An Integrative Approach to Complementary and Alternative Medicine in Community Settings

About This Presentation

Title:

An Integrative Approach to Complementary and Alternative Medicine in Community Settings

Description:

Chiropractic and massage are most frequently used practitioner-based CAM therapies (1) ... About 1/3 of US population reports having ever had a therapeutic massage. ... – PowerPoint PPT presentation

Number of Views:365

Avg rating:3.0/5.0

Slides: 70

Provided by: itce

Category:

more less

Transcript and Presenter's Notes

Title: An Integrative Approach to Complementary and Alternative Medicine in Community Settings

1
An Integrative Approach to Complementary and
AlternativeMedicine in Community Settings

Maureen A. Flannery MD, MPH
Department of Family Practice
and Community Medicine
University of Kentucky College of Medicine
WaysMeet
Berea Kentucky

2
Learning Objectives

To define complementary and alternative medicine
(CAM) in relationship to conventional medicine.
To discuss characteristics of CAM users and
practitioners and their implications for
conventional health providers.

3
Learning Objectives

To discuss issues that patient CAM use raises for
conventional health providers and suggest
strategies for communication with patients about
CAM.
To review current evidence and research in
progress about CAM modalities for common
problems.

4
Learning Objectives

To describe an approach to advising patients
about CAM that takes into account both
evidence-based research and patient values and
preferences.

5
Complementary and Alternative Medicine (CAM)

a group of diverse medical and health care
systems, practices, and products that are not
presently considered to be part of conventional
medicine (1)
healing therapies that typically fall outside the
Western biomedical model of disease, diagnosis,
and treatment (2)

(1) Eisenberg 1993 (2) Drivdahl 1998
6
Types of CAMincluded in national and KY surveys
Acupuncture Imagery Aromatherapy Magnets B
iofeedback Massage Chiropractic Prayer Diets
Reflexology Exercise Relaxation Folk
remedies Self-help/support groups Herbal/botani
cal therapy Spiritual healing (by others)
Homeopathy Vitamins Hypnosis Yoga
7
Major Domains of CAM

Alternative medical systems
Mind-body interventions
Biologically-based treatments
Manipulative and body-based methods
Energy therapies

www.nccam.nih.gov
8
Complementary and Alternative Medicine (CAM)

The list of what is considered to be CAM changes
continually
as those therapies that are proven to be safe and
effective become adopted into conventional health
care and as new approaches to health care emerge.

www.nccam.nih.gov
9
Who uses CAM?

Surveys show large increase in past 50 years in
U.S. and other industrialized countries (1).
Between 1990 to 1997, increase from 34 to 42 of
US households reporting CAM use (2).
In 2002, 75 of U.S. adults reported use of CAM
in lifetime and 62 in past 12 months (when
prayer included) (3)

(1) Kessler 2001 (2) Eisenberg 1998 (3) Barnes
2004
10
Who uses CAM?
11
Who uses CAM?

Surveys of primary care clinic populations show
28-47 utilization of CAM.
21 of patients in primary care practices
reported using CAM for the same health problem
for which they sought conventional care on that
visit.

Palinkas 2000
12
Do rural residents use CAM?

South Carolina (Oldendick 2000) 44
Rural PA FP clinic (Del Mundo 2002) 47
Rural IL FP clinics (Herron 2003) 63
Rural MS elderly (Cuellar 2003) 49
Western NC (Arcury 2004) 50

13
How about CAM use in Kentucky?

Report of primary care clinicians in
Kentucky Ambulatory Network
Patient(s) asked about CAM 86
Patient(s) reported CAM use 94
Clinician used CAM 49
Clinician recommended CAM 80

KAN CAM 1 2003
14
How about CAM use in Kentucky?

Pilot study of patients in
Kentucky Ambulatory Network practices

KAN CAM 2 2004
15
Who uses CAM?

Chiropractic and massage are most frequently used
practitioner-based CAM therapies (1).
An estimated 8-17 of US population visits a
chiropractor each year, 33 over lifetime.
About 1/3 of US population reports having ever
had a therapeutic massage.
Individuals in rural and underserved communities
are particularly likely to use chiropractic care
(2).

16
How about CAM use in Kentucky?

Pilot study of patients in
Kentucky Ambulatory Network practices

KAN CAM 2 2004
17
Who uses CAM?

Chiropractic and massage are most frequently used
practitioner-based CAM therapies (1).
An estimated 8-17 of US population visits a
chiropractor each year, 33 over lifetime.
About 1/3 of US population reports having ever
had a therapeutic massage.
Individuals in rural and underserved communities
are particularly likely to use chiropractic care
(2).

18
Who uses CAM?

Chiropractic and massage are most frequently used
practitioner-based CAM therapies (1).
An estimated 8-17 of US population visits a
chiropractor each year, 33 over lifetime.
About 1/3 of US population reports having ever
had a therapeutic massage.
Individuals in rural and underserved communities
are particularly likely to use chiropractic care
(2).

19
Who uses CAM?

Chiropractic and massage are most frequently used
practitioner-based CAM therapies (1).
An estimated 8-17 of US population visits a
chiropractor each year, 33 over lifetime.
About 1/3 of US population reports having ever
had a therapeutic massage.
Individuals in rural and underserved communities
are particularly likely to use chiropractic care
(2).
Chiropractors in every zip code region in KY
6 of massage therapists are in rural areas

20
What CAM do people use?

Chiropractic and massage are most frequently used
practitioner-based CAM therapies (1).
An estimated 8-17 of US population visits a
chiropractor each year, 33 over lifetime.
About 1/3 of US population reports having ever
had a therapeutic massage.
Individuals in rural and underserved communities
are particularly likely to use chiropractic care
(2).

(1) Kessler 2001 (2) Smith 2002
21
What CAM do people use?

Herbal therapy is used by 12-14 of the US
population, up from 2.5 in 1990.
16-18 of patients taking prescription
medications also take herbal remedies.

Kaufman 2002
22
Why do people use CAM?

Desire for health and wellness (1)
Prevention
Cancer- recent estimate 83 (2)
Pain
Musculoskeletal pain
Back and neck pain

Wolsko 2002
(2) NCCAM newsletter Winter 2003

23
Why do people use CAM?

Musculoskeletal pain accounted for 1/3 of CAM use
among primary care patients (1).
In national household survey, 54 reported using
CAM for neck or back pain in past year, compared
to 37 who had seen a conventional provider for
these symptoms (2).

Palinkas 2000 (2) Wolsko 2003

24
Why do people use CAM?

Desire for health and wellness (1)
Prevention
Cancer- recent estimate 83 (2)
Pain
Musculoskeletal pain
Back and neck pain

25
Why do people use CAM?

Very few individuals rely exclusively upon
alternative modalities (1).
Most individuals who use CAM do so because of
preference and the perception that the
combination of CAM and conventional treatments is
superior to either alone (2).

(1) Astin 1998 (2) Eisenberg 2001
26
Why do people use CAM?

Patients use CAM
when it is consistent with their worldview
and
when conventional care is not relieving their
symptoms.

Testerman 2004
27
What do CAM users want?

Empowerment in medical interactions
Chance to share their own views about health and
healing
Health provider who will spend time with them
Someone who will answer their questions

Weil 2000
28
What do CAM users want?

Empowerment in medical interactions
Chance to share their own views about health and
healing
Health provider who will spend time with them
Someone who will answer their questions

29
Who practices CAM?

Wide variation in background and approach
Diversity in training programs
Some weekend and/or distance learning certificate
programs
Non-MD acupuncture programs require 2,000-3,000
hours (4 year masters degree)
Chiropractic training involves 4 years beyond 2
or 4 years of college
No standardization of approach to accreditation
and licensure
Most require 300-500 hours and CEUs
Variations by type of practitioner and by state

Barrett 2000, Eisenberg 2002
30
Who practices CAM?

Chiropractors
Around 66,000 DCs in US (over 600 in KY)
Most accepted professional therapy
Licensed in all states
High patient satisfaction
Massage Therapists
Over 46,000 AMTA members in US
Most common CAM modality in hospital-based
programs
Licensed in 2/3 of states (KY in 2003)

31
Who practices CAM?

Increasing numbers of dual-trained practitioners
RNs
Holistic Nursing Certification
Therapeutic Touch, Healing Touch
MDs and DOs
American Board of Holistic Medicine
American Board of Medical Acupuncture

32
Who practices CAM?

How did I get to be
a dual-trained MD?

www.waysmeet.net
33
What about communication?

Between 40 and 70 of CAM users do not disclose
their use to their physician.
WHY?
Patients usually say that they do not report
because they are not asked.

Eisenberg 2001
34
Why does this matter?

The substantial overlap between use of
prescription medications and herbal supplements
raises concerns about unintended interactions.
Patient use of CAM is often a clue to values and
preferences that need to be acknowledged.

Kaufman 2002
35
How can we communicate?

Always ask! What else are you doing for your
health?
Be open and nonjudgmental.
Consider patient preferences and values.
Encourage self-monitoring of results.

Eisenberg 1997
36
How can we communicate?

Coordinate care as appropriate.
Be honest about your lack of knowledge and open
to education.
Monitor safety and efficacy, arrange follow-up.
8. Document all discussions and advice.

Eisenberg 1997
37
Evidence-based Medicine (EBM) and CAM

EBM aims to integrate
best research evidence
clinical expertise
patient values

Sackett 2000
38
EBM and CAM

While some scientific evidence exists regarding
some CAM therapies,
for most there are key questions that are yet to
be answered through well-designed scientific
studies
questions such as whether they are safe and
whether they work for the diseases or medical
conditions for which they are used.

39
Where are we now?