BACKGROUND: Despite the increased use and acceptance of complementary and alternative medicine (CAM) practices and practitioners by patients and health care providers, there is relatively little information available concerning the reasons for use or its effect on patient health status and well-being.
METHODS: We conducted a survey of 542 patients attending 16 family practice clinics that belong to a community-based research network in San Diego, California, to determine patients’ reasons for using CAM therapies in conjunction with a visit to a family physician and the impact of these therapies on their health and well-being.
RESULTS: Approximately 21% of the patients reported using one or more forms of CAM therapy in conjunction with the most important health problem underlying their visit to the physician. The most common forms of therapy were visiting chiropractors (34.5% of CAM users), herbal remedies and supplements (26.7%), and massage therapy (17.2%). Recommendations from friends or coworkers, a desire to avoid the side effects of conventional treatments, or failure of conventional treatments to cure a problem were the most frequently cited reasons for using these therapies. Use of practitioner-based therapies was significantly and independently associated with poor perceived health status, poor emotional functioning, and a musculoskeletal disorder, usually low back pain. Use of self-care–based therapies was associated with high education and poor perceived general health compared with a year ago. Use of traditional folk remedies was associated with Hispanic ethnicity.
CONCLUSIONS: Sociodemographic characteristics and clinical conditions that predict use of CAM therapies by primary care patients in conjunction with a current health problem vary with the type of therapy used.
Within the past 5 years several studies have pointed to the widespread use of complementary and alternative medicine (CAM) in the United States. In a study conducted in 1991,1 1 in 3 respondents in a national sample of adults reported using at least one unconventional therapy in the past year. By 1997 that number had risen to more than 4 in 10.2 Similar studies conducted in Europe3 and Canada4 have reported utilization rates between 18% and 75%. Although several studies have found substantial use among patients attending specialty clinics,5-7 between 28% and 50% of family practice patients have been found to have used some form of CAM.8-10 In response to its widespread use, CAM has gained increasing acceptance among family physicians and other primary care physicians and in schools of medicine where more courses are being taught on the subject.11
Despite this increased use and acceptance by patients and health care providers, there is relatively little information available concerning the reasons for use of the various forms of therapies and treatments considered alternative or complementary. Recent surveys of the extent of use of these treatments provide little insight into why certain patients are more likely to use CAM therapies in general or specific therapies, such as chiropractic, message, herbal therapy, acupuncture, and homeopathy. Small studies of specific groups of patients suggest that use of these therapies is associated with the disease and with patient characteristics such as education and level of dissatisfaction with the primary care provider,9-10 but the extent to which these findings are generalizable to all primary care patients remains unclear.
A second limitation to our understanding of the use of CAM therapies by primary care patients is that the effectiveness of these therapies has not been subjected to rigorous examination. Their use by the general public appears to be based on anecdotal evidence, primarily personal experience or the experiences of others. Although there is a consensus within the medical establishment that most of these therapies are harmless,12 there is increasing evidence of the adverse consequences related to their use and misuse.13 However, much of this evidence is also anecdotal, based on case reports and not on large population-based studies.
Our objective was to address these 2 deficiencies in the understanding of the likelihood of use and the effectiveness of CAM therapies by conducting a large survey of a diverse population of patients attending family practice clinics in several different settings throughout the San Diego area, making use of a recently formed network of family physicians committed to community-based primary care research. Our goal for this survey was to examine the characteristics of primary care patients who use CAM therapies, determine whether these characteristics are significantly different for patients who have not used these therapies, and determine whether use of CAM therapies is associated with clinical condition, functional status, and quality of life.
Methods
Subjects
Our subjects included 541 patients aged 18 years and older visiting 16 family practice clinics in the San Diego area during a 3-month period (June 1999-August 1999). Each of these practices was a member the recently formed San Diego Unified Research in Family Medicine Network (SURF*NET). In this practice-based research initiative, community physicians, faculty and educators of academic family medicine programs combine research and clinical practice to develop a vital body of knowledge in the discipline of family medicine. The 16 clinics participating in the study represented more than 40 family physicians who were SURF*NET members and a patient population of more than 30,000, covering a broad and representative cross-section of the San Diego community.