Compliance with Requests for Complementary-Alternative Medicine Referrals: A Survey of Primary Care Physicians

Abstract

Background: A majority of primary care physicians in many Western countries have referred patients for complementary and alternative medicine. Patient requests appear to be one of the primary determinants of CAM referral behavior. The present study was designed to identify potential correlates of compliance with these requests for referral. Methods: Questionnaires were mailed to a random sample of family practitioners, internists, and pediatricians. A total of 783 physicians responded regarding their prior training, requests for referrals, referrals made, attitudes, and observations of harmful/beneficial effects related to each of 16 specific CAM therapies. Results: At least 10% of the physicians had received one or more patient requests for referral for 15 of the 16 CAM therapies listed. When compliance was liberally defined as honoring at least one patient's request for a referral to a specific therapy, 11 of the 16 therapies registered compliance rates of 50% or greater. Physicians were most likely to comply with requests for biofeedback/relaxation therapies, massage/therapeutic touch, hypnotherapy, and prayer/spiritual direction. They were least likely to refer patients for homeopathy, herbal medicine, and megavitamin therapies. Conclusions: Physicians who have observed beneficial effects of a CAM therapy, consider a CAM therapy to be a legitimate medical practice, or have had training in a therapy are more likely to comply with requests for referral.