Users of CAM therapies in general (P <.01) and practitioner-based therapies (P <.01) and chiropractors (P <.001; data not shown) in particular reported significantly less satisfaction than nonusers with the conventional treatment they received from their family physician Figure 3. However, CAM users also reported no significant difference in the level of satisfaction with these therapies and the level of satisfaction with the care received from their family physician. Users of folk remedies reported significantly higher levels of satisfaction with conventional treatment than nonusers (P <.05), and higher levels of satisfaction with their CAM therapy than other CAM users (P <.05).
We examined the independent association between each of the sociodemographic and health status characteristics of patients and CAM use with a series of logistic regression models. Age, sex, marital status, place of birth, education, household income, method of payment, level of acculturation, satisfaction with primary care received, SF-36 measures of functional status, and presence or absence of a musculoskeletal disorder were entered into the model in a stepwise fashion. The best fitting models are presented in Table 5. Physical role functioning was the only significant independent predictor of use of one or more CAM therapies. The model correctly classified 70% of the patients. Musculoskeletal disorders, emotional functioning, and perceived general health were significant independent predictors of use of a practitioner-based therapy. The model correctly classified 86.4% of the patients. Patients with musculoskeletal disorders were 7.37 times (95% confidence interval [CI], 2.37-23.51) as likely to use some form of practitioner-based therapy (usually a chiropractor or massage therapist) as patients with other physical conditions. Level of education and general perceived health compared with a year ago were significant independent predictors of use of self-care–based therapies. The model correctly classified 86.4% of the patients. College graduates were 1.44 times (95% CI, 1.04-2.01) as likely to use some form of self-care–based therapy as patients with 12 or fewer years of education. Hispanic ethnicity was the only significant independent predictor of use of traditional folk remedies. The model correctly classified 97.8% of the patients. Hispanics were 10.27 times (95% CI, 3.10-33.95) as likely to use traditional folk remedies as members of other ethnic groups.
Logistic regression analyses predicting use of specific CAM therapies revealed that general perceived health was a significant independent predictor of use of acupuncture (b=-0.0665; standard error [SE]=0.0253; P=.0086) and chiropractors (b=-0.0314; SE=0.0139; P=.0243). A musculoskeletal disorder was a significant independent predictor of use of chiropractors (b=2.0123; SE=0.6720; P=.0005) and massage therapists (b=1.8467; SE=0.7792; P=.0178). Patients with musculoskeletal disorders were 10.23 times (95% CI, 2.00-27.92) as likely to use a chiropractor and 6.34 times (95% CI, 1.38-29.19) as likely to use a massage therapist as patients with some other clinical condition. Emotional functioning was also a significant independent predictor of use of massage therapy (b=-0.0902; SE=0.0347; P=.0094), and household income was a significant independent predictor of use of acupuncture (b=2.5045; SE=1.2428; P=.0439).
DISCUSSION
In our study approximately 1 in 5 patients reported having used some form of complementary or alternative therapy or therapist in the past year in conjunction with a current health problem. This percentage is smaller than the 42% reported by Eisenberg and colleagues.2 However, that study was a population-based survey and was not tied to use of primary care services. Although previous studies of primary care patients have reported higher percentages of patients using CAM therapies, differences in methods preclude a comparison with those percentages. Drivdahl and Miser,9 for example, reported that 28% of 177 family practice patients in a military clinic had ever used some form of alternative medicine. Elder and colleagues10 reported that 50% of 113 family practice clinic patients had used some form of CAM, but this includes use for reasons other than those precipitating the visit to the physician. To our knowledge this is the largest study conducted of a broad spectrum of family practice patients, focusing on use related to a specific health problem that precipitated a visit to a family physician.
Consistent with the findings of previous studies,1,2,9 use of CAM therapies in general and self-care–based therapies in particular by this group of primary care patients, was significantly associated with a high level of education. This may be attributed to the fact that better educated patients tend to be more informed or at least more likely to be exposed to information about the benefits of CAM.17,18 Consistent with previous research,1,2,17,18 use of self-care–based therapies was also associated with high household income in our study. Many of these therapies are not always covered by health insurance plans, which means they require cash payments that those with higher incomes are more likely to be able to afford.