In our study use of traditional folk remedies was inversely associated with levels of education and acculturation and positively associated with Hispanic ethnicity and being foreign-born. Low-acculturated, predominately Hispanic immigrants are more likely to be uninsured or underinsured,19 not able to afford cannot afford conventional treatment,20 and be more familiar with the efficacy of those traditional folk remedies.21
We also found that users of CAM therapies generally perceive their health to be worse compared with others their age and with their health a year ago than nonusers. Emotional functioning was also a significant independent predictor of use of practitioner-based therapies. Given the cross-sectional nature of the study design, it is difficult to determine whether health status is a cause or consequence of CAM use. However, a further examination of the experience of these patients with conventional treatment and their specific clinical condition provides some insight into this relationship.
Failure of regular treatment to cure the problem and a desire to avoid side effects were each cited by 1 in 4 users of CAM therapies in our study. Users were also significantly less satisfied than nonusers with the care they had received from their primary care provider. They were significantly more likely to report visiting a primary care provider for a musculoskeletal or genitourinary disorder than nonusers. Both of these disorders are noteworthy for the limited treatment effectiveness or inconsistency in treatment approach of conventional therapies.22,23 Taken together, these observations suggest that many users of CAM do so because they are dissatisfied with the care received from their primary care provider.
However, complementary and alternative medicine users were found to be no more satisfied with these alternatives than with the care received from their family physician. Furthermore, unhappiness with the attitude of their family physician and failure to correctly diagnose the problem was cited by a relatively small number of patients as a reason for using CAM therapies. Only 20% of users reported doing so after seeing a physician; the others did so either before or concurrent with a visit. This suggests that experience with the family physician played a relatively minor role in the decision of most patients to use CAM therapies.
Conclusions
The results of our study can be used to acquaint family physicians with the characteristics of users of complementary and alternative therapies and therapists in conjunction with specific health problems. Such information may have implications for diagnosis and treatment regimens, especially if contraindications to certain forms of treatment arise as a result of potential adverse reactions when used in combination with specific forms of CAM (eg, lead poisoning resulting from the use of certain traditional Mexican remedies used as laxatives24). In contrast to the results of previous studies,25 relatively few patients were reluctant to notify their primary care provider of their use of CAM therapies. However, patients were more likely to share this information if the physician made an effort to ask. An understanding of the characteristics associated with CAM use should enable the physician to obtain this information.
The results of our study suggest that patterns and predictors of CAM use by primary care patients vary with the type of therapy used. It is important to realize that all CAM therapies are not alike. Self-care–based therapies are more likely to be used by patients who are well educated, while traditional folk remedies are more likely to be used by Hispanic immigrants with low levels of education. Practitioner-based therapies are more likely to be used by patients with musculoskeletal disorders. Family physicians should keep these distinctions in mind when evaluating the likelihood of CAM use by a particular patient and potential implications for primary care delivery.
Acknowledgments
Our study was funded by a grant from the California Academy of Family Physicians.
Related Resources
National Center for Complementary and Alternative Medicine
A branch of the National Institutes of Health that conducts and supports basic and applied research and training and disseminates information on complementary and alternative medicine to physicians and the public. www.nccam.nih.gov
Whole Health MD
Information on combining alternative medicine, supplements, vitamins, herbs, and nutrition with conventional medicine. www.wholehealth.com
alternativeDr.com
Resources for books, reports, and practitioner searches serving various categories in alternative medicine therapies. www.alternativedr.com
HealthWorld Online
Alternative and Complementary Medicine Center-provides in-depth information about a range of therapies, as well as discussion forums, conference listings, and other resources. www.healthy.net/clinic/therapy/altmedcolumn