Alternative Medicine Providers Research Articles

Food, Food Components, and Botanicals Affecting Drug Metabolism in Transplantation

IN2006, THEUS Food and Drug Administration (FDA) issued the draft guidance document ‘‘Complementary and Alternative Medicine Products and Their Regulation by the Food and Drug Administration’’ partly because of the increasingly widespread use of complementary and alternative medicine (CAM) providers and CAM products in the United States. CAM products are subject to regulation in the United States. The terms complementary and alternative represent 2 categories—1 complements traditional medicine and the other is an alternative to traditional medicine. One of the 4 domains of CAM includes biologically based products, such as botanicals and their extracts, animal-derived extracts, vitamins, minerals, fatty acids, and prebiotics and probiotics. It is important to understand how a product falls under the regulatory oversight of the FDA depending on its intended use. An item that is intended to treat a disease will generally be regulated as a drug, whereas that same item could be classified as a dietary supplement if the intended use is to ‘‘add further nutritional value to (supplement) the diet.’’ The same item may also be considered a food if the intended use is as an ingredient in a food product. However, a claim to treat, cure, palliate, or prevent disease or disease symptoms cannot be used on dietary supplement or food labels. Instead, this intended use would classify the product as a drug and require an Investigational New Drug approval from the FDA. Botanically based products are widely accessible, and claims for treatment, prevention, or cure abound in the public sector (e.g., the Internet, magazines, newspaper advertisements, and word of mouth), regardless of whether the manufacturer is making a viable claim or not. Therefore, it is important to remind patients who are being treated for kidney disease that botanicals should generally be avoided unless carefully reviewed with their dietitian

Collaborative Care for Older Adults with low back pain by family medicine physicians and doctors of chiropractic (COCOA): study protocol for a randomized controlled trial

BackgroundLow back pain is a prevalent and debilitating condition that affects the health and quality of life of older adults. Older people often consult primary care physicians about back pain, with many also receiving concurrent care from complementary and alternative medicine providers, most commonly doctors of chiropractic. However, a collaborative model of treatment coordination between these two provider groups has yet to be tested. The primary aim of the Collaborative Care for Older Adults Clinical Trial is to develop and evaluate the clinical effectiveness and feasibility of a patient-centered, collaborative care model with family medicine physicians and doctors of chiropractic for the treatment of low back pain in older adults.Methods/designThis pragmatic, pilot randomized controlled trial will enroll 120 participants, age 65 years or older with subacute or chronic low back pain lasting at least one month, from a community-based sample in the Quad-Cities, Iowa/Illinois, USA. Eligible participants are allocated in a 1:1:1 ratio to receive 12 weeks of medical care, concurrent medical and chiropractic care, or collaborative medical and chiropractic care. Primary outcomes are self-rated back pain and disability. Secondary outcomes include general and functional health status, symptom bothersomeness, expectations for treatment effectiveness and improvement, fear avoidance behaviors, depression, anxiety, satisfaction, medication use and health care utilization. Treatment safety and adverse events also are monitored. Participant-rated outcome measures are collected via self-reported questionnaires and computer-assisted telephone interviews at baseline, and at 4, 8, 12, 24, 36 and 52 weeks post-randomization. Provider-rated expectations for treatment effectiveness and participant improvement also are evaluated. Process outcomes are assessed through qualitative interviews with study participants and research clinicians, chart audits of progress notes and content analysis of clinical trial notes.DiscussionThis pragmatic, pilot randomized controlled trial uses a mixed method approach to evaluate the clinical effectiveness, feasibility, and participant and provider perceptions of collaborative care between medical doctors and doctors of chiropractic in the treatment of older adults with low back pain.Trial registrationThis trial registered in ClinicalTrials.gov on 04 March 2011 with the ID number of NCT01312233.

Chelation: Therapy or quackery?

More than 110,000 American adults used chelation in 2007, according to the National Health Interview Survey—a signifi cant increase from the 66,000 patients using this therapy in 2002. Although chelation therapy is indicated for acute poisoning due to lead, iron, and other toxic compounds, much of its use has been by alternative medicine providers, especially for the treatment of cardiovascular disease (CVD).

US Spending On Complementary And Alternative Medicine During 2002–08 Plateaued, Suggesting Role In Reformed Health System

Complementary and alternative medicine services in the United States are an approximately $9 billion market each year, equal to 3 percent of national ambulatory health care expenditures. Unlike conventional allopathic health care, complementary and alternative medicine is primarily paid for out of pocket, although some services are covered by most health insurance. Examining trends in demand for complementary and alternative medicine services in the United States reported in the Medical Expenditure Panel Survey during 2002-08, we found that use of and spending on these services, previously on the rise, have largely plateaued. The higher proportion of out-of-pocket responsibility for payment for services may explain the lack of growth. Our findings suggest that any attempt to reduce national health care spending by eliminating coverage for complementary and alternative medicine would have little impact at best. Should some forms of complementary and alternative medicine-for example, chiropractic care for back pain-be proven more efficient than allopathic and specialty medicine, the inclusion of complementary and alternative medicine providers in new delivery systems such as accountable care organizations could help slow growth in national health care spending.

Integrating Complementary and Alternative Medicine with Primary Health Care

Complementary/alternative medicine (CAM) has been described as “diagnosis, treatment, and/or prevention which complements mainstream medicine by contributing to a common whole, satisfying a demand not met by orthodoxy, or diversifying the conceptual frameworks of medicine” [1]. Approximately, 1500 articles on CAM are published annually in the literature covered by MEDLINE [2]. In the United Kingdom, the market for herbal and homoeopathic remedies and aromatherapy oils increased by 41% between 1992 and 1996 [3]. In Germany, a herbal remedy (St. John's wort) is now the most frequently prescribed drug for depression. In the USA, the sales of St. John's wort rose by 2800% between 1997 and 1998, and the total market for medicinal botanicals was worth US$ 3.87 billion in 1998 [4]. Most experts agree that the interest in and practice of CAM are driven mainly by consumer pressure. A 1990 national survey of alternative medicine prevalence in US, costs, and patterns of use [5] demonstrated that alternative medicine has a substantial presence in the US health care system. Data from a survey in 1994 [6] and a public opinion poll in 1997 [7] confirmed the extensive use of alternative medical therapies in the United States. An increasing number of US insurers and managed care organizations now offer alternative medicine programs and benefits [8]. The majority of US medical schools now offer courses on alternative medicine [9]. In western Europe and Australia, 20–70% of the population regularly use complementary and alternative medicine [10, 11]. In the USA, it was estimated in 1992 that at least one in three Americans utilized one of those methods, and the number of annual visits to providers of alternative medicine exceeds the number of visits to all primary care physicians [12]. These therapies include acupuncture, chiropractic, herbal medicine and dietary supplements, nutraceuticals, homeopathy, mind-body techniques, spirituality, and faith healing, massage, and therapeutic touch. In a 1998 follow-up study, the percentage of CAM patients had increased to 42% of the US population [13]. Subsequent analyses showed that 67.6% of respondents had used at least one CAM therapy in their lifetime. This trend suggests a continuing demand for CAM therapies that will affect health care delivery for the foreseeable future [14]. The WHO report of 2002 states that at least 70% of the world population still believes in alternative medicine, and therapies which include homeopathy, Ayurveda, Siddha, Unani, Amchi, acupuncture, aromatherapy, herbal medicine in general, dietary supplements, nutraceuticals, Yoga, mind-body techniques, spirituality and faith healing, and massage. The current trend is indicative of a continuing demand for CAM therapies which will definitely have its impact on health care delivery in the future [15].

Complementary and alternative medicine (CAM) providers’ views of chronic low back pain patients’ expectations of CAM therapies: a qualitative study

BackgroundSome researchers think that patients with higher expectations for CAM therapies experience better outcomes and that enthusiastic providers can enhance treatment outcomes. This is in contrast to evidence suggesting conventional medical providers often reorient patient expectations to better match what providers believe to be realistic. However, there is a paucity of research on CAM providers’ views of their patients’ expectations regarding CAM therapy and the role of these expectations in patient outcomes.MethodsTo better understand how CAM providers view and respond to their patients’ expectations of a particular therapy, we conducted 32 semi-structured, qualitative interviews with acupuncturists, chiropractors, massage therapists and yoga instructors identified through convenience sampling. Interviews were recorded, transcribed and analyzed thematically using Atlas ti version 6.1.ResultsCAM providers reported that they attempt to ensure that their patients’ expectations are realistic. Providers indicated they manage their patients’ expectations in a number of domains— roles and responsibilities of providers and patients, treatment outcomes, timeframe for improvement, and treatment experience. Providers reported that patients’ expectations change over time and that they need to continually manage these expectations to enhance patient engagement and satisfaction with treatment.ConclusionsProviders of four types of CAM therapies viewed patients’ expectations as an important component of their experiences with CAM therapy and indicated that they try to align patient expectations with reality. These findings suggest that CAM providers are similar in this respect to conventional medical providers.

A Sociobehavioral Model of Use of Complementary and Alternative Medicine Providers, Products, and Practices: Findings From the 2007 National Health Interview Survey.

This study tested a modification of the Andersen behavioral model of health services use to assess the effects of predisposing factors, enabling resources, need, and personal health practices on the use of complementary and alternative medicine providers, products, and practices in the past 12 months. Data were from the 2007 National Health Interview Survey (n = 23 149 adults). Prevalence estimates and logistic regression results were weighted and adjusted for complex sample design. Overall, 16.6% used providers, 18.8% products, and 22.2% practices. There were significant associations in the expected directions between variables in each domain of the model and each type of complementary and alternative medicine use. There were also notable differences in patterns across types: for example, income was more strongly associated with use of providers. The findings support the potential usefulness of a modified health services approach to better understand differences in types of complementary and alternative medicine use.

Addressing provider shortage in underserviced areas: The role of traditional, complementary and alternative medicine (TCAM) providers in Canadian rural healthcare

IntroductionThis study examined the role of traditional, complementary and alternative medicine (TCAM) providers in rural/remote communities of Ontario that provide care to underserviced areas and may collaborate with biomedical (BM) providers to provide “integrative” medicine (IM). Research questions(1) To what extent are TCAM providers delivering care in rural/remote communities? (2) How might TCAM providers be interacting with BM providers? (3) In what specific ways may TCAM providers be contributing to human resources for health (HRH)? MethodologyUsing purposive sampling, we conducted 29 in-depth interviews from four TCAM provider groups within multiple rural localities in Ontario: naturopathic doctors, doctors of chiropractic, registered midwives and traditional Aboriginal healers. A minimum of five interviews per provider-group was conducted. Interviews were analyzed using qualitative content analysis. ResultsTCAM providers are essential for rural healthcare in Canada, as they are accessible and without common wait time issues as with BM providers. TCAM providers fill healthcare gaps by providing holistic care based on cultural/philosophical and spiritual congruency, “health promotion/education” and lifestyle counseling. TCAM providers deliver primary healthcare, bridged care and interim care. Though they strive toward interprofessional collaboration (IPC) and IM, few TCAM providers accomplish this due to perceived and/or real barriers with interprofessional education (IPE). ConclusionTCAM providers currently provide rural care to warrant an HRH role in Canada. There is a need for more research into IPE, IPC and IM between rural TCAM professions and the BM community in order for their role to become embedded in future rural health policy.

Effect of Risk Adjustment Method on Comparisons of Health Care Utilization Between Complementary and Alternative Medicine Users and Nonusers

Complementary and alternative medicine (CAM) providers are becoming more integrated into the United States health care system. Because patients self-select CAM use, risk adjustment is needed to make the groups more comparable when analyzing utilization. This study examined how the choice of risk adjustment method affects assessment of CAM use on overall health care utilization. Insurance claims data for 2000-2003 from Washington State, which mandates coverage of CAM providers, were analyzed. Three (3) risk adjustment methods were compared in patients with musculoskeletal conditions: Adjusted Clinical Groups (ACG), Diagnostic Cost Groups (DCG), and the Charlson Index. Relative Value Units (RVUs) were used as a proxy for expenditures. Two (2) sets of median regression models were created: prospective, which used risk adjustments from the previous year to predict RVU in the subsequent year, and concurrent, which used risk adjustment measures to predict RVU in the same year. The sample included 92,474 claimants. Prospective models showed little difference in the effect of CAM use on RVU among the three risk adjustment methods, and all models had low predictive power (R(2) ≤0.05). In the concurrent models, coefficients were similar in direction and magnitude for all risk adjustment methods, but in some models the predicted effect of CAM use on RVU differed by as much as double between methods. Results of DCG and ACG models were similar and were stronger than Charlson models. Choice of risk adjustment method may have a modest effect on the outcome of interest.

Pediatric integrative medicine: pediatrics' newest subspecialty?

BackgroundIntegrative medicine is defined as relationship-centered care that focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare professionals and disciplines to achieve optimal health and healing, including evidence-based complementary and alternative medicine. Pediatric integrative medicine (PIM) develops and promotes this approach within the field of pediatrics. We conducted a survey to identify and describe PIM programs within academic children’s hospitals across North America. Key barriers and opportunities were identified for the growth and development of academic PIM initiatives in the US and Canada.MethodsAcademic PIM programs were identified by email and eligible for inclusion if they had each of educational, clinical, and research activities. Program directors were interviewed by telephone regarding their clinical, research, educational, and operational aspects.ResultsSixteen programs were included. Most (75%) programs provided both inpatient and outpatient services. Seven programs operated with less than 1 FTE clinical personnel. Credentialing of complementary and alternative medicine (CAM) providers varied substantially across the programs and between inpatient and outpatient services. Almost all (94%) programs offered educational opportunities for residents in pediatrics and/or family medicine. One fifth (20%) of the educational programs were mandatory for medical students. Research was conducted in a range of topics, but half of the programs reported lack of research funding and/or time. Thirty-one percent of the programs relied on fee-for-service income.ConclusionsPediatric integrative medicine is emerging as a new subspecialty to better help address 21st century patient concerns.

Exploring older and younger adults' preferences for health information and participation in decision making using the Health Information Wants Questionnaire (HIWQ)

Existing measurements of patient preferences cover only a limited range of health information and participation in decision making. A broader approach is necessary to understand the breadth and variations in patient preferences. To explore the breadth and variances in patient preferences for health information and participation in decision making and to understand the relationship between age and each type of preference. The Health Information Wants Questionnaire (HIWQ) was administered during May-December 2010 to gather data about the information and corresponding decision-making autonomy participants would want in seven areas: diagnosis, treatment, laboratory tests, self-care, complementary and alternative medicine (CAM), psychosocial factors and health-care providers. A large state university, public libraries and senior centres in Maryland, USA. A convenience sample of 438 individuals, including 226 undergraduates (mean age = 20; SD = 2.15) and 212 community-dwelling older adults (mean age = 72; SD = 9.00). Ratings on the information and decision-making items of the HIWQ. Participants expressed higher levels of preference for information than for participation in decision making on six of seven subscales. On the psychosocial subscale, they expressed stronger desire for participation in decision making than for information. Age had no predictive effect on the overall preferences or specific preferences for information and participation in decision making about standard treatments and CAM. The predictive effect of age on the other types of preferences varied significantly. Physicians should take into account the breadth and variations in patient preferences. The predictive effect of age on patient preferences varied depending on the specific area of preferences.

Bogus arguments for unproven treatments

Bogus arguments for unproven treatments

Exposure to Alternative Healthcare Providers and Adherence to Guidelines among Patients with Diabetes

OBJECTIVES: Diabetes is increasing in prevalence across Canada. In the continuously evolving primary care landscape, practitioners from varied training paths are claiming rights to care for patients, including those with diabetes. Little is known about patient exposure to complementary and alternative medicine (CAM) providers, or about such providers' use of guideline-based monitoring and treatment recommendations. The purpose of this study was to examine compliance with 4 recommendations (influenza vaccination, eye examination, glycated hemoglobin measurement and foot exam) by patients with diabetes who use CAM providers compared to those who exclusively use primary care physicians.METHODS: We analyzed data on 7209 patients with diabetes using the Canadian Community Health Survey. Patients with exposure to CAM providers were compared with individuals who were exposed to a family physician only. Multivariate logistic regression was conducted adjusted for age, sex, duration of diabetes, insulin/oral antihyperglycemic agent use and education.RESULTS: Approximately 4% of persons had been exposed to CAM providers in the preceding year. The odds ratio for receiving influenza vaccination among those exposed to a CAM provider was 0.94 (95% CI 0.74–1.17). The odds ratios for eye examinations in the preceding 24 months, and for foot examinations and glycated hemoglobin tests in the preceding 12 months were 1.02 (95% CI 0.69–1.48), 1.18 (0.83–1.67) and 1.09 (95% CI 0.71–1.66), respectively.CONCLUSION: Our results did not show statistical significance in any of the 4 outcomes analyzed. This study supports others suggesting that persons using CAM providers do so to complement traditional medical care, rather than as an alternative to such care.

Type 2 diabetes, cardiovascular disease and the utilisation of primary care in urban and regional settings

There are marked inequities in access to and use of different primary care providers - including GPs, practice nurses, allied health services and complementary and alternative medicine (CAM) providers among populations residing in different geographical areas of Australia. Little research has focused on patterns of primary care health service utilisation according to locality in relation to the management of serious chronic illness, with even less on the use of CAM. In this article geographic similarities and differences in primary care service usage are examined among people with cardiovascular disease and/or type 2 diabetes mellitus residing in regional and urban Victoria, Australia. Between April and July 2010, hard-copy questionnaires were sent to a random selection of 10 000 registrants from the National Diabetes Services Scheme, 2162 were distributed via Heart Support Australia and community organisations within the state of Victoria; an online version yielded 290 valid responses. This article draws on data from the 2914 returned survey responses in which people provided their residential postal codes. From this information, geographic location was determined on the basis of the Australian Standard Geographical Classification. Data were subject to inferential analyses using PASW Statistics 18.0 (SPSS; Chicago, IL, USA). A series of contingency table analyses were conducted to evaluate the relationship between primary care service use and respondents' geographical locality. Contingency analyses and χ(2) tests were also conducted to examine the differences between rural and metropolitan frequency of GP use. In comparison with urban respondents, rural respondents reported greater use of allied health practitioners, district or practice nurses, and community health centres. Conversely, use of hospital outpatient services was significantly higher among metropolitan respondents. Use of GP clinics was not related significantly to respondents' locality, nor was use of inpatient hospital services or use of counselling, psychiatry or psychology services. Frequency of GP use, however, varied significantly among geographical categorisations, with urban respondents visiting their GPs more frequently. While GPs play an important role in chronic disease management in Australia, the rate of GP attendance remains lower among patients living in regional areas. By contrast, the level of patient engagement with nurse practitioners and allied health professionals in this study was significantly higher among rural respondents. Issues related to access appear to play an important role in determining what primary care services people use when managing their chronic conditions and their frequency of consultation.

Asthma Education Information Source Preferences and Their Relationship to Asthma Knowledge

This study recounts the findings from a year-long survey of Brooklyn residents. Survey respondents were questioned about their knowledge of asthma signs, triggers, symptoms and their attitudes and beliefs about asthma. If they had asthma or were responsible for a child or adult who had asthma they were asked questions to determine how well that asthma was controlled. They were also questioned about their preferred sources of asthma information. Descriptive and inferential statistics indicate that the survey respondents (mostly African American, middle aged, females) were generally knowledgeable about asthma, although they shared some misconceptions about asthma treatments and triggers. They showed a marked preference for obtaining their asthma information from traditional Western medicine providers rather than friends, family members, alternative or complimentary medicine providers or spiritual leaders. This information is useful in guiding investments of time and resources for asthma education programs addressing such audiences. It is also useful for planning health care education programs for a variety of disorders, including high blood pressure and diabetes.

Distribution of complementary and alternative medicine (CAM) providers in rural New South Wales, Australia: A step towards explaining high CAM use in rural health?

Complementary and alternative medicine (CAM) use is high in rural health and an agenda for research in the geography of CAM has been outlined. Unfortunately, no studies to date have mapped the geographic distribution of CAM practitioners in rural areas. For the first time we investigate CAM practitioner distributions across a large district/region in rural Australia. A CAM infrastructure audit of practitioners was performed in rural Divisions of General Practice in New South Wales, Australia. CAM providers form a significant part of the health care system in rural New South Wales with substantial representation across all degrees of rurality and in both under-serviced and well-serviced areas. CAM practitioners outnumbered GPs in four NSW Divisions of General Practice and in no Division numbered less than half of the total number of GPs. Given the challenges of access to and recruitment and retention of conventional health care providers in rural settings and the significant presence of CAM practitioners, it is possible to consider such practitioners as an untapped resource in rural health care delivery. Assuming appropriate regulatory and quality standards are in place this resource should attract careful attention as part of future rural health policy and planning. The significant presence and high prevalence of use of CAM practitioners should also serve as an impetus to reform CAM service delivery in Australia.

Potential role of complementary and alternative health care providers in chronic disease prevention and health promotion: An analysis of National Health Interview Survey data

ObjectiveTo make a preliminary assessment of the potential role of the most frequently used licensed or certified United States complementary and alternative medicine (CAM) providers in chronic disease prevention and health promotion. MethodThis was a secondary analysis of the 2007 United States National Health Interview Survey (NHIS), the most recent to include CAM use. The Adult Core Sample, Person and Adult Complementary and Alternative Medicine data files were included. NHIS's complete survey design structure (strata, cluster and survey weights) was applied in generating national population estimates for CAM usage. ResultsChiropractic or osteopathic manipulation (8.4%) and massage (8.1%) were most commonly used; acupuncture was used by 1.4% and naturopathy by 0.3% of respondents. Substantial proportions of respondents reported using CAM for wellness and disease prevention, and informed their medical physician of use. Fifty-four percent were overweight or obese, 22.0% physically inactive, and 17.4% smokers; 18.0% reported hypertension, 19.6% high cholesterol, and 9.1% prediabetes or diabetes. ConclusionCAM users present with risk factors which are priority public health issues. This implies a need to train CAM providers in evidence-based health promotion counseling. CAM encounters may provide opportunities to coordinate health promotion and prevention messages with patients' primary care providers.

Stem Cell Stratagems in Alternative Medicine

Stem cell research has attracted an extraordinary amount of attention and expectation due to its potential for applications in the treatment of numerous medical conditions. These exciting clinical prospects have generated widespread support from both the public and private sectors, and numerous preclinical studies and rigorous clinical trials have already been initiated. Recent years, however, have also seen alarming growth in the number and variety of claims of clinical uses of notional 'stem cells' that have not been adequately tested for safety and/or efficacy. In this article, I will survey the contours of the stem cell industry as practiced by alternative medicine providers, and highlight points of commonality in their strategies for marketing.

Associations between Hours Worked, Symptoms and Health Resource Utilization among Full‐time Male Japanese Workers

To investigate the association between hours worked, symptoms experienced, and health resource utilization. Data were collected from a nationally representative sample of households in Japan. We studied full-time male workers aged 18-65 yr who worked 100 h or more per month. First, we examined the association between hours worked and symptoms experienced. Second, we examined the association between hours worked and the type of health resource utilized, such as physician visits, over-the-counter (OTC) medication use, dietary supplement use, and complementary and alternative medicine (CAM) provider visits. We used a multivariable negative binominal model in each analysis. Of the 762 male workers, 598 reported experiencing symptoms at least once a month. We categorized participants based on the number of hours worked per month (h/mo): 100-200 h/mo, 201-250 h/mo, and over 250 h/mo. Compared with those working 201-250 h/mo, those working 100-200 h/mo had more frequent physician visits (rate ratio:1.67, 95% CI: 1.17 to 2.38) and those working over 250 h/mo had significantly lower rates of CAM provider visits and tended to use dietary supplements for symptoms. Participants who worked 201-250 h/mo used OTC medication most frequently. No significant association was observed between the number of hours worked and number of symptoms experienced. The more hours worked by full-time male workers, the more likely they were to use health resources that had a lower time requirement. Greater attention should be paid to patterns of health resource utilization among workers and their consequent influence on long-term health status.

Seeking Help for Mental Health Problems outside the Conventional Health Care System: Results from the European Study of the Epidemiology of Mental Disorders (ESEMeD)

In certain countries, it is not uncommon to turn to professionals outside the conventional health care system for psychological problems. As this situation is not well documented in Europe, we assessed use of nonconventional care for mental health in 6 European countries. A cross-sectional survey was conducted in representative samples of noninstitutionalized adults in 6 European countries. Participants (n = 8796) completed a survey, which included, among other items, the Composite International Diagnostic Interview 3.0 and in-depth questions about lifetime consultations for mental health problems. Among the respondents (n = 2928) who reported having already sought help in their lifetime for psychological problems (20.0%), 8.6% turned to complementary and alternative medicine (CAM) providers, such as chiropractors and herbalists, and a similar proportion (8.4%) to religious advisers such as ministers, priests, or rabbis. Only a small proportion (2.9%) consulted only these professionals for their problems. CAM providers were more frequently used in the Netherlands (13.5%) and Germany (9.4%), while religious advisers were more often consulted in Italy (12.6%) and Germany (11.6%). Multivariate analyses confirmed differences between countries and revealed that people turning to religious advisers tended to be older, foreign born, and with alcohol problems, whereas those consulting CAM providers were younger, wealthier, and more frequently depressed. In Europe, patients who turn to CAM therapists and those who seek help from religious advisers for psychological problems are not exactly the same. In addition, these professionals are not consulted frequently in most countries, and are almost always associated with more traditional follow-up when used.