Determinants of complementary alternative medicine (CAM) use
Introduction
During the last few decades complementary alternative medicine (CAM) has received a great deal of attention and has gained in popularity, particularly among specific patient groups.1, 2, 3 The reasons for this popularity have been variously discussed but no consensus has been reached.4 Many types of CAM, such as acupuncture, chiropractic and other manipulative therapies, have been recognised and some of them are financed by taxes, while others are paid, either by the insurance companies, or by the employer or out of pocket by the patients.5, 6
In the literature, divergent results are presented regarding the proportion of the population using various types of CAM. For example, Eisenberg et al. showed that 0.9% of their sample reported having visited an acupuncturist during the previous year compared with 0.7% based on the Medical Expenditure Panel Survey (MEPS).2, 7 However, several authors from different parts of the world report escalating costs and prevalence of the use of CAM and therefore, there is an increased need for regulation.8, 9, 10, 11, 12, 13
Previous research has reported that users of CAM tend to be female, white, and highly educated patients who perceive their health as poor and report chronic pain, e.g. back pain.14
In their study of 542 primary care patients Palinkas and Kabongo report that the use of CAM in general and self-care-based therapies in particular was significantly associated with a higher education level and that the users generally perceived their health as worse than that of others in their age group.15 They also suggest that the patterns and the predictors of CAM use by primary care patients vary with the type of therapy used.
The present investigation is part of a comprehensive project titled “Improving Health Care in Jordbro (IHCJ)” and aimed to assess the influence of socio-demographic characteristics including country of birth, and morbidity on health care and drug utilisation in patients resident in Jordbro, a small multi-ethnic sub-community of Stockholm, Sweden.
The main aim of the study was to describe the pattern of consultations with CAM providers and identify the determinants of CAM use in a multi-ethnic Swedish primary health care practice population.
The study was approved by the Research Ethics Committee at the Medical School of the Karolinska Institute, Stockholm, Sweden.
Section snippets
Definition and procedure
In this study “CAM” was defined as manipulative therapy or, in line with previous definitions, as “non-allopathic” rather than unconventional medicine.16 We excluded herbal medicine users from this study, since both the reason for taking herbal medicines and their administration and side effects differ in many ways from the reason and side effects in manipulative alternative medicine.17, 18 The results on use of herbal medicine among this population have been reported elsewhere.19 This study
Population characteristics
Characteristics of the study population are presented in Table 1. The respondents’ mean age was 44.8 years (95% confidence interval (CI) 43.9–45.6 years) and the mean age of non-respondents was 45.2 years (95% CI 43.9–47.2 years) while that of patients who consulted a CAM provider was 43.8 years (95% CI 42.0–45.6 years). The pattern and distribution of use of various CAMs are shown in Fig. 1. The most frequently used CAM was massage, followed by acupuncture, chiropractic and naprapathy.
Discussion
In this study numerous patients in primary care had consulted CAM providers during the previous year and had consulted several types of CAM providers. Users of CAM reported higher consultations both with any physician and with the GP at the JHC during the previous year as compared with non-users of CAM. Chronic disease and exercise were significantly and independently related to consultations with CAM providers.
In the present investigation the response rate was 80%, which is relatively high in
Acknowledgement
This study was supported by grants from the Stockholm County Council (the Dagmar & ALF Fund) and the Haninge Community Council (Economic Target to Large Cities), Stockholm, Sweden.
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