Knowledge and Usage of CAM by ED Patients and Physicians
Objectives: To evaluate Emergency Department (ED) patients' desire to discuss complementary and alternative medicine (CAM) with their emergency physicians, their willingness to try CAM for their presenting complaint, and emergency physicians' attitudes, beliefs, and usage of CAM.
Methods: A written questionnaire asking about CAM knowledge, usage, and interest was administered to a convenience sample of ED patients and put in work mailboxes of emergency physicians at an academic tertiary care referral center with an emergency medicine residency program.
Results: Of the 75 patients surveyed, 54.7% stated that they were currently using or had used some form of CAM in the past. Only 24% of patients stated that they would discuss their usage of CAM with their emergency physician. Eighty-one percent of patients thought it was important for their physicians to be educated about CAM, and 85% would be willing to incorporate CAM into the treatment of their presenting complaint. Out of 34 emergency physicians, 28 (82%) completed their surveys. Forty percent of physicians stated that they are currently using or had used some form of CAM in the past. Ninety-six percent of physicians surveyed thought it was important for physicians to be educated about CAM and were willing to discuss CAM with their patients.
Conclusion: The use and public acceptance of CAM in our study population, for both patients and physicians, was high. Although patients and physicians need more education about CAM, both made it clear that they desire and are willing to discuss CAM with each other.
Background
The National Center for Complementary and Alternative Medicine at the National Institutes of Health defines complementary and alternative medicine (CAM) as "a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine". Using this definition, it is estimated that in 2002 at least 72 million US adults used some form of CAM. Current trends show no evidence that its usage or popularity is declining. According to a recent analysis that compared two large-scale national US studies on CAM, and included over 33,000 patients, CAM treatments most commonly used are herbal therapy (18.6%, representing over 38 million US adults), relaxation techniques (14.2%, representing 29 million US adults), and chiropractic (7.4%, representing 15 million US adults).
Historically, CAM usage has been associated with higher education, higher incomes, female gender, non-black/non-Hispanic race, age 30 to 64 years, and dissatisfaction with conventional medicine to treat chronic illnesses. However, more recent studies have failed to find some of these associations. For example, a recent multivariate analysis found that among demographic variables, only educational level predicted use of CAM. This study found that having more education, poorer health status, and a holistic approach to health and life (i.e., belief in the importance of mind, body, and spirit) were all predictive of CAM usage.
A few studies have also investigated the beliefs, practices, referral and prescribing patterns of allopathic physicians in regards to CAM. A comprehensive literature review including 19 studies found that approximately half of the physicians surveyed believed in the efficacy of acupuncture (51%), chiropractic (53%), and massage (48%), whereas fewer believed in the value of homeopathy (26%) and herbal approaches (13%). This comprehensive review also reports high physician referral rates for acupuncture (43%), chiropractic (40%), and massage (21%). Findings from this review, as well as other physician surveys, suggest that allopathic physicians are more likely to prescribe alternative therapies or refer patients to alternative practitioners that they themselves believe are useful or efficacious.
The significance of CAM use in emergency medicine (EM) is just beginning to become recognized. Several surveys of Emergency Department (ED) patients have shown a higher rate of CAM usage by ED patients than that found in the general population. In previous patient surveys, CAM usage by ED patients has been found to be as high as 56%. This may be due to the fact that virtually all patients presenting to the ED have a symptomatic acute or chronic condition and are therefore self-treating these conditions more often than asymptomatic individuals. Despite the high prevalence of ED patients using CAM, several studies have shown that many patients do not discuss their usage with their doctors. This may be dangerous because some alternative therapies, especially some herbal preparations, can cause adverse effects.
Several studies have evaluated the prevalence of CAM usage both in the community and in patients presenting to the ED. We were unable, however to identify a study that specifically evaluates the beliefs, attitudes, and referral practices of emergency physicians regarding CAM. In this study, we evaluated ED patients' desire to discuss CAM with their emergency physicians, as well as their willingness to try CAM for their presenting complaint. Finally, we attempted to learn about the attitudes, beliefs, and usage of CAM among emergency physicians.
Abstract and Introduction
Abstract
Objectives: To evaluate Emergency Department (ED) patients' desire to discuss complementary and alternative medicine (CAM) with their emergency physicians, their willingness to try CAM for their presenting complaint, and emergency physicians' attitudes, beliefs, and usage of CAM.
Methods: A written questionnaire asking about CAM knowledge, usage, and interest was administered to a convenience sample of ED patients and put in work mailboxes of emergency physicians at an academic tertiary care referral center with an emergency medicine residency program.
Results: Of the 75 patients surveyed, 54.7% stated that they were currently using or had used some form of CAM in the past. Only 24% of patients stated that they would discuss their usage of CAM with their emergency physician. Eighty-one percent of patients thought it was important for their physicians to be educated about CAM, and 85% would be willing to incorporate CAM into the treatment of their presenting complaint. Out of 34 emergency physicians, 28 (82%) completed their surveys. Forty percent of physicians stated that they are currently using or had used some form of CAM in the past. Ninety-six percent of physicians surveyed thought it was important for physicians to be educated about CAM and were willing to discuss CAM with their patients.
Conclusion: The use and public acceptance of CAM in our study population, for both patients and physicians, was high. Although patients and physicians need more education about CAM, both made it clear that they desire and are willing to discuss CAM with each other.
Introduction
Background
The National Center for Complementary and Alternative Medicine at the National Institutes of Health defines complementary and alternative medicine (CAM) as "a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine". Using this definition, it is estimated that in 2002 at least 72 million US adults used some form of CAM. Current trends show no evidence that its usage or popularity is declining. According to a recent analysis that compared two large-scale national US studies on CAM, and included over 33,000 patients, CAM treatments most commonly used are herbal therapy (18.6%, representing over 38 million US adults), relaxation techniques (14.2%, representing 29 million US adults), and chiropractic (7.4%, representing 15 million US adults).
Historically, CAM usage has been associated with higher education, higher incomes, female gender, non-black/non-Hispanic race, age 30 to 64 years, and dissatisfaction with conventional medicine to treat chronic illnesses. However, more recent studies have failed to find some of these associations. For example, a recent multivariate analysis found that among demographic variables, only educational level predicted use of CAM. This study found that having more education, poorer health status, and a holistic approach to health and life (i.e., belief in the importance of mind, body, and spirit) were all predictive of CAM usage.
A few studies have also investigated the beliefs, practices, referral and prescribing patterns of allopathic physicians in regards to CAM. A comprehensive literature review including 19 studies found that approximately half of the physicians surveyed believed in the efficacy of acupuncture (51%), chiropractic (53%), and massage (48%), whereas fewer believed in the value of homeopathy (26%) and herbal approaches (13%). This comprehensive review also reports high physician referral rates for acupuncture (43%), chiropractic (40%), and massage (21%). Findings from this review, as well as other physician surveys, suggest that allopathic physicians are more likely to prescribe alternative therapies or refer patients to alternative practitioners that they themselves believe are useful or efficacious.
Importance
The significance of CAM use in emergency medicine (EM) is just beginning to become recognized. Several surveys of Emergency Department (ED) patients have shown a higher rate of CAM usage by ED patients than that found in the general population. In previous patient surveys, CAM usage by ED patients has been found to be as high as 56%. This may be due to the fact that virtually all patients presenting to the ED have a symptomatic acute or chronic condition and are therefore self-treating these conditions more often than asymptomatic individuals. Despite the high prevalence of ED patients using CAM, several studies have shown that many patients do not discuss their usage with their doctors. This may be dangerous because some alternative therapies, especially some herbal preparations, can cause adverse effects.
Goals of this Investigation
Several studies have evaluated the prevalence of CAM usage both in the community and in patients presenting to the ED. We were unable, however to identify a study that specifically evaluates the beliefs, attitudes, and referral practices of emergency physicians regarding CAM. In this study, we evaluated ED patients' desire to discuss CAM with their emergency physicians, as well as their willingness to try CAM for their presenting complaint. Finally, we attempted to learn about the attitudes, beliefs, and usage of CAM among emergency physicians.
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