Complementary Health Practitioners Research Articles

Profiles and predictors of healthcare utilization: using a cluster-analytic approach to identify typical users across conventional, allied and complementary medicine, and self-care

IntroductionThe identification of typologies of health care users and their specific characteristics can be performed using cluster analysis. This statistical approach aggregates similar users based on their common health-related behavior. This study aims to examine health care utilization patterns using cluster analysis; and the associations of health care user types with sociodemographic, health-related and health-system related factors.MethodsCross-sectional data from the 2012 National Health Interview Survey were used. Health care utilization was measured by consultations with a variety of medical, allied and complementary health practitioners or the use of several interventions (exercise, diet, supplementation etc.) within the past 12 months (used vs. not used). A model-based clustering approach based on finite normal mixture modelling, and several indices of cluster fit were determined. Health care utilization within the cluster was analyzed descriptively, and independent predictors of belonging to the respective clusters were analyzed using logistic regression models including sociodemographic, health- and health insurance-related factors.ResultsNine distinct health care user types were identified, ranging from nearly non-use of health care modalities to over-utilization of medical, allied and complementary health care. Several sociodemographic and health-related characteristics were predictive of belonging to the respective health care user types, including age, gender, health status, education, income, ethnicity, and health care coverage.ConclusionsCluster analysis can be used to identify typical health care utilization patterns based on empirical data; and those typologies are related to a variety of sociodemographic and health-related characteristics. These findings on individual differences regarding health care access and utilization can inform future health care research and policy regarding how to improve accessibility of different medical approaches.

Integrative health services use for depression in middle-aged and older Australian women

IntroductionGlobally, depressive disorders affect over 311 million people and women are more likely than men to suffer depression. However, no study has comprehensively described the diverse health services used for managing depression in middle-aged and older women. MethodsA cross-sectional survey was sent to 800 Australian women aged over 45-years reporting a diagnosis of depression, (a sub-study of the 45 and Up Study) in 2016. The survey measured consultations with conventional, allied, and complementary health practitioners, and use of medications and complementary health products/practices for depression, and the associated out-of-pocket expenses. ResultsOf the 361 (45.1%) participants returning a completed questionnaire, most women (72.2%) consulted at least one health practitioner, while 40.7% used at least one prescription medication and 51.8% used at least one form of complementary product or practice for depression in the previous 12 months. Women with more severe self-reported depression were more likely to consult with doctors and allied health practitioners, and use prescription medications and multiple complementary health products/practices. Combined integrative health out-of-pocket expenditure on depression management by the women in our study was $568.0 per annum, equating to approximately AU$367 million per annum for Australian women aged 50 years and over. ConclusionMiddle-aged and older Australian women were high users of integrative health services for the management of depression. Women with depression have an additional financial burden associated with their mental health services requiring consideration by primary health practitioners when recommending treatments for depression.

Professional Counselors’ Referral Processes to Complementary Health Practitioners

ABSTRACT There is a growing interest in the utility of complementary health approaches (CHAs) to promote wellness and health in the United States. Research from medical, allied health, and mental health fields reflect this expanding interest; however, very little research focuses on counselors and the integration of CHAs within practice or referral of counseling clients to Complementary Health Practitioners (CHPs). The current study expanded this research using transcendental phenomenology to explore the experiences, perspectives, and processes in use by current independently licensed professional counselors referring to complementary health practitioners (CHPs). The authors discuss and explore implications of these findings.

Complementary Health Practitioners in the Acute and Critical Care Setting: Nursing Considerations.

In response to the rising demand by patients and their families for complementary health approaches, hospitals are increasingly integrating complementary health approaches with their conventional medical practices to create healing environments. Results of the 2010 Complementary and Alternative Medicine Survey of Hospitals indicated that the top 6 inpatient modalities included pet therapy, massage therapy, music or art therapy, guided imagery, relaxation therapy, and Reiki and therapeutic touch. Whether complementary health approaches are provided by complementary health practitioners through hospital-based integrative medicine programs, volunteer practitioners, or bedside nurses, the regulatory, legal, ethical, and safety concerns remain constant. Previous articles in this column of Critical Care Nurse provided an overview of complementary health approaches that nurses may encounter in their practices, with specific attention to implications for acute and critical care nurses, as well as important legal, ethical, safety, quality, and financial implications that acute and critical care nurses should consider when integrating complementary health approaches with conventional care. This column provides the acute and critical care nurse with key information about validation of credentials, experience, and competence of nurses and volunteers providing complementary health approaches, as well as about institutional policies and scope of practice.

The use of conventional and complementary health services and self-prescribed treatments amongst young women with constipation: An Australian national cohort study

BackgroundLittle research has been conducted regarding the comprehensive health service utilisation in constipation care. This study investigates the comprehensive health service utilisation amongst Australian women with constipation. MethodsThis study draws upon data from the Australian Longitudinal Study on Women's Health. A total of 8074 young women were asked about their frequency of constipation, measures of quality of life, and use of a range of health services and self-prescribed treatments via two postal surveys conducted in 2006 and 2009, respectively. ResultsThe prevalence of constipation was 18.5% amongst women in 2009. Constipated women had poorer quality of health than women without constipation. Women who sought help for constipation were more likely to visit multiple groups of conventional and complementary health practitioners compared to women who did not experience constipation (p<0.005). However, women were less likely to visit a specialist for the management of constipation over time (2006 to 2009). There was an increase in the proportion of women with constipation who self-prescribed vitamins/minerals over time (p<0.001). ConclusionAlthough only 4.5% of women sought help for their constipation, given the increasing use of multiple health services across time, more studies are required regarding the optimal treatment in constipation care.

Expectation and experience of ‘nonspecific’ (whole person) feelings elicited by acupuncture: Content validity of a set of questionnaires

BackgroundTwo 32-item questionnaires designed to assess expectation and experience of the relatively nonspecific feelings (whether bodily, emotional or mental) that may arise in response to acupuncture-type interventions have been developed and tested on acupuncture and other complementary health practitioners and students (N = 204). ObjectivesTo conduct a survey to assess content validity (CV) for the questionnaires, following two methods popularised by Lawshe and Lynn, and to compare the results. A secondary objective was to reduce questionnaire length from 32 to 20 items. MethodsTwo surveys (Phase 1, 48 items; Phase 2, 18 items) were conducted among 20 experienced acupuncture practitioners and researchers, who scored items as either ‘essential’, ‘useful but not essential’, or ‘not necessary’. Lawshe's and Lynn's methods were applied to the returned data, the former using Wilson's recent modification, the latter with ‘useful but not essential’ rescored as either ‘essential’ or ‘not necessary’. Some subgroup analysis was carried out. In addition, Randolph's multi-rater kappa was used to assess inter-rater reliability as a further measure of content validity. ResultsThere were 17 usable responses in Phase 1, 13 in Phase 2. In both surveys, women considered more items as ‘essential’ than men, but fewer as ‘not necessary’, and vice versa (p < 0.001). Lawshe's content validity ratio (CVR) was significant for only 3 items, and the resulting content validity index (CVI) therefore meaningless. When ‘useful’ was rescored as ‘essential’ and Lynn's Scale CVI (S-CVI) calculated as the average of the CVI only for those items considered appropriate for retention (S-CVIAV-UA), acceptable values were found for subsets of the full list of items, although only for the women respondents. Inter-rater reliability was low for most items, but on the basis of the content validity analysis, together with respondent reservations about particular items and analysis of actual questionnaire usage, a 20-item list was created and circulated to the survey respondents for further feedback. DiscussionThis shorter scale is now being tested on electroacupuncture training courses, and may be useful in determining whether different feelings are elicited by different types of acupuncture, other CAM modalities, or even other, unrelated activities. ConclusionsA modified content validity assessment method was found to give more usable results than conventional methods. With this new approach, 32-item questionnaires on expectation and experience of nonspecific feelings were shortened to more manageable 20-item instruments. In general, CV was greater among women than among men.

Consultations with complementary and alternative medicine practitioners by older Australians: results from a national survey

BackgroundThe use of complementary and alternative medicines (CAM) and CAM practitioners is common, most frequently for the management of musculoskeletal conditions. Knowledge is limited about the use of CAM practitioners by older people, and specifically those with other long term or chronic conditions.MethodsIn 2011 we conducted an Australia wide survey targeting older adults aged over 50 years (n = 2540). Participants were asked to identify their chronic conditions, and from which health professionals they had ‘received advice or treatment from in the last 3 months’, including ‘complementary health practitioners, e.g. naturopath’. Descriptive analyses were undertaken using SPSS and STATA software.ResultsOverall, 8.8% of respondents reported seeing a CAM practitioner in the past three months, 12.1% of women and 3.9% of men; the vast majority also consulting medical practitioners in the same period. Respondents were more likely to report consulting a CAM practitioner if they had musculoskeletal conditions (osteoporosis, arthritis), pain, or depression/anxiety. Respondents with diabetes, hypertension and asthma were least likely to report consulting a CAM practitioner. Those over 80 reported lower use of CAM practitioners than younger respondents. CAM practitioner use in a general older population was not associated with the number of chronic conditions reported, or with the socio-economic level of residence of the respondent.ConclusionSubstantial numbers of older Australians with chronic conditions seek advice from CAM practitioners, particularly those with pain related conditions, but less often with conditions where there are clear treatment guidelines using conventional medicine, such as with diabetes, hypertension and asthma. Given the policy emphasis on better coordination of care for people with chronic conditions, these findings point to the importance of communication and integration of health services and suggest that the concept of the ‘treating team’ needs a broad interpretation.

Recognition and the Creation of Wellbeing

Whilst much research into alternative and complementary medicine use indicates that these practices enable experiences of control, agency and empowerment, few theoretically informed answers have been given to why and how consultations with alternative and complementary health practitioners facilitate experiences that are felt to be ‘healing’.This article utilizes theories of recognition in order to reflect on the healing experiences of women seeking health and wellbeing through varied forms of alternative and complementary medicine. I analyse the empowering and agency-giving aspects of alternative and complementary medicines, in particular in relation to wider societal conceptualizations of the self. This article is based on qualitative interviews with both practitioners and clients of varying alternative and complementary medicines.

Thoughts on scepticism

Scepticism, the questioning of one's assumptions about the world, is an ancient intellectual tradition. In the last few years, people proclaiming themselves as sceptics have questioned the integrity, beliefs and healing practices of many alternative and complementary health practitioners. Based on many years of dealing with members of the sceptical community, the authors reflect on strategies for dealing with sceptics' challenges. Many self-professed sceptics are in reality, more akin to religious zealots, promoting an agenda that has little to do with logic, science or rationality. Alternative and complementary health practitioners who are approached by such members of the sceptic community with offers to assist with ‘research’ will wisely limit their contact with such people and understand that they are not seekers of truth, justice or spiritual growth. Practitioners can and should comfortably ignore the concerns of ill-informed sceptics while applying their own critical faculties to the production of evidence for their healing practices and efficient ways to transmit knowledge and skill. Copyright © 2006 John Wiley & Sons, Ltd.