Complementary And Alternative Medicine Practitioners Research Articles

Attitudes and Practices of Massage Therapists as Related to Conventional Medicine

Research into opinions about complementary and alternative medicine (CAM) has focused on conventional medical practitioners with little exploration of CAM practitioners' views. To survey attitudes and practices of massage therapists toward conventional medicine. An anonymous online survey consisting of Likert-type scales, fill-in answers, and multiple-choice questions was used. Members of the Associated Bodywork & Massage Professionals (ABMP), the largest massage therapy association in the US with over 77,000 members. Participants were asked about their years of practice and training, choice of health care practitioners, sources for information about CAM and Western/allopathic medicine, client referral patterns, optimal treatment approaches for various medical conditions, and overall impressions of CAM and Western/ allopathic medicine. Analysis of n = 3,148 responses indicated that while 66.9% of respondents had a neutral or worse impression of Western/allopathic medicine, 64.3% use a conventional medicine practitioner as their primary health care provider, 61.9% have referred clients to a conventional medicine practitioner in the past six months, and 90.5% seek out information on Western/allopathic medicine. The mode response of the best treatment approach to various medical problems was a mix of Western/allopathic medicine and CAM. This study suggests that despite the ambivalence of many massage therapists towards conventional medicine, many use it, encourage clients to do so, and see involvement of both as crucial to health.

Editorial: Consensus on CAM methods for nursing research?

Editorial: Consensus on CAM methods for nursing research?

Knowledge and Attitudes of Primary Health Care Physicians Towards Complementary and Alternative Medicine in the Riyadh Region, Saudi Arabia

Background: The aim of this study was to assess the level of knowledge, attitudes, and utilization of complementary and alternative medicine (CAM) of primary health care (PHC) physicians in Riyadh, Saudi Arabia. Material and Methods: A crosssectional study including all physicians working at PHC centers in the Riyadh region, Saudi Arabia, was carried out from the beginning of April 2010 to the end of June 2010. Using a self-administered questionnaire, 1,113 physicians answered questions regarding their socio-demographic data, and knowledge, attitudes and utilization of CAM. Results: About 8% of the participants had attended a continuous medical education or a training activity. Most of them were unfamiliar with reflexology, energy healing, aromatherapy, ozone therapy, homeopathy, or chiropractic care (77.4, 71.3, 71.2, 67.2, 65.7, and 63.9%, respectively). On the other hand, most physicians felt that they could understand and feel comfortable about counseling patients about Ruqyah (spiritual healing), honey and bee products, dietary supplements, massage therapy, relaxation, herbal medicine, and cupping (40.3, 38.3, 34.9, 34.4, 25.8, 22.8, and 21.4%, respectively). More than half (51.7%) of the physicians used CAM for themselves or their family, but only 14.2% referred their patients to CAM practitioners. 85.1% of studied physicians agreed that physicians should have knowledge about CAM therapies commonly used in the region. 82.5% agreed that health authorities should have a role in regulating CAM, and 75.7% agreed that the physicians’ knowledge about CAM practices leads to better patient outcome. Conclusion: There is a positive attitude regarding the concept of CAM, but there is a reluctance to refer or to initiate discussion with patients regarding CAM practices, which may be attributed to a lack of knowledge.

Health Service Use Among Persons With Self-Reported Depression: A Longitudinal Analysis of 7,164 Women

Depression is a common mental disorder and a leading contributor to the global burden of disease. In Australia, depression is reportedly the leading cause of morbidity for young women. In addition to conventional treatments, there is also some evidence that there is common use of complementary and alternative medicine (CAM) among people with depressive symptoms. However, there has been little research focus upon broad health care and practitioner use (including consumption of both conventional and CAM practitioners as well as self-prescribed care) among young adults with depression. This article aims specifically to address this knowledge gap by providing the first longitudinal analysis of the use of health service among women with self-reported depression. Data from a longitudinal cohort study (Australian Longitudinal Study on Women's Health) conducted over a 3-year period on 7,164 young Australian women were analyzed. Information on health status, health service use, and self-prescribed treatments was obtained from two questionnaires mailed to study participants in 2003 and 2006. The study identified that only a small proportion of the women had sought professional assistance for their self-reported depression. It also shows that many women who reported depression used CAM alongside or as a complement to conventional health care services. In particular, young women who did not seek help for their depression were more likely to self-prescribe CAM than were women without depression. The frequent use of a range of conventional providers and practitioner-based CAM and self-prescribed CAM among women with self-reported depression warrants further investigation.

Using Role Substitution To Address The Health Workforce Shortage And To Facilitate Integration?

The health workforce is perceived to be in short supply in most developed and developing countries. There are concerns that this could result in reduced coverage of health services and the delivery of suboptimal care. Strategies to address the health workforce shortage have focussed predominantly on recruitment and training, with relatively little regard to the equally important issue of retention. One approach that may improve job satisfaction, opportunities for specialisation and the workload of health workers, and thus, improve retention and more importantly, patient outcomes, is role substitution. Many complementary and alternative medicine (CAM) practitioners appear to be well placed in terms of educational preparation to substitute (either horizontally or vertically) a number of roles traditionally performed by conventional health disciplines. As well as the potential benefits to the health workforce and the quality of patient care, role substitution could provide an important first step toward integrating CAM practitioners into mainstream health care settings.

Patterns and Determinants of Complementary and Alternative Medicine Practitioner Use among Adults with Diabetes in Queensland, Australia.

There is evidence that complementary and alternative medicine (CAM) use is common among people with diabetes. The role of CAM in the treatment or management of diabetes is an emerging health issue given the potential side effects and benefits associated with the use of this kind of medicine. This paper examined patterns and determinants of CAM practitioner use in Queensland, Australia, using a large population-based sample of people with type 1 and type 2 diabetes. The study found that within a 12-month period, 7.7% of people with diabetes used the services of CAM practitioners alongside or as a complement to conventional health care service. Younger age, female gender, a higher education, having private health insurance, and engagement in preventive health behaviours are significant predictors of individuals who are more likely to visit a CAM practitioner. There was no significant difference in CAM practitioner use between people with type 1, type 2 insulin requiring, or type 2 noninsulin requiring diabetes. The findings highlight the need for further research on the role of CAM in the prevention and management of diabetes.

Use of Complementary and Alternative Medicine by Cancer Patients at a Montreal Hospital

To assess feasibility of methods for a future study of complementary and alternative medicine (CAM) use by cancer patients treated in conventional health care settings. Patients aged 18 years and older, fluent in English or French, and diagnosed with cancer from St. Mary's Hospital Center, Montreal, Canada participated. Feasibility was measured by the rates of participation and CAM use in the past 1 and 12 months. Following the survey, one patient focus group was held to better understand cancer patient perspectives on discussions of CAM that occur or not with their family physicians. Of 103 patients approached, 100 (97.1%; 77% female, 87% white) participated. Overall, 86% and 91% of respondents used at least one CAM in the past 1 and 12 months, respectively. More patients with breast compared with colorectal and other cancers (90.2%, 86.2%, and 80%, respectively) used CAM in the previous year. In the past 1 and 12 months, natural health products were used by 70% and 80% of respondents, respectively; mind-body therapies by 61% and 64%, respectively, and CAM practitioners by 11% and 29%, respectively. More than 98% of patients used CAM to improve quality of life and 68% disclosed CAM use to their physicians. Four of 5 focus group participants used CAM. Patient-physician CAM discussions varied from receiving a CAM referral to complete dismissal of the topic. Recruitment methods were well accepted but a sampling strategy stratified by sex and ethnicity will ensure sufficient representation by males and non-whites. Whereas disclosure of natural health products use is occurring, informative CAM discussion is not.

Factors influencing the use of complementary and alternative medicine and whether patients inform their primary care physician

Use of complementary and alternative medicines (CAMs) is widespread. Several studies have explored why individuals chose to use CAM but there are fewer data to explain how its use 'dovetails' with conventional medicine. This study aimed to determine the prevalence of CAM use in the adult population in Australia and the proportion that seek advice or tell their primary care physician after CAM use, and also to investigate which demographic characteristics, health behaviours and health status are associated with CAM use and disclosure. A cross sectional survey. a random sample of 1261 adults was interviewed as part of 2010 Queensland Social Survey, which contained questions about CAM use, frequency of use, types of CAM used, reasons for use, discussing and reporting CAM use with the doctor and confidence in CAM use. Relationships were explored using bivariate and multiple logistic regression. use of CAM; sought advice from doctor before CAM use; informed doctor after CAM use. 61.7% of respondents had used self-prescribed CAM or visited a CAM practitioner. Being female and being younger predicted CAM use. Being male and in better health predicted seeking advice from the doctor before and also after CAM use. Our results confirm the relatively high use of CAM in Queensland, Australia and found that a significant proportion of people did not seek advice from their primary care physician before using CAM, or disclose its use afterwards. These factors should be taken into account in the doctor-patient consultation.

Hospitals and Complementary and Alternative Medicine: Managing Responsibilities, Risk, and Potential Liability

Patients and families increasingly press hospitals to facilitate provision of complementary and alternative medicine (CAM) therapies and products. At the same time, a growing number of hospitals and health care facilities have taken steps to integrate CAM and conventional care. In this article we consider institutional responsibilities when patients/parents use or are considering CAM. We (1) review hospitals' responsibilities to patients and parents, (2) explain how these principles apply in the case of CAM practitioners and products, (3) address institutional responsibilities for different models of service delivery, and (4) highlight issues that should be addressed when developing institutional policies to govern CAM use and propose ways to do so.

Predictors for Adolescent Visits to Practitioners of Complementary and Alternative Medicine in a Total Population (the Young-HUNT Studies)

AimTo investigate the factors predicting adolescent visits to practitioners of complementary and alternative medicine (CAM).MethodsA longitudinal cohort study conducted in an adolescent total population in Central Norway (The Nord-Trøndelag Health Studies (HUNT)). In Young-HUNT 1, all inhabitants aged 13 to 19 years (N = 8944, 89% response rate) were invited to participate, and the youngest group (13 to 15 year olds) was surveyed again 4 years later (Young-HUNT 2, N = 2429, 82% response rate). The participants completed a comprehensive questionnaire on health and life style which included a question regarding visits to a CAM practitioner in the last 12 months.ResultsOne in eleven (8.7%, 95%CI 7.6-9.8%) had visited a CAM practitioner, an increase of 26% in 4 years (1.8% points). The final multivariable analysis predicted increased odds of an adolescent becoming a CAM visitor four years later (p<0.05) if she or he had previously visited a CAM practitioner (adjOR 3.4), had musculoskeletal pain (adjOR 1.5), had migraine (adjOR 2.3), used asthma medicines (adjOR 1.8) or suffered from another disease lasting more than three months (adjOR 2.1). Being male predicted reduced odds of visiting a CAM practitioner in the future (adjOR 0.6).ConclusionWe can conclude from this study that future visits to a CAM practitioner are predicted by both predisposing factors (being female, having visited a CAM practitioner previously) and medical need factors (having had musculoskeletal pain, migraine, used asthma medicines or experienced another disease lasting more than three months). None of the specific variables associated with CAM visits were predictive for CAM visits four years later.

Potentials and barriers in cooperation between conventional and complementary practitioners at a Danish Multiple Sclerosis Hospital

Introduction: More than 50% of the People with Multiple Sclerosis (PwMS) in Denmark have used complementary and alternative medicine (CAM). The majority of these combine CAM and conventional treatment, and from 2004 to 2010 the Danish Multiple Sclerosis Society conducted a research project with the purpose of investigating and testing models for cooperation between conventional and complementary practitioners. Theory: Five health care providers and five CAM practitioners were set up to work together from 2004 to 2010 in developing and offering integrated treatment to 200 PwMS at a Danish MS Hospital. The investigation of the collaborative process between practitioners has been based on theories of epistemic cultures as well as learning theories, focusing on interdisciplinary development. Methods: Empirical material consists of individual interviews with practitioners, a group interview with practitioners, a group interview with professional staff at the Danish MS Hospital, interviews with patients as well as written responses from the practitioners. Results and conclusions: The six-year cooperation among the practitioners documented mutual inspiration and learning within the team, as well as numerous basic challenges involved in developing interdisciplinary treatment for PwMS. Cooperation between researchers and the treatment team resulted in the development of four interdisciplinary models, which describe the potentials and barriers in relation to various types of collaboration. Discussions: In many cases, integrating CAM and conventional treatment providers is seen as an ideal. This paper points out the importance of not overlooking the opportunities, values and the potential inherent in a pluralistic ideal in terms of the patients’ own active efforts and the dynamism that can arise when the patient becomes a co-informant, co-coordinator and/or co-integrator.

Changes among male and female visitors to practitioners of complementary and alternative medicine in a large adult Norwegian population from 1997 to 2008 (The HUNT studies)

BackgroundThe aim was to investigate changes in the prevalence and characteristics of male and female visitors to practitioners of complementary and alternative medicine (CAM) in a large adult population from 1997 to 2008.MethodsTwo cross sectional adult total population health surveys from Central Norwegian (the Nord-Trøndelag Health Studies (HUNT)). In 1997 42,277 and in 2008 50,713 respondents were included. Variables included demographics (age, education, working status), lifestyle (daily smoker, did hard physical activities), health status (self-rated health status, recent complaints, chronic complaints, psychiatric complaints, a range of diseases) and health care use (visit general practitioner, chiropractor). A test of difference between the results of multivariable logistic regression models for each year, including all variables, was used to analyse changes from 1997 to 2008.ResultsIn 1997 9.4% (95%CI 9.1-9.6) of the population had visited a CAM practitioner in the last 12 months and this increased to 12.6% (12.3-12.9) in 2008 (p < 0.001 for difference). Prevalence of CAM use in females was almost twice as high as that in males both years. For males, the significant changes from 1997 to 2008 (p < 0.05) were an increase in odds of visiting for those under 50 years, who had a recent complaint, were widower or did hard physical activities. There was a decrease for males who had a university degree, psychiatric complaint or hay fever. For females there was an increase in the odds for those under 50 years, who had a recent complaint or chronic complaint. It was a decrease for females with reported fair global health, psychiatric complaint, hay fever or if they had visited a chiropractor.ConclusionThe increase in visits was mainly among younger people of both genders with more limited complaints. A larger proportion of the more healthy part of the population is increasing their visits to CAM practitioners.

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.

Complementary and Alternative Medicine Used by Children in Military Pediatric Clinics

The objective of this study was to evaluate the prevalence, types, perceived effects, and factors that influence the use of complementary and alternative medicine (CAM) by military children. A parent survey was administered in two military general pediatric clinics from June to September 2009. Parents completed surveys about their children including the following items: demographic information, a list of specific CAM therapies, family CAM use, and child health status. Caregivers completed 278 surveys. The overall use of CAM was 23%. The most common type of CAM used was herbal therapy (34%). The CAM therapies most commonly reported to be very helpful were special diets (67%), melatonin (57%), vitamins and minerals used at doses higher than the recommended daily allowance (50%), and massage therapy (50%). The majority of users reported no side-effects (96%). Among CAM users, 53% had discussed their CAM use with a physician and 47% had seen a CAM practitioner. Factors associated with CAM use in multiple regression analysis included chronic conditions (p = 0.001), parent/sibling use of CAM (p < 0.001), and parent age over 30 years (p = 0.02). Primary sources of CAM information were friends and family (68%) and doctors (44%). Common reasons for using CAM were to promote general health (70%), to relieve symptoms (56%), and to improve quality of life (48%). Eighty percent (80%) of all respondents indicated they would use CAM if recommended by a physician. In this military population with access to universal health care, CAM use is higher than the U.S. national average and nearly double that of the 2007 National Health Interview Survey study. Patients with chronic conditions, family members using CAM, and parental age over 30 years are more likely to use CAM. CAM is perceived as helpful with minimal to no side-effects. Pediatricians should inquire about CAM use and be prepared to provide guidance on this topic.

Are complementary medicine practitioners implementing evidence based practice?

Over the past few decades the health professions have witnessed increasing pressure to shift from a culture of delivering care based on tradition and intuition, to a situation where decisions are guided and justified by the best available evidence. While there are concerns that many complementary and alternative medicine (CAM) practitioners may be cautious about embracing such an approach, no studies to date have effectively tested this assumption. To identify the skills, attitude, training and use of evidence-based practice (EBP) amongst CAM practitioners. Descriptive survey, using the evidence-based practice attitude and utilisation survey (EBASE). Randomly selected nationwide sample of system-based, non-medically qualified CAM practitioners practicing in a clinical capacity within Australia. Practitioner skill, attitude, training and use of EBP. Of the 351 questionnaires successfully dispatched, 126 were returned (36%). Most practitioners believed EBP was useful (92%) and necessary (73%) in CAM practice. While the majority of clinicians (>74%) reported participation in EBP activities, albeit infrequently, only a small to moderate proportion of decisions were based on evidence from clinical trials, with most practitioners relying on traditional knowledge, textbooks and clinical practice guidelines. Lack of available evidence, time, industry support and skills were perceived as barriers to EBP uptake. While the small response rate limits the generalisability of these findings, the sample was considered representative of Australian CAM practitioners. What this study shows is that even though CAM practitioners may be supportive of EBP, education and training is needed to further improve clinician understanding and application of evidence-based practice.

Complementary and alternative medicine: Perception and use by physiotherapists in the management of low back pain

The aim of this survey was to investigate complementary and alternative medicine (CAM) use by physiotherapists for the treatment of low back pain (LBP). Questionnaires (n=1000) were distributed to physiotherapists randomly selected from the UK's Organisation of Chartered Physiotherapists in Private Practice (OCPPP). Results were analysed by SPSS. A response rate of 46% was obtained (n=459). 94.3% of respondents stated that they currently treated LBP; the most common CAMs used by physiotherapists were acupuncture (46.9%) and massage (2.1%). Physiotherapists perceived acupuncture, massage, osteopathy, chiropractic and yoga to be effective in the treatment of LBP, but were unsure about the effectiveness of other CAMs. Physiotherapists in this sample often use acupuncture and massage to treat LBP, but appear to have little knowledge of other CAMs. Physiotherapists use mainstream methods such as mobilization and massage which could be perceived as CAM depending on the physiotherapists' perceptions and training, as these therapies have also been used and investigated by CAM practitioners. More research is required on the use of CAM as little is known regarding the effectiveness of these therapies on LBP.

A Longitudinal Analysis of Complementary and Alternative Medicine Use by a Representative Cohort of Young Australian Women with Asthma, 1996–2006

Background. There is evidence of asthma patients using complementary and alternative medicine (CAM). This article reports the findings of the first ever longitudinal study of CAM use among women with asthma from a large nationally representative sample. Methods. A longitudinal analysis of questionnaires completed in 1996, 2000, 2003, and 2006 as part of the Australian Longitudinal Study on Women's Health. The cohort began with 14,701 randomly selected young women (aged 18–22 years). CAM use was defined as a consultation with a range of complementary practitioners in the 12 months prior to each survey. Statistical analyses included the use of generalized estimating equations. Results. Over the 10-year period, approximately 26% of the women were asthmatic. Asthmatic women were significantly more likely to use CAM (19%, 22%, and 36% for surveys 2–4, respectively) than non-asthmatic women (15%, 20%, and 32% for surveys 2–4, respectively). CAM use increased as time since asthma diagnosis increased. However, only the increase in consultations with a naturopath/herbalist remains statistically significant when the CAM modalities are considered individually alongside asthma status. The longitudinal model suggests that women with asthma are 1.13 (95% CI: 1.05–1.21) times more likely to consult with a CAM practitioner (p< .001). The study also shows that CAM users have a higher dissatisfaction with conventional healthcare services and consultations when compared to CAM non-users. Conclusion. These findings suggest that women with asthma may turn to CAM after conventional care fails to adequately address their healthcare needs.

Editorial: Evaluation of CAM interventions

Editorial: Evaluation of CAM interventions

Classification of CAM Use and Its Correlates in Patients With Early-Stage Breast Cancer

Self-reported use of complementary and alternative medicine (CAM) has been shown to increase following a cancer diagnosis, and breast cancer survivors are the heaviest users among cancer survivors. The aim of this study was to determine whether the prevalence estimate of CAM use varied according to classification of CAM. The authors used a comprehensive system to classify CAM users and test differences in demographic, lifestyle, quality of life, and cancer characteristics among them. Participants were 2562 breast cancer survivors participating in the Women's Healthy Eating and Living (WHEL) Study, aged 28 to 74 years. A structured telephone interview assessed CAM use, questioning about specific CAM practices, and whether use was related to cancer. This study examined CAM use in relation to demographics, health behaviors, and quality of life. Approximately 80% of the women used CAM for general purposes but only 50% reported CAM use for cancer purposes. Visual imagery, spiritual healing, and meditation were the most frequently used practices for cancer purposes. CAM use, defined as consulting a CAM practitioner and regular use, was significantly related to younger age, higher education, increased fruit and vegetable intake, and lower body mass index (P < .05). CAM users who had seen a practitioner were also more likely to report poor physical and mental health than non-CAM users (P < .05). CAM use was not associated with changes in physical and mental health between study baseline and 1-year follow-up. This study addressed important differences in the classification of CAM use among breast cancer survivors. Future studies need to further test the potential benefits and risks associated with CAM use.

A Methodological Framework for Evaluating the Evidence for Complementary and Alternative Medicine (CAM) for Cancer

In spite of lacking evidence for effects on cancer progression itself, an increasing number of cancer patients use various types of complementary and alternative medicine (CAM). There is disagreement between CAM practitioners, researchers and clinical oncologists, as to how evidence concerning effects of CAM can and should be produced, and how the existing evidence should be interpreted. This represents a considerable challenge for oncologists; both in terms of patient needs for an informed dialogue regarding CAM, and because some types of CAM may interact with standard treatments. There is a need for insight into which kinds of CAM may work, for whom they work, what the possible effects and side-effects are, and in what ways such effects may come about. The present article presents a framework for evaluating effects of CAM by suggesting a taxonomy of different levels of evidence related to different types of research questions and discussing the relevance of different research methodologies for different types of effects.