To participate in the study patients had to identify a specific health complaint as the reason for a clinic visit. Individuals who made a visit for a general physical examination or to transport a pediatric patient were excluded. Our study participants represented 89% of all patients who met eligibility criteria and were invited to participate. Participants and nonparticipants exhibited no significant differences with respect to age, sex, ethnicity, or insurance status.
Data
Patients were asked to complete a questionnaire administered by a survey worker in the waiting room before the scheduled visit with a family physician. The survey instrument included questions about the social and demographic characteristics of the patient, including age, sex, marital status, ethnicity, place of birth, level of acculturation, education, and 1998 household income. Level of acculturation was assessed on the basis of a 5-item scale used in previous studies of patient populations.14 Patients were then grouped into acculturation categories: low, medium, and high. They were also grouped into categories based on their level of education (no college, some college, and college graduate), the method of payment for the clinic visit (cash, Medi-Cal/Medicare, and health maintenance organization or health insurance), and median 1998 household income (<$50,000 or Ž$50,000).
The Medical Outcomes Study Short Form (SF-36)15 was used to assess a patient’s current health status and quality of well-being. The patients were evaluated on the basis of physical and social functioning, physical and emotional role functioning, mental health, energy or fatigue, pain, general perceived health compared with others the same age, and general health compared with a year ago.
Finally, each patient was asked to describe the most important or significant health problems experienced during the past year and whether any of these problems had precipitated the current clinic visit. Health problems were then coded by investigators according to International Classification of Diseases—9th revision—Clinical Modification (ICD-9-CM) criteria.16 Symptoms and complaints that could not be attributed to a specific diagnosis were placed under the ICD-9-CM category of Symptoms and Ill-Defined Conditions. Using a list derived from previous studies,1,2 patients were then asked whether they had used one or more of 16 CAM therapies or therapists for their principal medical condition during the past 12 months. Information was also collected on the level of satisfaction with these CAM therapies, level of satisfaction with care provided by their family physician for the problem, reasons for using a CAM therapy or therapist, and whether the family physician had been notified by the patient that he or she was using such alternatives. Patients’ level of satisfaction with conventional and CAM treatments was rated on a scale from 1 (not at all satisfied) to 10 (completely satisfied). Reasons for using a CAM therapy were derived from a list compiled by Lazar and O’Connor.17
Statistics
Univariate statistics (percentages and means) were used to describe the characteristics of CAM use. Bivariate analyses (chi-square tests for categorical variables and paired-sample t tests and analysis of variance for continuous measures) were used to determine whether there were any significant differences between patients reporting use of any form of CAM therapy in the past year and those reporting no use of such therapy with respect to the following predictors: (1) social and demographic characteristics; (2) functional status and quality of wellbeing; (3) dissatisfaction with conventional treatments; and (4) ICD-9-CM diagnostic category of chief health complaint. Similar analyses were performed by 3 classes of therapy: (1) practitioner-based therapies (acupuncture, biofeedback, chiropractic, homeopathy, massage therapy, naturopathy); (2) self-care based therapies (energy healing, meditation and prayer, dietary interventions, herbal remedies, multivitamin supplements); and (3) traditional folk remedies. When appropriate (ie, based on the number of users), analyses were also conducted for individual types of therapy (chiropractic, acupuncture, herbal remedies, dietary interventions, massage therapy). Logistic regression models with stepwise entry of all potential independent variables were used to assess the odds of using a CAM therapy associated with each patient characteristic.
Results
Characteristics of CAM Users
Of the 541 adults participating in our study, 116 (21%) reported using 1 or more forms of CAM therapy or therapists within the past year for the primary health problem contributing to the present clinic visit. A visit to a chiropractor was the most frequent form of alternative therapy, followed by the use of herbal remedies or supplements, and message therapy Figure 1.
Approximately 60% of these patients had informed their physicians of the use of these CAM therapies. Of those who had not done so, 60% had indicated that there had been no previous opportunity to inform their physicians, since this had been the first visit for the health problem in question. When examined by class of CAM usage, approximately two thirds of those using practitioner-based and self-care– based therapies reported use to their physician, compared with 40% of those using traditional folk remedies.