Complementary and Alternative Medicine and Therapy Use in a Diverse New Mexican Population

Introduction

The national center for complementary and Integrative Health defines complementary and alternative medicine as a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine. ¹ This includes, but is not limited to, herbal medicines, vitamins and supplements, therapeutic massage, and acupuncture.

The use of complementary and alternative medicines and therapies (CAMT) has risen over the past several years, with non-Hispanic whites among the highest users. ¹ CAMT use is estimated to be significantly higher among people living in rural areas than urban areas, with use in some rural areas reaching 63%. ^2,3 Additionally, national CAMT use is reported to be highest in New Mexico (NM) and other states in the U.S. Mountain region. ⁴ The population of NM is ethnically, culturally, and geographically diverse compared with the overall U.S. population. ⁵ Approximately 47% of NM's population is of Hispanic/Latino origin compared with 17% of the United States, and 40% is non-Hispanic white compared with 63% in the United States. ⁵ While studies have shown high rates of CAMT use among the elderly population in NM, ^6,7 local observations from a variety of patient populations served by clinical pharmacy services indicate that CAMT use in Hispanics may be higher than CAMT use in non-Hispanic whites in NM.

The 2010 U.S. Census reported that 50.4% of children younger than age 1 are minorities, an increase from the previous census. Additionally, there are now four majority-minority states in the United States (NM, California, Hawaii, and Texas), along with the District of Columbia. As the racial and ethnic landscape of the United States changes, an understanding of the attitudes and actual CAMT use in diverse populations will be important in order to provide high-quality patient care.

The purpose of this study was to characterize CAMT use in patients representative of a Southwestern population.

Materials and Methods

A self-administered, cross-sectional survey was administered among a convenience sample of respondents receiving health care in the following College of Pharmacy faculty–staffed outpatient clinics associated with the University of New Mexico: heart failure, HIV, hepatitis C, geriatric, and pediatric pulmonary. One chain pharmacy offering clinical services also participated. None of the clinics specialized in offering CAMT services.

Each survey respondent was assigned a unique identification code that could not be linked to his or her identity. An informed consent letter for anonymous surveys was provided to the respondents, and completion of the survey indicated consent and willingness to participate in the study. The University of NM Health Sciences Center Human Research Review Committee approved the study.

Results

Discussion

NM has a diverse population, being one of only five majority-minority states or equivalents in the United States. Consistent with the demographics of NM, half of the survey respondents self-identified as Hispanic. The results of this study are similar to national data, ¹ with the exception of CAMT use in rural and urban respondents. The survey found that CAMT use was statistically higher in female participants, those with higher household incomes, and in those with an education level beyond a bachelor's degree.

Other studies have reported higher CAMT use in women. ^1,8,9 In a recent study by Zhang and colleagues, ⁸ women were nearly three times more likely than men to use complementary and alternative medicine (CAM) (odds ratio, 2.8; 95% confidence interval, 2.5–3.0). The authors reported that female CAM users were more likely to use CAM for general wellness and disease prevention. The current results are similar: the leading reason for CAMT use in the respondents was general well-being (65%). In general, women have been more likely to use conventional health care and preventive care services, ^{10 –12} and this appears to also be the case in regard to CAMT use.

CAMT use is normally associated with significant cost and is often not covered by medical or prescription benefits. ¹³ Despite the cost or the paucity of evidence regarding the benefits of CAMT use, ^{14 –16} the results of this study clearly show that survey respondents who indicated that they used CAMT are satisfied with their choice and plan to continue to use CAMT. In addition, previous studies show that CAMT use in the United States appears to be increasing. ¹ In the current survey, more adult respondents identified themselves as using CAMT (48.7%) compared with national numbers (38.3%). ¹ This may be an underestimate, considering that CAMT use often falls in the realm of self-care outside of the clinic setting and the current participants used allopathic health care. Regardless, the large number of CAMT users confirms that health care providers need to discuss CAMT use with each patient to ensure safety and efficacy of both traditional therapies and CAMT.

Patients who use CAMT are not necessarily dissatisfied with traditional therapies. Astin and colleagues found that a large percentage of patients who use CAMT are highly satisfied with conventional practitioners/therapy. ¹⁷ Previous studies show that most patients who use CAMT do so to augment, rather than substitute for, traditional therapy. ^18,19 This is further supported by the data in this study. Only 11% of the survey respondents reported using CAMT instead of prescription therapies. Thirty-eight percent of respondents reported using CAMT as an adjunct to prescription medications. Our survey also found that physicians and pharmacists are actually recommending CAMT. Although vitamin and mineral supplements are beneficial in certain conditions (e.g., anemia), patients may not be aware that CAMT can be associated with risk. ^20,21 Some survey respondents in our study believe that CAMT results in fewer adverse effects than prescription medications (2.5 ± 1.4; Table 3) and drug interactions are unlikely (3.3 ± 1.3; Table 3). If health care professionals are aware of CAMT use, they can address misinformation and support individuals in making informed, safe, and appropriate choices while preventing potential adverse drug interactions.

Compared with previous studies, the only difference seen in the current study results was the difference in CAMT use in rural and urban respondents. Previous studies have identified that people who live in rural areas are more likely to use CAMT. ^2,22 Although the opposite result was found, this finding may be due to few (11.2%) respondents living in rural areas. Additionally, participants identified as living in rural areas were treated within an urban hospital system or outpatient pharmacy and so may not reflect individuals in rural areas not receiving care in an urban area. CAMT use was also higher in non–U.S.-born respondents, but was not found to be statistically significant.

Despite the lack of major differences between NM CAMT users and those on a national level, the results of this survey do confirm that CAMT use is high among patients utilizing conventional care. Several studies have documented that health care providers ^{23 –25} do a poor job of inquiring about and documenting CAMT use. Because patients may not regularly disclose their CAMT use to their providers (with this lack of disclosure seen more frequently with Latinos, Asian-Americans, and African-Americans compared with non-Hispanic whites ²⁶ ), it is crucial for providers to be proactive and ask patients about their CAMT use. The results of this study re-emphasize the importance for providers to take a thorough medication history, which includes CAMT. Additionally, providers should document CAMT use as a part of the therapeutic monitoring plan.

While this study offers important information regarding the use of CAMT in a diverse population, it does have several limitations. First, this is a cross-sectional study; thus, only associations can be made. Second, while demographic data were collected from the entire population, the attitude/belief questions were completed only by the group who reported using CAMT, creating a response bias. Other limitations include the underrepresentation of the rural population and the exclusion of patients unable to speak, read, and write in English. Enhanced representation of these populations could influence the survey results. The results are self-reported and the answers depend on the respondents' ability to remember and accurately report the information. Finally, data were collected only from patients who were willing to participate, creating the possibility for self-selection bias in the study sample.

Despite these limitations, this study evaluating CAMT use had a majority of Hispanic respondents and provides valuable information to health care providers who serve this population. The results provide useful information regarding CAMT use. The results also help identify possible misconceptions regarding these items and services. Discussion regarding CAMT will give providers the opportunity to address information regarding regulation, efficacy, adverse effects, and drug interactions.

In conclusion, over half of the patients in this study reported recent use of CAMT. A majority of the patients who reported use of CAMT reported using CAMT in addition to conventional therapy. The leading reason for CAMT use was for general well-being. Those reporting CAMT use felt it was very safe, useful for their condition, a good idea, and very easy. CAMT use continues to be prevalent, popular, and costly among patients. Health care providers need to inquire and document CAMT use with all patients in order to avoid potential interactions and to ensure adherence with conventional therapy.