Policy implications of complementary and alternative medicine use in Australia: data from the National Health Survey

Impact of spiritual healing on moderate depression in adults: a study protocol of a pilot randomised controlled trial (RCT)

INTRODUCTION

Depression is a common mental disorder and the (global) leading cause of all non-fatal burden of disease worldwide. Currently, supported treatment for depression is antidepressant medication and different psychotherapeutic interventions. Many patients experience, however, adverse effects of antidepressant medication, while at the same time the access to psychotherapeutic interventions are limited. Many patients who suffer from depression turn to complementary medicine and among those modalities often spiritual healing. There is some evidence that consulting a spiritual healer can be beneficial for patients who suffer from depression, and that spiritual healing is associated with low risk. The aim of this protocol is to conduct a pilot randomised controlled trial (RCT) (spiritual healing as addition to usual care vs usual care alone) in preparation of a larger trial in adults with moderate depression, to examine feasibility and individuals' experience of spiritual healing.

METHODS AND ANALYSIS

This study is a pilot RCT with two parallel groups. A total of 28 adult patients with moderate depression, diagnosed by the physician and according to the Montgomery and Åsberg Depression Rating Scale criteria will be randomised to spiritual healing in addition to usual care (n=14) or usual care alone (n=14). To determine if there is a statistical indication of an effect of healing warranting a full-scale study; the separation test will be used. To investigate participants' experience with spiritual healing, a qualitative study will be included using semistructured interviews. The data will be analysed based on a direct content analysis.

ETHICS AND DISSEMINATION

This protocol was approved by regional committees for medical and health research ethics by the identifier (63692). The results will be disseminated through open-access, peer-reviewed publications, in addition to stakeholders' reporting and presenting at conferences.

TRIAL REGISTRATION

Norwegian Centre for Research Data (845302) and clinicaltrials.gov (ID: NCT04766242).

Is mental health co-morbidity an influencing factor in the health service utilisation of women with diabetes mellitus?

Diabetes Mellitus, affecting nearly half a billion people worldwide, is a substantial global public health issue. Although diabetes predominantly affects men, women with diabetes have specific risks and self-management characteristics. Women have a higher risk of either presenting with or developing depression or anxiety, as well as being high users of complementary medicine which can create clinical governance issues. In spite of these known gender differences, limited research has explored gender-specific diabetes care, especially health service use patterns. As increasing attention has turned to supporting people with diabetes to successfully self-manage their diabetes, it is important that we understand how women with diabetes are using health services, and if their specific risk profile is influencing their health care choices. Our study sought to examine the relationship between mental health status and the patterns of conventional and complementary medicine health service use by women diagnosed with diabetes mellitus. Our results showed that women with diabetes and any mental health co-morbidity were more likely to visit their general practitioner more frequently or use herbal medicine than those without a mental health co-morbidity. Women with depression and anxiety were also less likely to consult a physiotherapist and those with anxiety less likely to consult a podiatrist over time when compared to the other mental health groups.

Prevalence of Use of Traditional, Complementary and Alternative Medicine by the General Population: A Systematic Review of National Studies Published from 2010 to 2019

INTRODUCTION

Traditional, complementary and alternative medicine (TCAM) refers to a broad range of health practices and products typically not part of the 'conventional medicine' system, and its use is substantial among the general population. TCAM products and therapies may be used in addition to, or instead of, conventional medicine approaches, and some have been associated with adverse reactions or other harms.

OBJECTIVES

The aims of this systematic review were to identify and examine recently published national studies globally on the prevalence of TCAM use in the general population, to review the research methods used in these studies and to propose best practices for future studies exploring prevalence of use of TCAM.

METHODS

MEDLINE, Embase, CINAHL, PsycINFO and AMED were searched to identify relevant studies published since 2010. Articles/reports describing the prevalence of TCAM use in a national study among the general population were included. The quality of included studies was assessed using a risk of bias tool developed by Hoy et al. Relevant data were extracted and summarised.

RESULTS

Forty studies from 14 countries, comprising 21 national surveys and one cross-national survey, were included. Studies explored the use of TCAM products (e.g. herbal medicines), TCAM practitioners/therapies, or both. Included studies used different TCAM definitions, prevalence time frames and data collection tools, methods and analyses, thereby limiting comparability across studies. The reported prevalence of use of TCAM (products and/or practitioners/therapies) over the previous 12 months was 24-71.3%.

CONCLUSION

The reported prevalence of use of TCAM (products and/or practitioners/therapies) is high, but may underestimate use. Published prevalence data varied considerably, at least in part because studies utilise different data collection tools, methods and operational definitions, limiting cross-study comparisons and study reproducibility. For best practice, comprehensive, detailed data on TCAM exposures are needed, and studies should report an operational definition (including the context of TCAM use, products/practices/therapies included and excluded), publish survey questions and describe the data-coding criteria and analysis approach used.

To Use or Not Use Complementary and Alternative Medicine (CAM) in Psychiatric Care: Interviews with Clinical Decision-Makers in Sweden

Complementary and alternative medicine (CAM) is used as a complementary intervention in psychiatric healthcare. The reasons for using or not using CAM in psychiatric care in Sweden, and how such decisions are taken, are largely unknown. The aim was to investigate arguments for and against the use of CAM in Swedish psychiatric care, and how decisions are made. Interviews with 10 persons in decision-making positions in psychiatric health care were analysed thematically. The result shows diverging understandings of the evidence base for CAM. Arguments against CAM referred to scepticism, the importance of evidence-based practice and the obligation to follow national guidelines. Arguments in favour of CAM were that CAM was person-centred, safe, cost-effective, nursing interventions with positive effects, appreciated and demanded by patients, providing space for non-verbal communication and reflection, supporting the therapeutic alliance. Decision paths were described as top-down through a hierarchical structure, or bottom-up, driven by committed staff members. We discuss how detailed national guidelines should be to achieve equal and evidence-based care, while still allowing clinics to make local exceptions, adjusting the care according to clinical expertise and patients' preferences. Conclusion: Evidence-based, safe and cost-effective CAM methods may be relevant complementary interventions in psychiatric care, or as self-care, not to cure the psychiatric disease, but to reduce symptoms and promote sleep. With better knowledge of CAM, health professionals could guide patients through the jungle of CAM methods. Due to research problems on complex multicomponent interventions, high-quality pragmatic trials, including biomarkers, and qualitative studies are recommended.

Integration of hatha yoga and evidence-based psychological treatments for common mental disorders: An evidence map

BACKGROUND

Interest in the use of yoga to enhance engagement with and augment the benefits of psychological treatment has grown. However, a systematic approach to reviewing existing research examining the use of yoga with psychological treatment is lacking.

MATERIALS AND METHODS

This mapping review identified and synthesised research trialling yoga as an integrated or adjunct therapy with evidence-based psychological interventions for the treatment of anxiety, depression, PTSD, and eating disorders.

RESULTS

Overall, the review identified ten published and three unpublished studies, representing either single group or small quasi-experimental research designs.

DISCUSSION

Limited but promising findings were shown for yoga with CBT for anxiety and depression, and the integration of yoga within intensive treatment models for PTSD.

CONCLUSIONS

Future research is encouraged to focus on controlled trials that enable examination of the component effect of yoga when applied with evidence-based psychological treatment and acceptability and feasibility data to further knowledge regarding a role for yoga in clinical practice.

Allied health and complementary therapy usage in Australian women with chronic pelvic pain: a cross-sectional study

Background

Chronic pelvic pain (CPP) causes non-cyclical pelvic pain, period pain, fatigue and other painful symptoms. Current medical and surgical management strategies are often not sufficient to manage these symptoms and may lead to uptake of other therapies.

Aims

To determine the prevalence of allied health (AH) and complementary therapy (CM) use, the cost burden of these therapies and explore predictive factors for using allied health or complementary medicines.

Materials and methods

An online cross-sectional questionnaire using the WERF EndoCost tool was undertaken between February to April 2017. People were eligible to participate in the survey if they were aged 18–45, living in Australia and had chronic pelvic pain.

Results

From 409 responses, 340/409 (83%) of respondents reported a diagnosis of endometriosis. One hundred and five (30%) women with self-reported endometriosis, and thirteen (18%) women with other forms of CPP saw at least one AH or CM practitioner in the previous two months, with physiotherapists and acupuncturists the most common. Women who accessed CM or AH services spent an average of $480.32 AUD in the previous two months. A positive correlation was found between education and number of AH or CM therapies accessed in the past two months (p < 0.001) and between income level and number of therapists (p = 0.028).

Conclusions

Women with CPP commonly access AH and CM therapies, with a high out of pocket cost. The high cost and associations with income and education levels may warrant a change to policy to improve equitable access to these services.

Conventional and complementary health care use and out-of-pocket expenses among Australians with a self-reported mental health diagnosis: a cross-sectional survey

Background

Mental health disorders are a global health concern. In Australia, numerous national reports have found that the current mental healthcare system does not adequately meet the needs of Australians with mental illness. Consequently, a greater understanding of how people with a mental health disorder are using the broader healthcare system is needed. The aim of this paper is to explore conventional and complementary health care use and expenditure among Australian adults reporting a mental health disorder diagnosis.

Methods

A cross-sectional online survey of 2,019 Australian adults examined socio-demographic characteristics, complementary and conventional health care use and the health status of participants.

Results

32 % (n = 641) of the total sample (N = 2019) reported a mental health disorder in the previous 3 years. Of these, 96 % reported consulting a general practitioner, 90.6 % reported using prescription medicines, 42.4 % consulted a complementary medicine practitioner, 56.9 % used a complementary medicine product and 23 % used a complementary medicine practice. The estimated 12-month out-of-pocket health care expenditure among Australians with a mental health disorder was AUD$ 4,568,267,421 (US$ 3,398,293,672) for conventional health care practitioners and medicines, and AUD$ 1,183,752,486 (US$ 880,729,891) for complementary medicine practitioners, products and practices. Older people (50–59 and 60 and over) were less likely to consult a CM practitioner (OR = 0.538, 95% CI [0.373, 0.775]; OR = 0.398, 95% CI [0.273, 0.581] respectively) or a psychologist/counsellor (OR = 0.394, 95% CI [0.243, 0.639]; OR = 0.267, 95% CI [0.160, 0.447] respectively). People either looking for work or not in the workforce were less likely to visit a CM practitioner (OR = 0.298, 95% CI [0.194, 0.458]; OR = 0.476, 95% CI [0.353, 0.642], respectively).

Conclusions

A substantial proportion of Australian adults living with a mental health disorder pay for both complementary and conventional health care directly out-of-pocket. This finding suggests improved coordination of healthcare services is needed for individuals living with a mental health disorder. Research examining the redesign of primary health care provision should also consider whether complementary medicine practitioners and/or integrative health care service delivery models could play a role in addressing risks associated with complementary medicine use and the unmet needs of people living with a mental health disorder.

Utilization of complementary and traditional medicine practitioners among middle-aged and older adults in India: results of a national survey in 2017-2018

BACKGROUND

Lack of information exists about the use of traditional and complementary medicine (TCM) use among middle-aged and older adults in India, which led to studying the estimates of past-12-month Ayurveda/Yoga/Naturopathy/Unani/Siddha/Homeopathy (AYUSH) practitioner and traditional health practitioner (THP) utilization in India.

METHODS

The study included 72,262 individuals (45 years and older) from the cross-sectional 2017-2018 Longitudinal Ageing Study in India (LASI) Wave 1.

RESULTS

The prevalence of past 12-month AYUSH practitioner utilization was 6.5%, THP use 7.0%, and AYUSH or THP use 13.0%. The rate of AYUSH practitioner utilization was determined by older age (≥60 years) (Adjusted Odds Ratio-AOR: 1.20, 95% Confidence Interval-CI: 1.07-1.34), having pain (AOR: 1.48, 95% CI: 1.29-1.69), any bone or joint diseases (AOR: 1.57, 95% CI: 1.35-1.82), current tobacco use (AOR: 1.30, 95% CI: 1.12-1.50), male sex (AOR: 0.76, 95% CI: 0.68-0.85), high subjective socioeconomic status (AOR: 0.72, 95% CI: 0.60-0.87), urban residence (AOR: 0.71, 95% CI: 0.57-0.88), diabetes (AOR: 0.66, 95% CI: 0.55-0.81), chronic heart disease (AOR: 0.52, 95% CI: 0.37-0.73), and having a health insurance cover (AOR: 0.36, 95% CI: 0.30-0.44). The rate of THP utilization was determined by depressive symptoms (AOR: 1.17, 95% CI: 1.01-1.35), sleep problems (AOR: 1.28, 95% CI: 1.08-1.51), having pain (AOR: 1.82, 95% CI: 1.55-2.15), current tobacco use (AOR: 1.35, 95% CI: 1.22-1.51), having health insurance cover (AOR: 0.41, 95% CI: 0.33-0.51), hypertension (AOR: 0.82, 95% CI: 0.71-0.95), diabetes (AOR: 0.50, 95% CI: 0.39-0.65), urban residence (AOR: 0.25, 95% CI: 0.19-0.34), and high subjective socioeconomic status (AOR: 0.70, 95% CI: 0.58-0.85).

CONCLUSION

A moderate prevalence of AYUSH practitioner and THP use among middle-aged and older adults in India was found and several factors associated with AYUSH practitioner and THP use were identified.

The Use of Complementary and Alternative Medicine (CAM) in Psychiatric Units in Sweden

Mental ill-health has been termed the pandemic of the 21^st century, and a large share of those exposed do not receive treatment. Many people with depression, anxiety and other mental health problems consult complementary or alternative medicine (CAM), and CAM is used in conventional psychiatric care, in Sweden and in other countries. However, the extent to which CAM is used in psychiatric care, and for what purposes, are largely unknown. This study is based on a survey distributed to all heads of regional, municipal, private and governmental health care units treating persons with psychiatric symptoms across Sweden in 2019. CAM was reportedly used by 62% of the 489 responding health care units, for symptoms including anxiety, sleep disturbances and depression. Main motivations for CAM use were symptom relief, meeting patients' requests and reduced demand for pharmaceutical medication. Very few respondents reported side effects. The most common reason for interrupting CAM use at a unit was a lack of trained professionals. This study confirms the need for further research about CAM, and for CAM education and training among healthcare professionals.

Mind and body exercises (MBE), prescribed antidepressant medication, physical exercise and depressive symptoms - a longitudinal study

AIMS

Earlier studies show that participation in mind and body exercises (MBE) is cross-sectionally associated with high levels of depressive symptoms and antidepressants. This study investigates the longitudinal interrelationship between depressive symptoms, MBE and antidepressants.

METHODS

3269 men and 4318 women aged 24-74 years participated in the Swedish Longitudinal Occupational Survey of Health (SLOSH). Measures of MBE practice and depressive symptoms were drawn from the SLOSH questionnaire, data on prescription drugs were obtained from the Swedish Prescribed Drug Register. Structural Equation Modeling (SEM) was used to analyze temporal relationships.

RESULTS

Both MBE practice and antidepressants in 2012 was associated with higher levels of depressive symptoms two years later. Depressive symptoms in turn were associated with higher levels of later MBE practice and antidepressants. These relationships seemed to be explained by confounding by indication and were of higher magnitude for antidepressants than for MBE.

CONCLUSION

Overall, SEM analysis shows that MBE and antidepressant treatment were both bi-directionally associated with depressive symptoms over time. Part of the explanation is likely to be confounding by indication: those with symptoms of depression more likely to undertake treatment, and MBE alone may be more common among those with less severe depression. The results clarify some of our findings from earlier studies and give some important, new information on what people are doing to manage depressive symptoms on a societal level, regarding self-care, medication, and the combination of both.

The prevalence, characteristics, expenditure and predictors of complementary medicine use in Australians living with gastrointestinal disorders: A cross-sectional study

AIMS

To determine the prevalence, characteristics, expenditure and predictors of complementary medicine (CM) use in Australian adults living with gastrointestinal disorders (GID).

METHODS

A cross-sectional study involving 2,025 Australian adults was conducted. Participants were recruited through purposive convenience sampling. Descriptive statistics were conducted to report the prevalence of people living with GIDs and their CM use, including CM products, mind-body practices and CM practitioner services. Chi-square test and independent-samples t-test were used to determine the associations between sociodemographic or health-related variables with CM use. Binary logistic regression was conducted to determine the significant predictors of CM use in GID participants. Economic data was calculated based on the mean out-of-pocket expenditure on CM.

RESULTS

Of the 293 participants reporting a GID, 186 (63.5%) used CM products, 55 (18.8%) used a mind-body practice and 141 (48.1%) visited at least one CM practitioner in the last 12 months. Collectively, the majority of GID participants using any type of CM were female, aged 40-49 years, married and employed. The mean score for health-related quality of life was 49.6 out of 100 in GID participants and 68.2 in participants without a GID (p < 0.001). Average annual out-of-pocket expenditure on CM products was AUD127.29 by CM products users with a GID. The predictors of CM products, mind-body practices and CM practitioner services use differed. Of the 111 CM product users with a GID, 103 (92.8%) disclosed all or some of their CM use to general practitioner, 89 (80.2%) to specialist doctor, 79 (71.2%) to pharmacist and 69 (62.1%) to hospital doctor.

CONCLUSIONS

A substantial proportion of Australian adults living with GID use CM products, mind-body practices and CM practitioner services. This study provides important insights to inform and guide the development of a more coordinated health care services for individuals living with GID.

Complementary medicine use in the Australian population: Results of a nationally-representative cross-sectional survey

In order to describe the prevalence and characteristics of complementary medicine (CM) practice and product use by Australians, we conducted a cross-sectional online survey with Australian adults aged 18 and over. Rates of consultation with CM practitioners, and use of CM products and practices were assessed. The sample (n = 2,019) was broadly representative of the Australian population. Prevalence of any CM use was 63.1%, with 36% consulting a CM practitioner and 52.8% using any CM product or practice. Bodywork therapists were the most commonly consulted CM practitioners (massage therapists 20.7%, chiropractors 12.6%, yoga teachers 8.9%) and homeopaths were the least commonly consulted (3.4%). Almost half of respondents (47.8%) used vitamin/mineral supplements, while relaxation techniques/meditation were the most common practice (15.8%). CM users were more likely to be female, have a chronic disease diagnosis, no private health insurance, a higher education level, and not be looking for work. Prevalence of CM use in Australia has remained consistently high, demonstrating that CM is an established part of contemporary health management practices within the general population. It is critical that health policy makers and health care providers acknowledge CM in their attempts to ensure optimal public health and patient outcomes.

Utilization of traditional and complementary medicine in Indonesia: Results of a national survey in 2014-15

BACKGROUND AND PURPOSE

Scant information exists about traditional, complementary and alternative medicine (TCAM) use in Indonesia, which prompted investigating its prevalence and correlates in Indonesia.

MATERIALS AND METHODS

Participants were 31,415 individuals 15 years and older that participated in the cross-sectional Indonesia Family Life Survey in 2014-15.

RESULTS

In all, 24.4% had used a traditional practitioner and/or traditional medicine in the past four weeks, and 32.9% had used complementary medicine in the past four weeks. In adjusted logistic regression analysis, being of older age, being a Muslim, residing in an urban area or on Java, being unhealthy, having a chronic condition, having depression symptoms, experiencing sleep disturbance, and having high social support were associated with both current traditional practitioner and/or medicine use and complementary medicine use.

CONCLUSION

The study shows a high prevalence of TCAM use in Indonesia and several sociodemographic and health related factors of its use were identified.

Prevalence and reasons for intentional use of complementary and alternative medicine as an adjunct to future visits to a medical doctor for chronic disease

Background

Intentional use of complementary and alternative medicine (CAM) has previously only been researched in small, possibly biased, samples. There seems to be a lack of scientific information regarding healthy individual’s attitudes and presumed use of CAM. The aim of this study is to describe prevalence and characteristics of participants who intend to see a CAM provider compared to participants who intend to see a medical doctor (MD) only when suffering from a chronic, non- life-threatening disease and in the need of treatment. Further to describe differences between the groups regarding expected reasons for CAM use and expected skills of CAM providers.

Method

The survey was conducted in January 2016 as part of the “TNS Gallup Health policy Barometer”. In total, 1728 individuals aged 16–92 years participated in the study, constituting an overall response rate of 47%. The survey included questions regarding opinions and attitudes towards health, health services and health politics in Norway.

Results

The majority of the participants (90.2%) would see a MD only if they were suffering from a chronic, non- life-threatening disease and were in the need of treatment. Men over the age of 60 with a university education tended to see a MD only. Only 9.8% of all respondents would in addition visit a CAM provider. Being an intentional user of a MD + CAM provider was associated with being a woman under the age of 60. The respondents believed that CAM providers have professional competence based on formal training in CAM. They also believed that individuals seeing a CAM provider have poor health and are driven by the hope of being cured. Further, that they have heard that others have good experience with such treatment.

Conclusion

Intentional use of CAM is associated with positive attitudes, trustworthiness, and presumed positive experiences in the CAM-patient-setting. Intentional CAM users also have the impression that CAM providers have professional competence based on formal training in alternative therapies.

Electronic supplementary material

The online version of this article (10.1186/s12906-018-2179-8) contains supplementary material, which is available to authorized users.

Prevalence and Determinants of Traditional, Complementary and Alternative Medicine Provider Use among Adults from 32 Countries

OBJECTIVE

To estimate recent prevalence data (2011-2013) on traditional, complementary and alternative medicine (TCAM) provider use and sociodemographic and health related correlates in nationally representative population samples from 32 countries from all world regions.

METHODS

This secondary analysis was based on the International Social Survey Program (ISSP), 2011-2013, Health and Health Care Module. In a cross-sectional population-based survey (N=52,801), simple or multi-stage stratified random sampling was used, resulting in representative samples of the adult population of respective countries.

RESULTS

Overall, the 12-month TCAM provider use prevalence was 26.4%, ranging from under 10% in Bulgaria, Poland and Slovenia to over 50% in China mainland, the Philippines and Republic of Korea. Over 80% TCAM treatment satisfaction was found in Europe in Denmark, Slovenia, Spain and Switzerland, in Asia in Taiwan (China) and USA. Multivariate logistic regression found sociodemographic variables (middle age, female sex, lower educational status, not having a religious affiliation, and lower economic indicators) and health variables (perceived poor or fair health status, being unhappy and depressed, having a chronic condition or disability, and having positive attitudes towards TCAM) were associated with TCAM provider use.

CONCLUSIONS

A high prevalence TCAM provider use was found in all world regions and several sociodemographic and health related factors of its use were identified.

The use of CAM providers and psychiatric outpatient services in people with anxiety/depression: a cross-sectional survey

BACKGROUND

Depression has been identified as one of the most frequent predictors of CAM use. However, limited data exist about the use of CAM providers among people with anxiety/depression in Norway. The aim of this study was to investigate the use of CAM providers, and the use of CAM providers and psychiatric outpatient services in combination, among people with self-reported anxiety and/or depression.

METHODS

We used questionnaire data from 12,982 participants (30-87 years) in the cross-sectional sixth Tromsø Study (conducted in 2007-8). Eligible for analyses in our study were 1685 participants who reported suffering from anxiety and/or depression. By descriptive statistical methods, we estimated the use of CAM providers, psychiatric outpatient services, and the combination of these. By logistic regressions we studied the association between the use of these services and gender, age, income, education, and self-reported degree of anxiety/depression.

RESULTS

During the previous year, 17.8 % of people with anxiety/depression visited a CAM provider once or more, 11.8 % visited psychiatric outpatient services, and 2.5 % visited both. Men with anxiety/depression were less likely to visit CAM providers compared to women (odds ratio [OR] 0.40, confidence interval [CI] 0.30-0.55), whereas higher educated people were more likely to visit compared to the lowest educated (OR 1.47, CI 1.02-2.13). The use of CAM providers was not associated with the degree of anxiety/depression. For those who used both CAM providers and psychiatric specialist services during the previous year, severe anxiety/depression was strongly associated with use compared to moderate disease (OR 7.53, CI 2.75-20.65).

CONCLUSIONS

People with severe anxiety/depression seem to use CAM providers and psychiatric services additionally, whereas those with moderate disease seem to use these services more as alternative pathways. CAM provider treatment might be a substitute for conventional care, particularly in patients with moderate disease.

Mapping the Health Care Policy Landscape for Complementary and Alternative Medicine Professions Using Expert Panels and Literature Analysis

OBJECTIVES

The purpose of this project was to examine the policy implications of politically defining complementary and alternative medicine (CAM) professions by their treatment modalities rather than by their full professional scope.

METHODS

This study used a 2-stage exploratory grounded approach. In stage 1, we identified how CAM is represented (if considered as professions vs modalities) across a purposely sampled diverse set of policy topic domains using exemplars to describe and summarize each. In stage 2 we convened 2 stakeholder panels (12 CAM practitioners and 9 health policymaker representatives), and using the results of stage 1 as a starting point and framing mechanism, we engaged panelists in a discussion of how they each see the dichotomy and its impacts. Our discussion focused on 4 licensed CAM professions: acupuncture and Oriental medicine, chiropractic, naturopathic medicine, and massage.

RESULTS

Workforce policies affected where and how members of CAM professions could practice. Licensure affected whether a CAM profession was recognized in a state and which modalities were allowed. Complementary and alternative medicine research examined the effectiveness of procedures and modalities and only rarely the effectiveness of care from a particular profession. Treatment guidelines are based on research and also focus on procedures and modalities. Health plan reimbursement policies address which professions are covered and for which procedures/modalities and conditions.

CONCLUSIONS

The policy landscape related to CAM professions and modalities is broad, complex, and interrelated. Although health plan reimbursement tends to receive the majority of attention when CAM health care policy is discussed, it is clear, given the results of our study, that coverage policies cannot be addressed in isolation and that a wide range of stakeholders and social institutions will need to be involved.

Complementary medicine use by the Australian population: a critical mixed studies systematic review of utilisation, perceptions and factors associated with use

BACKGROUND

There is increasing evidence that complementary medicine (CM) services are being used by a substantial proportion of the Australian population and this topic has attracted keen interest from primary health care providers and policy makers. This article outlines the first summative critical review of the predictors of CM use in Australia as well as the characteristics and perceptions of Australian CM users over the last 14 years.

METHODS

A literature search was conducted to ascertain original research from 2000 to 2014 in the AMED; CINAHL; and PubMed databases. Selected articles were subject to a critical appraisal analysis to identify the quality of the article. The search was confined to peer reviewed original articles published in English which identified the nature of CM services use in Australia.

RESULTS

The findings indicate a correlation between CM users and gender, with reports of a higher rate of use from females compared to males. Female CM users are more likely to be middle-aged with a higher education and higher annual income in comparison to female non-CM users. An association between resident location and use of CM disciplines was also identified with reports of rural residents utilising manual therapies more frequently compared to urban residents. CM users are more likely to seek CM services for a range of chronic conditions including diseases identified as National Health Priority Areas by the Australian Government.

CONCLUSIONS

This article provides the first comprehensive review examining the nature of CM use in Australia. The review findings offer important insights into the characteristics and features of CM use in Australia and provide insights for national and regional primary health care initiatives and of interest to medical doctors, allied health professionals, CM practitioners, researchers and policy makers.

Lost in the crowd? Using eye-tracking to investigate the effect of complexity on attribute non-attendance in discrete choice experiments

BACKGROUND

The provision of additional information is often assumed to improve consumption decisions, allowing consumers to more accurately weigh the costs and benefits of alternatives. However, increasing the complexity of decision problems may prompt changes in information processing. This is particularly relevant for experimental methods such as discrete choice experiments (DCEs) where the researcher can manipulate the complexity of the decision problem. The primary aims of this study are (i) to test whether consumers actually process additional information in an already complex decision problem, and (ii) consider the implications of any such 'complexity-driven' changes in information processing for design and analysis of DCEs.

METHODS

A discrete choice experiment (DCE) is used to simulate a complex decision problem; here, the choice between complementary and conventional medicine for different health conditions. Eye-tracking technology is used to capture the number of times and the duration that a participant looks at any part of a computer screen during completion of DCE choice sets. From this we can analyse what has become known in the DCE literature as 'attribute non-attendance' (ANA). Using data from 32 participants, we model the likelihood of ANA as a function of choice set complexity and respondent characteristics using fixed and random effects models to account for repeated choice set completion. We also model whether participants are consistent with regard to which characteristics (attributes) they consider across choice sets.

RESULTS

We find that complexity is the strongest predictor of ANA when other possible influences, such as time pressure, ordering effects, survey specific effects and socio-demographic variables (including proxies for prior experience with the decision problem) are considered. We also find that most participants do not apply a consistent information processing strategy across choice sets.

CONCLUSIONS

Eye-tracking technology shows promise as a way of obtaining additional information from consumer research, improving DCE design, and informing the design of policy measures. With regards to DCE design, results from the present study suggest that eye-tracking data can identify the point at which adding complexity (and realism) to DCE choice scenarios becomes self-defeating due to unacceptable increases in ANA. Eye-tracking data therefore has clear application in the construction of guidelines for DCE design and during piloting of DCE choice scenarios. With regards to design of policy measures such as labelling requirements for CAM and conventional medicines, the provision of additional information has the potential to make difficult decisions even harder and may not have the desired effect on decision-making.

Interface, interaction and integration: how people with chronic disease in Australia manage CAM and conventional medical services

OBJECTIVES

To understand the extent to which conventional and complementary health care are integrated for CAM users with chronic conditions.

METHODS

In-depth interviews and a self-administered questionnaire were used to collect data on care-seeking, self-management and CAM use among people with type 2 diabetes and/or cardiovascular disease living in Victoria, Australia.

RESULTS

Many participants reported regular, frequent and long-term use of CAM therapies to maintain their health or assist in the management of their chronic condition. They generally managed the interface between convention and complementary health care on their own, as the perceived or expressed negative attitudes of some doctors, or the belief that the doctor did not need to know, were barriers to the disclosure of CAM use. For a smaller group, there was interaction between conventional and CAM providers, which limited the extent of uncertainty and conflicting information being (mis)interpreted by consumers.

CONCLUSIONS

Greater interaction between CAM and medical providers would be beneficial to consumers. Structural barriers, related to financing and service organization, need to be addressed. Attitudinal shifts of some health-care practitioners also need to be addressed, in the context of workforce development.

The use of complementary and alternative medicine in adults with depressive disorders. A critical integrative review

BACKGROUND

Depression has been identified as one of the most frequent indications for CAM use and is a strong predictor of CAM use. The present article provides a critical review of CAM use for depressive disorders including bipolar depression by addressing prevalence of CAM use and CAM users׳ characteristics, motivation, decision-making and communication with healthcare providers.

METHODS

A comprehensive search of 2003-2014 international literature in the Medline, CINAHL, AMED, and SCOPUS databases was conducted. The search was confined to peer-reviewed articles published in English with abstracts and reporting new empirical research findings regarding CAM use and depressive disorders.

RESULTS

A considerable level of CAM use was observed among both general and clinical populations of people suffering from depressive disorders, many of whom use CAM concurrently with their conventional medicine. In particular, high rates of CAM use were found among those with bipolar disorder, an illness known to cause substantial impairments in health-related quality of life. Concomitant prescription medication use ranged from 0.52% to as high as 100%.

LIMITATIONS

Study design such as the inclusion of bipolar and depression in the same diagnostic category hamper the differentiation and attribution of CAM usage for symptoms.

CONCLUSION

Findings of our review show that enduring impairments in function and persistence of symptoms (as reflected by increased CAM use proportional to severity of illness and comorbidity) are the impetus for sufferers of depressive illness to seek out CAM. The psychosocial factors associated with CAM use in depressive illnesses and severe mental illness are yet to be established. Subsequent research amongst those with depressive disorders would be informative in clarifying the range of motivations associated with mental illness.

Integrating complementary and alternative medicine into mainstream healthcare services: the perspectives of health service managers

Background

Complementary and alternative medicine (CAM) is increasingly included within mainstream integrative healthcare (IHC) services. Health service managers are key stakeholders central to ensuring effective integrative health care services. Yet, little research has specifically investigated the role or perspective of health service managers with regards to integrative health care services under their management. In response, this paper reports findings from an exploratory study focusing exclusively on the perspectives of health service managers of integrative health care services in Australia regarding the role of CAM within their service and the health service managers rational for incorporating CAM into clinical care.

Methods

Health service managers from seven services were recruited using purposive and snowball sampling. Semi-structured interviews were conducted with the health service managers. The services addressed trauma and chronic conditions and comprised: five community-based programs including drug and alcohol rehabilitation, refugee mental health and women’s health; and two hospital-based specialist services. The CAM practices included in the services investigated included acupuncture, naturopathy, Western herbal medicine and massage.

Results

Findings reveal that the health service managers in this study understand CAM to enhance the holistic capacity of their service by: filling therapeutic gaps in existing healthcare practices; by treating the whole person; and by increasing healthcare choices. Health service managers also identified CAM as addressing therapeutic gaps through the provision of a mind-body approach in psychological trauma and in chronic disease management treatment. Health service managers describe the addition of CAM in their service as enabling patients who would otherwise not be able to afford CAM to gain access to these treatments thereby increasing healthcare choices. Some health service managers expressly align the notion of treating the whole person within a health promotion model and focus on the relevance of diet and lifestyle factors as central to a CAM approach.

Conclusions

From the perspectives of the health service managers, these findings contribute to our understanding around the rationale to include CAM within mainstream health services that deal with psychological trauma and chronic disease. The broader implications of this study can help assist in the development of health service policy on CAM integration in mainstream healthcare services.

Health care utilisation and out-of-pocket expenditure associated with back pain: a nationally representative survey of Australian women

BACKGROUND

Back pain impacts on a significant proportion of the Australian population over the life course and has high prevalence rates among women, particularly in older age. Back pain care is characterised by multiple practitioner and self-prescribed treatment options, and the out-of-pocket costs associated with consultations and self-prescribed treatments have not been examined to date.

OBJECTIVE

To analyse the extent of health care practitioner consultations and self-prescribed treatment for back pain care among Australian women, and to assess the self-reported costs associated with such usage.

METHODS

Survey of 1,310 women (response rate 80.9%) who reported seeking help for back pain from the '1946-51 cohort' of the Australian Longitudinal Study on Women's Health. Women were asked about their use of health care practitioners and self-prescribed treatments for back pain and the costs associated with such usage.

RESULTS

In the past year 76.4% consulted a complementary and alternative practitioner, 56% an allied health practitioner and 59.2% a GP/medical specialist. Overall, women consulted with, on average, 3.0 (SD = 2.0) different health care practitioners, and had, on average, 12.2 (SD = 9.7) discrete health care practitioner consultations for back pain. Average self-reported out-of-pocket expenditure on practitioners and self-prescribed treatments for back pain care per annum was AU$873.10.

CONCLUSIONS

Multiple provider usage for various but distinct purposes (i.e. pain/mobility versus anxiety/stress) points to the need for further research into patient motivations and experiences of back pain care in order to improve and enhance access to and continuity of care. Our results suggest that the cost of back pain care represents a significant burden, and may ultimately limit women's access to multiple providers. We extrapolate that for Australian working-age women, total out-of-pocket expenditure on back pain care per annum is in excess of AU$1.4 billion, thus indicating the prominence of back pain as a major economic, social and health burden.

Complementary and alternative medicine (CAM) use and quality of life in people with type 2 diabetes and/or cardiovascular disease

OBJECTIVES

To quantify the association between complementary and alternative medicine (CAM) use and quality of life in a population with type 2 diabetes and/or cardiovascular disease, accounting for demographics, socioeconomic status, health and lifestyle factors.

DESIGN AND SETTING

Data are from a purpose-designed survey of 2915 individuals aged 18 years and over, all with type 2 diabetes and/or cardiovascular disease (CVD), collected in 2010. Key variables are compared for comparability with nationally representative data. It was hypothesised that CAM use would be associated with higher quality of life, as measured by the Assessment of Quality of Life-4 dimension (AQoL-4D) instrument. Three key variables are used for CAM use in the previous twelve months. In the robustness analysis, CAM use is further disaggregated into the types of practitioner or product used, the frequency of use, the reason for use and expenditure on CAM.

RESULTS

CAM use is not associated with higher QoL for this sub-population, and in fact intensive use of CAM practitioners is associated with significantly lower QoL.

CONCLUSIONS

It is important not to assume that patients have sufficient information with which to make optimal choices regarding CAM use in the absence of accessible and relevant evidence-based guidance.

Characteristics of Female and Male Visitors to Practitioners of Acupuncture in the HUNT3 Study

Characteristics of female and male visitors to practitioners of acupuncture were investigated in a large cross-sectional adult population in Central Norway. A total population health survey, HUNT3, conducted in 2008 with 50,827 respondents provided the data. Demographic variables, lifestyle, health, and use of conventional medicine were analyzed using multivariable logistic regression models. The one year prevalence of visiting a practitioner of acupuncture was 5.7% for females and 2.2% for males. Visitors of both genders were five times more likely to have had somatic complaints in the preceding year and were 2–3 times more likely to report poor global health than female or male non-visitors. Also, visitors of both genders were more likely to do hard physical activities every week, and they were less likely to live alone or be daily smokers. Further, female visitors were characterized by having higher education and were more likely to have a paid job than other females. Corresponding differences were not seen among males. Age showed limited associations with being a visitor, and for females only. Valid for both genders, our findings draw a picture of visitors to acupuncture treatment as persons who actively contribute to promoting their health through lifestyle choices of physical activity and non-smoking while simultaneously having worse global health and higher burdens of somatic complaints than other adults. In contrast to males, it is suggested that females may be more dependent on personal income, as indicated by higher education and being in a paid job, in choosing acupuncture treatment in addition to conventional medicine.