Integrating complementary and integrative medicine into primary care — the patient’s perspective

Moshe Frenkel, M.D.
Department of Family Medicine, University of Texas Medical Branch at Galveston

Aim of Study

To estimate the proportion of patients attending a family medicine clinic who would be interested in having complementary and integrative medicine services available in their primary care clinic.

Context and Objective

The use of complementary and integrative medicine in primary care is growing,1-4 but little is known about how these therapies can be integrated into mainstream care. Until now most of the studies have evaluated trends of complementary and integrative medicine use in different localities, geographic locations and specific patient populations (cancer patients, pediatrics etc.) There is a lack of information on how patients perceive the process of integrating these therapies into their conventional care. To fill some of this gap, a study to explore the extent of interest of integrating complementary and integrative medicine into care was designed for a sample of patients attending a large academic family medicine clinic in Texas.

Research Design and Methods

A combined faculty and resident practice at a university-based family medicine clinic served as the setting and population for this study. The information was obtained from a survey that was administered by research interviewers to a random sample of 502 patients attending the family medicine clinic between Nov. 2005 and May 2006. The survey questions were developed after a comprehensive literature review and discussions with local complementary and integrative medicine, or CIM, academic experts. The survey development process also includ­­ed a focus group with the clinic advisory board and a pilot sample of patients in the clinic. All the collected data were obtained by two experienced research assistants and results were computerized. A statistical analysis that followed evaluated responses.

Results

The 502 participants represented the adult patient population that attends this clinic: 68.7 percent were females and 31.3 percent were males. The average age of the patients was 53 and ranged from 18 to 89. Of the 502 participants in this study, 88 percent believed that the use of natural medicine is moderately helpful to very helpful. Sixty-six percent indicated that they had used natural medicine treatments in the last year. The leading treatments were nutritional supplements and vitamins (35.9 percent), herbal medicine (25.1 percent), massage therapy (21.3 percent), aromatherapy (12.5 percent), meditation (12.2 percent) and chiropractic care (12 percent).

Seventy-seven percent of participants indicated that they would be interested in using natural medicine over the next year. The leading treatments they would like to explore are: massage therapy (42 percent), herbal medicine (34.9 percent), nutritional supplements (31 percent), relaxation (27.9 percent) and acupuncture (21.5 percent). Of the participants who had interest in natural medicine use over the next year, 55.4 percent reported that they would like those therapies to be provided in their primary care clinic and 31.6 percent would like them to be provided in a holistic clinic with multiple providers and physician supervision.

Of those participants interested in using natural medicine over the next year, 90.7 percent felt that their family physician should be the one to refer them for these therapies. 93.6 percent of them felt that natural practitioners such as massage therapists, acupuncturists, homeopaths and chiropractors should be part of a family practice clinic, and 74.9 percent would be willing to pay out of pocket for some of those services.

Discussion

The results of this study support findings from a previous large study that found that 62 percent of the U.S. population is using CIM.4 This research adds some perspective on what patients want as far as the provision of those services. The study emphasizes the important role of the family physician and the primary care clinic in providing and supervising CIM treatments, as perceived by their patients. Analysis of the results gives a better sense of the extent of interest in integrating CIM into a primary care clinic. It seems that most patients attending this large family medicine clinic would like their family doctor to be involved in integrating and referring them to appropriate CIM treatments when necessary. They would like those therapies to be provided mostly in their primary care clinic, but they see referral to a specialized CIM clinic under physician supervision as a viable option. A significant number of patients would like massage therapy, herbs and nutritional supplements to be added to their future health care. These data give some food for thought for clinic administrators, insurance companies involved in health care and policymakers who are involved in planning and providing primary health care. The results of the study also stress the need for family physician involvement in providing and supervising CIM treatments as perceived by their patients. The findings of this study are preliminary and should be a base for a multi-center study that can further evaluate the patient perspective on the process of integrating natural and integrative medicine into the primary health care system so health care policymakers can better address public need.

References

1. Barnes P., Powell-Griner E., McFann K., Nahin R., Complementary and Alternative Medicine Use Among Adults: United States, 2002.” May 27, 2004. CDC Advance Data Report #343.
2. Burge S., Albright T., Residency Research Network of South Texas. “Use of Complementary and Alternative Medicine Among Family Practice Patients in South Texas.” American Journal of Public Health. 2002, 92(10):1614 - 1616.
3. Eisenberg D., Davis R., Ettner S., et al. “Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up national survey.” JAMA. Nov. 11, 1998, 280(18): 1569 - 1575.
4. Kessler R.C. “Long-term Trends in the Use of Complementary and Alternative medical Therapies in the United States.” Annals of Internal Medicine. 2001;136:262-268.