during the 6-year interval. TCM was widely used by the Chinese population to treat problems and diseases of major human organ systems recognised by western medicine. This study provides information about the use frequencies of TCM and the disease categories treated by TCM, which should be useful for health policy makers and for those considering the integration of TCM and Western medicine.

Demographics and patterns of acupuncture use in the Chinese population: the Taiwan experience

BACKGROUND

The use of complementary and alternative medicine (CAM), including Traditional Chinese Medicine (TCM) and acupuncture, has substantially increased in western countries in the past decade. However, informative data concerning large-scale investigations of acupuncture used in the Chinese society remain rare so far. DESIGN AND OUTCOME MEASURE: The complete datasets of acupuncture outpatient reimbursement claims from 1996 to 2002 were supplied by the National Health Insurance Research Database, Taiwan, and the usage frequencies and characteristics of the acupuncture users, as well as the disease categories that were treated by acupuncture in Taiwan were analyzed.

RESULTS

At the end of 2002, among the 21,869,478 total valid beneficiaries of National Health Insurance (NHI), 1,362,351 subjects (6.2%) used acupuncture during this year, but 4,948,464 subjects (22.6%) had used it for the whole 7-year period since 1996. A mean increment of 1,191,164 (53.6%) new users had been involved yearly. Among all those acupuncture users, a female predominance was observed (female:male = 1.12:1), and the age distribution displayed a peak at around the 40s, followed by the 30s and 50s. Private TCM clinics provided more acupuncture usage (82.0%) than did private TCM hospitals (13.7%). The disease categories treated mostly by acupuncture were diseases of the musculoskeletal system (46.2%); injury (41.8%); diseases of the nervous system (3.5%); and symptoms, signs, and ill-defined conditions (2.7%).

CONCLUSIONS

Twenty-three percent (23%) of people in Taiwan had used acupuncture during this 7-year period. Musculoskeletoal and neurologic disorders were two major categories commonly treated with acupuncture.

Pharmacokinetic Profile of the Isoflavone Puerarin After Acute and Repeated Administration of a Novel Kudzu Extract to Human Volunteers

OBJECTIVES

This study was undertaken to assess the pharmacokinetic profile of puerarin, the major isoflavone found in a kudzu (Pueraria lobata) extract after acute and repeated administration.

METHODS

Participants were given either single or repeated doses of kudzu extract, and blood samples were collected for either 8 or 72 hours for subsequent pharmacokinetic analyses of puerarin.

RESULTS

Using WinNonlin pharmacokinetic data analysis software, puerarin was found to be rapidly absorbed via the oral route, reach peak levels at 2 hours, and have a half-life of approximately 4.3 hours. The elimination half-life was not significantly altered after repeated administration.

CONCLUSIONS

A formulation of kudzu extract delivers a large amount of the principal isoflavone in a rapid manner. The elimination rate constants and the mono-exponential decline in blood levels suggest that a one compartment model adequately explains how puerarin is handled by the body. Three times a day dosing is recommended as accumulation will not occur, and plasma levels remain at levels that are biologically active, even 8 hours after the last steady-state dose.

Sociodemographic determinants of the utilization of specific types of complementary and alternative medicine: an analysis based on a nationally representative survey sample

OBJECTIVES

To evaluate the relationships between selected sociodemographic factors and the use of particular types of complementary and alternative medicine (CAM) in the general U.S. population. CAMs make up a heterogeneous group of practices. Although it is well established that sociodemographic factors impact the use of conventional medicine, it is unclear which, if any, influence the use of particular types of CAM.

DESIGN

Data from a 1997-1998 nationally representative survey (n = 2055) was examined using descriptive and univariate analyses.

RESULTS

The impact of particular sociodemographic factors was found to vary by type of CAM considered. Whites used more CAM than non-Whites except in the case of prayer. Users of CAM tended to be better educated than nonusers with the exception of prayer, self-prayer, and use of a lay midwife. Women used more CAM than men, especially weight-change diet.

CONCLUSIONS

As with conventional medicine use, the patterns of CAM use vary by individual type of therapy considered. Analytically, grouping many heterogeneous practices into the CAM category hides important differences in use patterns.

Patient requests and provider suggestions for alternative treatments as reported by rural and urban care providers

OBJECTIVES

Explored the relationship between different types of care providers' willingness to suggest alternative and complementary treatments (CAM), patients' requests for CAM, and provider perceptions about CAM as barriers to effective healthcare.

DESIGN

Large survey.

SETTING

Alaska and New Mexico.

MAIN MEASURES

Survey responses from 1528 physical and behavioral healthcare providers.

RESULTS

Over 97% of providers suggested CAM; over 97% reported patients asked for CAM. Providers were more likely to suggest CAM than perceived CAM as a barrier to care. Healthcare providers who were female, from small rural areas, or specializing in behavioral healthcare were more likely to suggest CAM and less likely to perceive CAM as a barrier. Patients of physical healthcare providers asked for CAM more often than patients of behavioral healthcare providers, yet physical care providers suggested CAM less frequently.

CONCLUSIONS

Healthcare providers of all disciplines, regions, and gender are sensitive to patients' desire for CAM and do not perceive CAM as a barrier to care.

Complementary therapy use among older rural adults

OBJECTIVE

Explore use, cost, and satisfaction with the quality and effectiveness of complementary therapy among older rural adults.

DESIGN

Descriptive survey.

SAMPLE

A random sample of 325 older adults from rural communities throughout Montana and North Dakota.

MEASUREMENTS

Participants were interviewed by telephone.

RESULTS

Only 57 participants (17.5%) had used complementary providers and most sought this care for chronic problems, heard about providers through word-of-mouth information, and were satisfied with the care. A total of 35.7% (116) used self-directed complementary practices and most used these practices for health promotion, heard about them through informal sources, and found them to be at least somewhat helpful. Of the 325 participants, 45.2% (147) used some form of complementary care, e.g., providers, self-directed practices, or both. Participants used as much complementary care as is found in national studies. Most spent relatively little out-of-pocket for complementary care.

CONCLUSIONS

Understanding the health care choices that older rural residents make, including complementary health care, is paramount for a comprehensive approach to meeting their health care needs.

Patient visits to a hospital-based alternative medicine clinic from 1997 through 2002: Experience from an integrated healthcare system

OBJECTIVE

Efforts to integrate complementary and alternative medicine (CAM) into conventional healthcare systems raise questions about expected levels of CAM use and its cost in an integrated system. This paper documents actual patient usage of a hospital-based alternative medicine clinic that has been operating on a conventional healthcare campus since 1993.

SETTING

Hennepin Faculty Associates (HFA) is a multispecialty physician organization serving the Hennepin County Medical Center (HCMC), a public teaching hospital in downtown Minneapolis. In 1993, HFA opened an alternative medicine clinic, primarily providing acupuncture. The clinic has since expanded services to offer chiropractic, massage/bodywork, and herbs. Administrative claims data showing visit dates, treatment received, payment source, charges, and patient complaints are available from 1997 through 2002.

RESULTS

Of all HFA patients who received conventional care on the HCMC campus every year (1997-2002), 6.5% also received care at the Alternative Medicine Clinic (AMC). Nearly 80% of AMC patients received third-party reimbursement for AMC services. Averaged over 6 years, self-pay patients had 3.2 visits per year and incurred $173 in charges per year; patients with a mixture of third-party payment sources had 8.0 visits per year and incurred $634 in charges per year. Number of visits per patient per year remained relatively constant over the 6 years, except for patients aged 65 or older, who showed an increase in number of visits, particularly for acupuncture.

CONCLUSIONS

This report contributes a new perspective on use of CAM in the general population. Results from this perspective differ markedly from those provided by published survey data, showing a lower prevalence of use and lower charges incurred. Concern that insurance coverage for CAM would increase healthcare costs dramatically are not substantiated by these data.

A survey of patients' out-of-pocket payments for complementary and alternative medicine therapies

OBJECTIVE

Investigate the out-of-pocket payments for complementary and alternative therapies.

DESIGN

Cross-sectional study using the 1996 Medical Expenditure Panel Survey.

SETTING

Fourteen thousand and twenty-six US adults aged > or =25 years from 10,597 answering households. Respondents to the survey were only included in this analysis if they used a single CAM therapy which was not covered by insurance.

MAIN OUTCOME MEASURE

Reported out-of-pocket payments.

RESULTS

Out of 836 users of alternative therapies, 577 used only a single therapy. Massage therapy (23.7%), spiritual healing (16.6%) and herbal therapy (14.7%) were the most frequently single used therapies. The out-of-pocket payments per visit for providers was on average $49 for nutritional advice, $44 for acupuncture, $33 for massage, $23 for herbal therapies, and $9 for spiritual healing.

CONCLUSIONS

These are the first estimates of the out-of-pocket payments for specific complementary and alternative therapies. They can help understand the importance people place on these therapies.

Determinants of complementary alternative medicine (CAM) use

OBJECTIVE

The aim of this study was to describe the pattern of use of complementary alternative medicine (CAM) and identify the determinants of CAM use in a multi-ethnic Swedish primary health care practice population.

METHODS

A questionnaire was handed out to 1433 patients aged 16 years and above who visited the Jordbro Health Centre (JHC) in Stockholm, Sweden, between 14 January and 30 June 2002. The results were linked to computerised medical records.

RESULTS

Seventeen percent of respondents had consulted a CAM provider during the preceding year and many patients had consulted several types of CAM providers. The most frequently CAM used was massage, followed by acupuncture, chiropractic and naprapathy. In the logistic regression, when adjusting for the influence of possible confounders, chronic disease and physical activity were the most important predictors of consultations with CAM providers. Users of CAM had had a higher number of consultations with medical professionals than had non-users of alternative medicine.

CONCLUSIONS

In our study population CAM, defined here as "manual therapy", was used in addition to traditional therapies and was related to high use of health care services. Chronic disease and physical activity were significantly and independently related to use of CAM.

Complementary and alternative therapy use by older adults in three ethnically diverse populations

Americans have overwhelmingly embraced complementary and alternative therapies. Although the primary purpose of this study was to refine a questionnaire on complementary and alternative therapy use by older adults, the findings of this pilot study identified knowledge and use of complementary and alternative therapies in a convenience sample of 60 older adults, 54 to 92 years of age from three ethnically diverse senior centers. Eighty percent of the participants used two or more therapies. There were no significant differences in therapy use by ethnicity. The most commonly used therapies were prayer, vitamins, diet, massage, and meditation. The participants rated the effectiveness of therapies higher than their knowledge of the therapies. Older adults need accurate information from health care providers to make safe decisions regarding the combination of complementary therapies and prescribed treatments to reduce the risk of interaction.

Complementary therapy in critical care settings: a review of surveys and implications for nurses

Critical care nurses have been leaders in this field and need to further expand their influence in the work environment and healthcare system. The time is ideal for initiating meaningful system-wide changes in policy and practice. This review provides an historical context of surveys conducted in a variety of critical care settings in this country. It is important for nurses to become familiar with these studies to communicate better with others and make recommendations based on research. Critical care nurses can maintain their lead by becoming principal investigators in this area of research. In this day and age there is no reason to dismiss or arbitrarily evaluate the use of CAM. Consumer use does not end when crossing over the threshold of a healthcare setting. The focus should be equally spread over safety issues and modalities that can enhance an individual's quality of life. The staff has an ethical and legal responsibility to be aware of and knowledgeable about any healthcare modality practiced by their patients regardless of whether "sufficient" randomized, double-blind controlled studies have been completed.

Development and validation of IMAQ: Integrative Medicine Attitude Questionnaire

BACKGROUND

Complementary/alternative medicine and integrative medicine (CAM/IM) are increasingly used in the U.S. We set out to develop and validate a brief questionnaire measuring health care provider and medical student attitudes regarding these approaches to healthcare.

METHODS

IMAQ is a 29-item, 7-point Likert scale rated instrument, developed from focus groups consisting of faculty, fellows, visiting residents, and medical students at a university based integrative medicine program. Respondents included 111 (of 574 contacted) internal medicine physicians on an academic medical center CME list and 85 healthcare providers (mostly physicians) attending an American Holistic Medical Association Annual Conference (296 attending). Cohorts were selected for expected differences in attitudes toward CAM/IM.

RESULTS

Factor analysis demonstrated that a 2 factor solution best explained the variance in responses (38%). Factor 1 ("openness to new ideas and paradigms") explained 26% of variance with loadings ranging from 0.79 to 0.3, with factor 2 ("value of both introspection and relationship to patient") contributing an additional 12% of the explained variance with loadings ranging from 0.69 to 0.42. Both factors demonstrated adequate reliability. Factor 1 had a Cronbach's alpha of 0.91, while factor 2 was 0.72. As expected, AHMA conference attendees scored higher (F = 120.00, p < 0.001) than the internists on the IMAQ, supporting the construct validity. Although 63% of the AHMA subjects, and only 32% of the internists were female, analysis revealed that gender did not explain the score differences (F = 2.6, p > 0.05).

CONCLUSIONS

Analysis of the IMAQ provided evidence of its reliability and validity in measuring attitudes toward CAM/IM, specifically openness to new ideas and paradigms, and the value of relationship to self and patient. Initial findings support use of the IMAQ in measuring attitudes of students and practitioners towards CAM/IM interventions as a first step in understanding willingness to use these approaches to healing. It is our desire that this preliminary instrument will continue to be refined as the field of CAM/IM matures.

Chronic pain and the use of conventional and alternative therapy

BACKGROUND

Chronic pain is a common problem affecting about half of the general population. This has implications for the utilization of both conventional and alternative health services.

OBJECTIVES

The aim of this study was to determine the use of conventional and alternative practitioners and medicines amongst individuals with chronic pain in the community.

METHODS

A total of 2422 individuals from a previous population-based survey in the Grampian region of the UK, who agreed to participate in further research, were sent a postal questionnaire. The questionnaire enquired about the presence, type and severity of chronic pain, socio-demographic details, consultations with conventional and alternative practitioners, and the consumption of conventional and alternative medicines. The main outcome measures were the number and frequency of self-reported consultations with GPs, hospital specialists, physical therapists and alternative therapists, and the consumption of prescription, non-prescription and alternative medicines amongst those with chronic pain.

RESULTS

Of the 840 individuals reporting chronic pain, 67.2% had seen their GP, 34.0% a hospital specialist, 25.9% a physical therapist and 18.2% an alternative therapist in the preceding year. Prescription medicines had been taken by 58.4%, non-prescription medicines by 57.4% and alternative medicines by 15.7% of individuals with chronic pain. The majority (67.0%) of individuals with chronic pain who sought alternative health care did so in conjunction with conventional health care. Differences in consultations with practitioners and consumption of medicines were found by age, sex, socio-economic status, site of pain and severity of pain.

CONCLUSIONS

Individuals with chronic pain consult their GP about their pain more than other practitioners and use conventional medicines more frequently than alternative medicines. Alternative health care is used most commonly in addition to conventional health care, although a small number of individuals with chronic pain use alternative care exclusively. The use of alternative health care amongst those with chronic pain is higher than previously estimated and suggests that the use of these services may be increasing amongst those with chronic pain.

Blending the boundaries: steps toward an integration of complementary and alternative medicine into mainstream practice

Complementary and alternative medicine (CAM) is growing in popularity among patients traditionally seen in an allopathic setting. A literature review and information search was conducted to determine the trend in demand for and the availability of CAM in the United States. The results of major surveys show that there is an increase in the use of CAM in the United States. The best predictor of CAM use is higher level of education. In addition, findings reveal that the field of CAM is poorly researched. Many studies in CAM therapies have flaws, such as insufficient statistical power, poor controls, inconsistent treatment, and lack of comparisons. The National Center for Complementary and Alternative Medicine of the National Institutes of Health, has declared their top strategic priority to be investing in research. Currently, more than 70 medical schools offer some type of training in alternative medicine, although there are few guidelines for curriculum and there is considerable heterogeneity in content, format, and requirements among CAM courses. As patients have greater access to information, their needs and values change. They become more involved in their overall health care and are taking a more natural and holistic approach to achieving well-being. Health care practitioners, both allopathic and alternative, must be well informed. There is an imperative to make CAM research a high priority. Valid and reliable empirical data must document the clinical efficacy and safety of CAM practices. In order to integrate CAM into the mainstream, there must be a coordinated effort among all the entities involved. Physicians need to be familiar with proven CAM therapies in order to advise patients about these modalities and the potential benefits and limitations. CAM practitioners should be licensed and regulated in scope of practice to provide a high standard of care, and be sufficiently educated in conventional medical science(s) in order to recognize how, where, and why their respective complementary practice is most effective for integration.

Herbal and nonherbal alternative medicine use in Northwest Ohio

OBJECTIVE

To determine the prevalence and characteristics of herbal and nonherbal alternative medicine use among adults living in northwest Ohio.

DESIGN

Cross-sectional survey.

SETTING

Three grocery store intercepts in northwest Ohio.

SUBJECTS

A consecutive sample of 326 English-speaking persons > or =18 years old.

METHODS

A 26-item survey self-administered to participants over a 6-month period.

OUTCOME MEASURES

Prevalence of herbal remedy use.

RESULTS

Forty percent of respondents have used an herbal remedy during the last 12 months. The average number of herbs used was 2.3 per person. Herbal remedy use was not associated with specific sociodemographic variables. Desire to improve general health was the most common reason for use of an herbal remedy (16%). Herbal users cited "herbals are natural" as the most common benefit. Magazines (17%), health food stores (16%), and friends (14%) were the most common sources of herbal remedy information. Only 50% of the population informed their physician of such use. Forty-one percent used an herbal remedy sometimes to always to self-treat before seeking medical care from a physician. Fifteen percent of adults treated their children with herbs. Nearly all (86%) respondents believed the herb was helpful or very helpful.

CONCLUSIONS

A significant number of the adults surveyed in the Toledo metropolitan area commonly used complementary and alternative medicine (CAM). There were no independent factors associated with herbal remedy use. It is important for healthcare providers to acknowledge this growing trend of CAM therapy use and begin to incorporate open discussion about CAM into the patient-provider relationship.

An investigation of the health beliefs and motivations of complementary medicine clients

The current study was concerned with factors associated with the use of complementary medicine (CM). The reasons for CM use were examined by dividing complementary medicine clients into two groups based on the frequency and length of their use of complementary therapies, and comparing them with conventional medicine clients as well as to each other. New/infrequent CM clients (n = 70), established CM clients (n = 71), and orthodox medicine clients (n = 58) were distinguished on the basis of health beliefs, socio-demographic, medical, and personality variables. Different patterns of predictors of CM use emerged depending on which client groups were compared. In general, health-aware behaviors and dissatisfaction with conventional medicine were the best predictors of overall and initial/ infrequent CM use, and more frequent health-aware behaviors were associated with continued CM use. Medical need also influenced the choice to use CM, and was the best predictor of committed CM use, with the established CM clients reporting more health problems than the new/infrequent CM group. Overall, income was a significant discriminator, but did not predict initial or continued CM use. Openness to new experience was associated with CM use in general, but was most notable in the decision to initially try or explore using CM. The findings support the utility of the three components (predisposing, enabling, and need factors) of the socio-behavioral model for explaining why some people choose CM. Overall, the results of the current study suggest that CM clients need to be looked at in more sophisticated ways, rather than being treated simply as a homogenous group with similar beliefs, motivations and needs.

Treatment seeking and experience with complementary/alternative medicine: a continuum of choice

OBJECTIVES

To examine the treatment seeking patterns of conventional medicine (CM) and complementary and alternative medicine (CAM) clients across different health problems, and to investigate whether CAM clients with different levels of experience with CAM use different modes of treatment for their health issues.

DESIGN

Three-group cross-sectional, self-administered survey study.

SETTINGS AND SUBJECTS

One hundred and ninety-nine (199) self-selected participants sampled from CM and CAM clinics and offices

OUTCOME MEASURES

Self-reported physical health problems, treatment seeking for health problems, and type of treatment used for each health problem (CM, CAM, or both) Results: Treatment rates for non-life-threatening health issues were significantly associated with client group membership after controlling for differences in the number of health problems (partial r = 0.35, p < 0.0001), with the more experienced CAM clients reporting the highest treatment rates and the CM clients reporting the lowest rates. The newer CAM clients also differed significantly from the more experienced CAM clients in the modes of treatment used for their health issues (p < 0.0001), with the less experienced CAM clients relying more on CM alone (42.0%) or in conjunction with CAM (38.3%), whereas the experienced CAM clients used more CAM with CM (45.0%), or CAM alone (33.5%) than just CM alone (21.5%), for treating their health issues.

CONCLUSIONS

CAM users may treat their health issues at higher rates than nonusers, independent of their greater number of health problems. This treatment rate increase may be associated with greater experience with CAM. CAM clients are not homogeneous in their choices of treatment modalities. Newer CAM users still rely heavily on CM treatments, whereas more experienced CAM users depend less on CM alone and more on CAM for treating their non-life-threatening health issues.

Association between use of complementary/alternative medicine and health-related behaviors among health fair participants

BACKGROUND

The relationship between complementary and alternative medicine (CAM) and standard preventive care is not well defined.

METHODS

We surveyed 1,593 health fair participants on their use of CAM and determined odds ratios for standard preventive care and healthy behaviors among users of provider-based CAM (e.g., chiropractic) and users of herbs or supplements.

RESULTS

Users of provider-based CAM were no less likely than nonusers to receive standard preventive care, with the exception of lower likelihood of influenza vaccination among elderly CAM users (OR 0.2). Herbs or supplements were used by a majority of respondents (61%), and users were more likely to report engaging in healthy behaviors such as eating a low-fat diet (OR 1.5) and taking a daily multivitamin (OR 2.0).

CONCLUSIONS

Those who use alternative therapies, including herbs or supplements, appear no less likely overall than nonusers to receive standard preventive care. In addition, users of herbs or supplements are more likely to engage in healthy behaviors and appear to be a more health-conscious group. Overall, our findings support the notion that unconventional therapies are more complementary than alternative to standard preventive care.