Docstoc

KAN CAM presentation 2003 05 04

Document Sample
KAN CAM presentation 2003 05 04 Powered By Docstoc
					Communication about Complementary and Alternative Medicine in Kentucky Ambulatory Network Practices
Maureen A. Flannery MD Department of Family Practice and Community Medicine University of Kentucky

Topics included in KAN CAM survey

 Experiences with CAM (patient and self)
 Communication with patients about CAM  Beliefs about efficacy of CAM modalities

 Education about CAM (past training and

interest in future)  Demographics

Complementary and alternative medicine (CAM)

 interventions neither taught widely in medical schools

nor generally available in U.S. hospitals (1) or  those healing therapies that typically fall outside the Western biomedical model of disease, diagnosis, and treatment (2)

(1) Eisenberg 1993 (2) Drivdahl 1998

Modalities included in KAN CAM survey

Acupuncture Aromatherapy Biofeedback Chiropractic Energy healing Folk remedies Herbal/botanical therapy Homeopathy Hypnosis

Massage Therapy Megavitamin therapy Reflexology Relaxation techniques Special diet Spiritual healing (by others) Yoga Other CAM in general

Kentucky Ambulatory Network (KAN)

Statewide practice-based research network Primary care clinicians Practices in 32 counties Primarily in central and eastern Kentucky About half of practices in Health Professional Shortage Areas

Demographic characteristics of KAN CAM survey sample
102 deliverable surveys, 64% response rate
Characteristics Responders
percent (number)

Non-Responders p-value
percent (number) for difference 0.009

Training
Physician (MD, DO) Nonphysician clinician (NP, CNM, PA) 67 (42) 33 (21) 90 (35) 10 (4)

Gender
Female Male 40 (25) 60 (37) 13 (5) 87 (34)

0.004

Practice location
Metropolitan Nonmetropolitan 32 (20) 68 (43) 41 (16) 59 (23)

0.4

KAN clinician report of experiences related to CAM
Yes
percent (number)

No
percent (number)

Patient(s) asked about CAM Patient(s) reported CAM use Clinician used CAM Clinician recommended CAM to patient(s)

86 (56) 94 (61) 49 (32) 80 (52)

14 (9) 6 (4) 51 (33) 20 (13)

How often KAN clinicians report that they ask patients about use of CAM
Never 5% Always 6% Over half the time 20%

Less than half the time 53%

About half the time 16%

How KAN clinicians characterize attitude towards patient use of CAM
Very positive 8%

Somewhat negative 10%

Somewhat positive 31%

Neutral 51%

How KAN clinicians describe comfort level in advising patients about CAM
Very uncomfortable 3% Somewhat uncomfortable 16% Very comfortable 10%

Neutral 26%

Somewhat comfortable 45%

KAN clinician report of past education about CAM
 21% reported having received “specialized

education in any form of CAM”
 Responses to “how often do you use this

CAM modality in your clinical practice?”
 Daily
 Occasionally  Rarely

7% 48% 44%

KAN clinician report of experiences related to CAM
Yes
percent (number)

No
percent (number)

Patient(s) asked about CAM

86 (56)

14 (9)

Patient(s) reported CAM use
Clinician used CAM

94 (61)
49 (32)

6 (4)
51 (33)

Clinician recommended CAM to patient(s)

80 (52)

20 (13)

CAM modalities that KAN clinicians recommended and used
Modalities clinicians recommended to patients Relaxation techniques (40%) Special diets (38%) Massage therapy (35%) Modalities clinicians used themselves Massage (22%) Relaxation techniques (22%) Herbal/botanical therapies (22%)

CAM modalities that KAN clinicians recommended and used

Significant relationship between number of modalities clinicians used and number of modalities recommended to patients

KAN clinician beliefs about efficacy of CAM modalities More than 80% of responders believe these “definitely or probably work”:
(83%)  Biofeedback (86%)  Chiropractic (81%)  Massage therapy (87%)  Relaxation techniques (94%)
 Acupuncture

Positive association between belief in efficacy of CAM and recommendation to patients by KAN clinicians Only for these modalities
Herbal/botanical

therapy Megavitamin therapy Special diet Spiritual healing

CAM modalities that KAN clinicians recommended and used Chiropractic as example
Patient inquiry Patient use Clinician use Clinician recommendation Belief in efficacy definitely works probably works 63% 88% 5% 29%

25% 56%

KAN clinician interest in further education about CAM

70% of KAN clinicians are interested in learning more about the safety and efficacy of specific CAM treatments.

Why KAN clinicians are interested in further education about CAM
Insurance plans with which I work are beginning to cover some CAM treatments.
6%

My patients are asking about CAM and I am unsure how to advise them.

36%

I want to know the facts about CAM.

46%

If a CAM treatment is safe and effective, I want to recommend it to patients.

55%

If a CAM treatment is unsafe or ineffective, I want to dissuade my patients from using it.
0% 10% 20% 30% 40% 50% 60% 70% 80%

89% 90% 100%

Percentage of responders that describe reason as very important

Communication about CAM in KAN practices

KAN clinicians do not routinely ask about CAM
but their patients both ask and tell!

Communication about CAM in KAN practices

Many KAN clinicians recommend CAM to patients but their recommendations may not be based upon knowledge of evidence or belief in efficacy.

Communication about CAM in KAN practices

KAN clinicians want to know more about CAM primarily in order to provide better advice to their patients.

Communication about CAM in KAN practices

Offering clinically-relevant and evidence-based education about CAM may lead to better communication between clinicians and patients.

Communication about CAM in KAN practices

Better communication between patients and well-informed clinicians about CAM may lead to more comprehensive care for patients in KAN practices.

A model for further exploration of communication about CAM patient

conventional clinician
Adler 2003

CAM practitioner

Communication about Complementary and Alternative Medicine in Kentucky Ambulatory Network Practices
Maureen A. Flannery MD Department of Family Practice and Community Medicine University of Kentucky


				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:9
posted:9/30/2008
language:
pages:26