wellpdx

by Amber Spradlin

Introduction

Understanding the use patterns and reasons for which people do or do not seek care from Complementary and Alternative Medicine (CAM) practitioners is a necessary step in becoming a strong community of wellness practitioners. Ultimately, understanding public perception of our work and reasons for use and disuse will allow us to anticipate and address the needs and concerns of current and potential patients*. This will also illuminate existing barriers to entry as regards CAM use and allow the practitioner community to address them as it sees fit. Through this process, a stronger connectivity among all practitioners will be fostered and future steps to cohesive public outreach will become clear.

While there are many studies regarding specific ailments and use of CAM among very specific demographics, this paper will set aside those specificities in order to focus on the overarching indicators for use and disuse of CAM modalities. While all of the referenced studies include non-practitioner-based modalities (such as prayer), wellpdx is currently concerned only with practitioner-based therapies.

Analysis

To date, no study shows higher than a 50% usage rate of CAM within a given year in any sample. The range of usage is between 36-50% depending on the parameters of the study. Disuse of CAM is predictable by being male, healthy, lacking physician support for CAM, believing CAM to be ineffective or inferior to conventional treatments, and perceiving practitioners to be in inaccessible locations.1 Conversely, one study showed that among those already using CAM, 28% did so because of uncertainty regarding the efficacy of conventional medicine,2 though 13% reported being detracted from it by the relative (perceived) cost of treatment as compared to conventional medicine.3

There are, of course, variations in all of the numbers depending on which modality is under consideration. However, age (increasing), marital status (unmarried), income (increasing, but less than might be expected), gender (female), race (white), and education (increasing) indicate an increased usage of CAM modalities.4

As to the modalities used, massage (20-37%), herbal medicine (16-20%), and chiropractic (10-37%) consistently lead the pack as far as the numbers go. Naturopathic medicine (1-2%), acupuncture (4-5%), homeopathy (5-9%), and lifestyle diets (7-11%) form a smaller percentage of reported CAM use.5 Furthermore, the majority of CAM users also use allopathic medicine.6

In addition to understanding the available quantifiable data, it is also necessary to consider the decision-making process that leads to CAM usage. Various studies and suggestions have been proffered on the subject, all of which reveal the complexity of the issue. There are any number of statements presuming that the ideals, values, and philosophies of patients are what drive them to embrace CAM modalities. There are also those stating or suggesting that the movement toward CAM usage is being driven not so much by the innate personal beliefs of users but by modern medicine practitioners who are alienating their patients and leaving them with so few attractive options for care that the patients are necessarily seeking other options.7 Through all of this, the web of socio-economic and cultural norms, whether a help or hindrance, clearly influence the process.

One of the clearest areas of disconnect regarding a patient's decision to use CAM is whether or not they feel they have their physician's support. Lack of physician support is a primary indicator in disuse of CAM as well as a hitch in accurate research as "the degree to which patients reveal their use of CAM to their physicians remains low."8

As Conboy, et al. suggest, it is also problematic that Complementary and Alternative Medicine has come to mean a collection of practices not commonly taught or practiced in the medical field. The definition neglects to differentiate between self-guided therapies and practitioner-based modalities. And of course, it fails to recognize the often crucial differences in practice and training within each modality.

Conclusion

In order to begin to collectively understand and address the needs and concerns of current and potential patients, as well as strengthen the overall community of wellness practitioners, some consensus should be reached. The thoughts here are meant to be a starting point for discussion and to offer parameters for the upcoming wellpdx Roundtable.

A recurring theme in the research is the problem of demonstrated efficacy but low use of modalities due to the variety of factors noted above. Whether this is a problem that can be solved with increased education of and outreach to the public, or is a larger problem of isolation that requires us to make ourselves more collectively visible not just to the public, but to the allopathic medical community as well, remains to be seen.

Additionally, the idea of a functioning community is enticing but potentially difficult to create. It requires significant buy-in from individual practitioners and the willingness and ability to share both professional knowledge and a set of values about public education and standards of practice. If it is to be achieved, we will need to establish and maintain a commitment to remaining cohesive as a group. Clearly, Erin and I believe this is both desirable and possible and we are excited about it.

Finally, our patients come to us seeking meaningful experiences, experiences that will help to create health and vitality in their lives. We should expect nothing less of our time with each other. We'll see you at the Roundtable!

*For the sake of ease and consistency, CAM users will be referred to as patients.

___________________

1 Jain, Neeta, Astin, John A., "Barriers to Acceptance: An Exploratory Study of Complementary/Alternative Medicine Disuse," The Journal of Alternative and Complementary Medicine 7.6 (2001): 689-696

2 Stratton, Terry D., McGivern-Snofsky, Jennifer L., "Toward a Sociological Understanding of Complementary and Alternative Medicine Use," The Journal of Alternative and Complementary Medicine 14.6 (2008):777-783

3 Ibid.

4 Conboy, Lisa et al., "Sociodemographic Determinants of the Utilization of Specific Types of Complementary and Alternative Medicine: An Analysis Based on a Nationally Representative Survey Sample," The Journal of Alternative and Complementary Medicine 11.6 (2008): 977-994

5 Jain and Astin; Conboy et al.

6 Stratton and McGivern-Snofsky

7 Ibid.

8 Conboy, et al. 992

(c) wellpdx 2009 All rights reserved.