Complementary and Alternative Medicine in the United States (2005) / Chapter Skim
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2 Prevalence, Cost, and Patterns of CAM Use
2 Prevalence, Cost, and Patterns of CAM Use
Pages 34-73
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From page 34... ...
Importantly, it also found that 72 percent of CAM therapy users did not inform their medical doctors that they used CAM (Eisenberg et al., 1993)
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From page 35... ...
The study also found that among the respondents who in the past year had used CAM and seen their medical doctor, 63 to 72 percent did not disclose to their doctor the fact that they had received at least one type of CAM therapy. Among 507 respondents who reported their reasons for
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From page 36... ...
(2002) Representative sample, 70 Data from 1999 n = 30,801, computer National Health assisted personal Interview Survey.
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From page 37... ...
. If a CAM 24.4% prayer by other's for one's own therapy was used in the last 12 health months, respondents were also 18.9% natural products asked about: condition being 11.6% deep breathing exercises treated; reason for choosing 9.6% participation in prayer group for therapy, insurance coverage for one's own health costs; satisfaction with 7.6% meditation treatment; and whether conventional 7.5% chiropractic care practitioner knew about CAM use.
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From page 38... ...
Adults who use both CAM and conventional medicine appear to value both and tend to be less concerned about their medical doctors' disapproval than they are about their doctors' inability to understand or incorporate CAM therapy use within the context of their medical management (Eisenberg et al., 1998)
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From page 39... ...
The majority of those who sought professional care from CAM providers also saw a medical doctor during the reference year. The study also observed that users of CAM therapies made almost twice as many visits to conventional medical providers as non-CAM users.
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From page 40... ...
Lastly, the investigators pointed out that the discrepancies in overall prevalence of CAM use may largely result from the lack of agreement in the definitions of "complementary and alternative medicine." The lack of consensus regarding a definition as to what is or what is not to be included in the category of complementary and alternative medicine has unquestionably complicated efforts to document, in a consistent fashion, the prevalence, patterns, and costs of CAM use by the American public. Barnes and colleagues (2004)
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From page 41... ...
. This suggests that women's use of CAM modalities may well serve as an indicator of probable family use of CAM in the future.
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From page 42... ...
of patients on Medicaid in a family health center used CAM; 70 percent (n = 157) of homeless young people in the Street Clinic youth program in Seattle, Washington, reported using CAM; and 56 percent (n = 187)
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From page 43... ...
found various patterns of use by race, depending on the type of CAM therapy. Use of mind-body therapies including prayer for health reasons was more prevalent among black adults (68.3 percent)
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From page 44... ...
They observed that during the previous 12 months 30 percent had used at least one type of CAM therapy for the treatment of their principal medical conditions. The complementary modalities most commonly used by individuals aged 65 and older used were chiropractic, herbal remedies and dietary supplements, relaxation and meditation techniques, and high-dose vitamins.
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From page 45... ...
. One reason for conducting such studies has been to identify possible CAMconventional medicine interactions, especially in cases in which it is vital to a patient's well-being to know of medications that may interfere with such things as blood clotting time when surgery is being performed (Allaire et al., 2000; Hepner et al., 2002)
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From page 46... ...
Those researchers pointed out that each condition was associated with unique patterns of health service use driving those costs. This finding highlights the need for a better understanding of what motivates patients with chronic complaints to seek both CAM and conventional medical services and the cost implications of combined care.
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From page 47... ...
Having any insurance coverage, it appears, is associated with higher rates of use of CAM therapy services. Rates of insurance coverage for CAM services varies significantly by state, treatment plan, and CAM modality (Tillman, 2002)
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From page 48... ...
Kessler and colleagues (2001) mention that "from an historical perspective, data from 1998 may not necessarily represent a consistent trend of increased use of CAM therapies, but rather a distinct peak in a long trend of constant fluctuation in complementary and alternative medicine use by the American public." They refer to previous peaks of CAM use such as survey data from the 1920s and 1930s indicating high rates of use of "unconventional" therapies and government statistics from 1900 documenting large numbers of registered "alternative" practitioners.
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From page 49... ...
This is often offered in support of the idea that CAM may provide more cost-effective treatments than conventional medicine. However, some CAM interventions involve more time with a practitioner, which may be costly (White and Ernst, 2000)
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From page 50... ...
or if they have engaged in self-treatment, and whether they have informed their conventional medical doctor that they are using CAM therapies or modalities (or whether they have informed their CAM practitioner that they are receiving biomedical treatments)
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From page 51... ...
The 2002 NHIS asked participants about their reasons for using CAM. For any type of CAM, 54.9 percent believed that CAM therapy combined with conventional medical treatments would help, 50.1 percent thought that CAM would be interesting to try and 25.8 percent indicated that CAM use was suggested by a conventional medical professional.
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From page 52... ...
until they are really needed -- extending the duration of their effectiveness; reduction of side effects from conventional medicine (for patients with
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From page 53... ...
"Needs an edge" user Expressed in terms of energy, focus, memory, and enhanced abilities "Can't afford to be ill" user CAM is a promotive or preventive health aid to ward off illness especially when feeling vulnerable Those who have limited access to CAM serves as a stop-gap function and is conventional medicine and who used as just another form of over-the cannot afford it except for cases counter medicine of severe illness Those who are able to mobilize social By being involved with CAM one support enlarges, solidifies or mobilizes his or her support network Those encouraged by friends or family Direct and indirect influence by people to try CAM who have heard that the CAM modality can help Those able to take personal time Self-care is justified; one is able to focus through CAM use on self and secure personal time Those making a lifestyle statement CAM use is part of bigger package and identity; the person may or may not understand the ethnomedical system, but does approve of what it stands for: meaning is derived from participation with the modality continued
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From page 54... ...
that most CAM therapies are used, at least in part, to prevent future illness or to maintain health and vitality as part of lifestyle choices linked to disease prevention and health promotion. Further investigation into the association between the use of CAM modalities and wellness-related behavior is warranted given national public health priorities and the burden of lifestyle-related diseases (DHHS, 2000)
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From page 55... ...
. A second hypothesis is that CAM users maintain health beliefs different from those of other people, but an answer to this question will require investigation of health perceptions before and after CAM use to determine whether users sought CAM modalities on the basis of their health ideology or underwent transformational experiences.
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From page 56... ...
They conducted one of the few studies to explore differences in the reasons for using CAM among two groups of CAM users, defined by the length and frequency of CAM use, and a comparison group of users of conventional medicine. New or infrequent CAM users, established CAM users, and users of conventional medicine were distinguished on the basis of health beliefs and sociodemographic, medical, and personality variables.
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From page 57... ...
12 past 087 prayer the NEITHER 0 self (%) of within 065 use 0 doctors Response of DISAGREE (including 043 medical 02 Frequency and therapies 01 AGREE CAM providers 0 any " " a care.
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From page 58... ...
. It is reasonable to assume that many of those contemplating or already using CAM modalities access the Internet to find out about these modalities.
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From page 59... ...
Closer monitoring of web sites, enforcement of the Dietary Supplement Health and Education Act of 1994 (DSHEA) and Federal Trade Commission regulations, and the creation of a user-friendly authoritative website or criteria for evaluating existing websites on CAM modalities are much needed.
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From page 60... ...
If this is a widespread practice, the availability of public access to a website recognized by health food store employees as authoritative might enhance the therapeutic advice given and minimize the potential for dangerous errors to be made when they offer information, especially if the customer was asked to indicate other medications taken at the time. HOW THE AMERICAN PUBLIC USES CAM MODALITIES Although reliable data exist on the percentage of people who have used a CAM modality in the last year and how many times the modality was used in general, far less is known about the reasons for CAM use at various times.
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From page 61... ...
Indeed, medicines and other CAM products and procedures may be the source of iatrogenic health problems if they are used incorrectly. It has been routinely observed that a significant proportion of those who take conventional medicine are noncomplaint for a host of reasons.
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From page 62... ...
(2001) explored the sequence in which individuals seek CAM therapy and found that 70 percent of respondents typically sought the services of a CAM professional concurrently with or after their visit to a medical doctor.
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From page 63... ...
Most visits to chiropractors and naturopathic physicians but less than one-third of visits to acupuncturists and massage therapists were covered by insurance. The investigators commented on the observation that CAM providers typically did not discuss with the conventional doctors the care that they were providing to patients who were concurrently seeking care from conventional doctors.
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From page 64... ...
As noted above, acupuncturists and naturopathic physicians see a broader range of conditions than chiropractors and massage therapists do and often provide care for such problems as anxiety, depression, fatigue, allergies, skin rashes, and menopausal symptoms. The investigators commented that the most notable differences between the practices of conventional physicians (i.e., medical doctors and doctors of osteopathy)
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From page 65... ...
Nondisclosure raises important safety issues, for example, the potential interactions of medications with herbs used as part of a CAM therapy. In addition, a majority of adults who use CAM therapies use more than one CAM modality and do so in combination with conventional medical care (Wolsko et al., 2002)
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From page 66... ...
Furthermore, closer monitoring of websites, enforcement of DSHEA and Federal Trade Commission regulations, and the creation of a user-friendly authoritative website on CAM modalities are needed. As a means to address the lack of information discussed above, the committee recommends that the National Institutes of Health and other public or private agencies sponsor quantitative and qualitative research to examine · The social and cultural dimensions of illness experiences, health care-seeking processes and preferences, and practitioner-patient interaction; · How often users of CAM, including patients and providers, adhere to treatment instructions and guidelines; · The effects of CAM on wellness and disease prevention; · How the American public accesses and evaluates information about CAM modalities; and · Adverse events associated with CAM therapies and interactions between CAM and conventional treatments.
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From page 67... ...
1999. Complementary and alternative medicine use among women with breast cancer.
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From page 68... ...
1999. Use of alternative medicine by women with early-stage breast cancer.
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From page 69... ...
2004. Complementary and alternative medicine use by women after completion of allopathic treatment for breast cancer.
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From page 70... ...
2002. Frequency of use of complementary and alternative medicine in women with breast cancer.
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From page 71... ...
2002. Utilization of complementary and alternative medicine by United States adults: Results from the 1999 National Health Interview Survey.
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From page 72... ...
2002. Complementary/alternative medicine in chronic illness as informed self-care decision making.
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From page 73... ...
2002. Insurance coverage, medical conditions, and visits to alternative medicine providers: Results of a national survey.
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