Use and expenditure on complementary medicine in England: a population based survey. Complement Ther Med

Medical Centre Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK.
Complementary Therapies in Medicine (Impact Factor: 1.55). 04/2001; 9(1):2-11. DOI: 10.1054/ctim.2000.0407
Source: PubMed


Many claims are made that complementary medicine use is a substantial and growing part of health-care behaviour. Estimates of practitioner visits in the USA and Australia indicate high levels of use and expenditure. No reliable population-based estimates of practitioner use are available for the UK.
In 1998, a previously piloted postal questionnaire was sent to a geographically stratified, random sample of 5010 adults in England. The questionnaire focuses on practitioner contacts, but also asked about the purchase of over-the-counter remedies. Additional information was requested on socio-demographic characteristics, perceived health, and recent NHS resource use. Information on use included reason for encounter, expenditure, insurance, and location of visit.
Population estimates (by age group and sex) of lifetime use and use in the past 12 months for acupuncture, chiropractic, homoeopathy, hypnotherapy, medical herbalism, osteopathy. Estimates for two additional therapies (reflexology and aromatherapy), and homoeopathic or herbal remedies purchased over-the-counter. Estimates of annual out-of-pocket expenditure on practitioner visits in 1998.
A crude response rate of 60% was achieved (adjusted response rate 59%). Responders were older and more likely to be female than non-responders. Usable responses (n = 2669) were weighted using the age/sex profile of the sample frame. From these adjusted data we estimate that 10.6% (95% CI 9.4 to 11.7) of the adult population of England had visited at least one therapist providing any one of the six more established therapies in the past 12 months (13.6% for use of any of the eight named therapies, 95% CI 12.3 to 14.9). If all eight therapies, and self-care using remedies purchased over the counter are included, the estimated proportion rises to 28.3% (95% CI 26.6 to 30.0) for use in the past 12 months, and 46.6% (95% CI 44.6 to 48.5) for lifetime use. All types of use declined in older age groups, and were more commonly reported by women than men (P < 0.01 for all comparisons). An estimated 22 million visits were made to practitioners of one of the six established therapies in 1998. The NHS provided an estimated 10% of these contacts. The majority of non-NHS visits were financed through direct out-of-pocket expenditure. Annual out-of-pocket expenditure on any of the six more established therapies was estimated at pound 450 million (95% CI 357 to 543).
This survey has demonstrated substantial use of practitioner-provided complementary therapies in England in 1998. The findings suggest that CAM is making a measurable contribution to first-contact primary care. However, we have shown that 90% of this provision is purchased privately. Further research into the cost-effectiveness of different CAM therapies for particular patient groups is now urgently needed to facilitate equal and appropriate access via the NHS.

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    • "The use of complementary health approaches was significantly more common in rural based population, in young and less educated patients. The use of complementary health approaches for KOA in developed countries has been reported [12] [13] [14] and it closely matches the frequency found in the present study. An Australian study reported a prevalence of 40% of CAM usage in hip and knee OA patients [2]. "
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    ABSTRACT: Aim of the work This study aimed to document the trends of complementary health approaches in Pakistani patients with knee osteoarthritis (KOA) and consider them in relation to demographic factors. Patients and methods A cross-sectional survey was carried out at the outpatient department, Armed Forces Institute of Rehabilitation Medicine (AFIRM), Rawalpindi, Pakistan. Recruited patients fulfilled the American College of Rheumatology criteria for KOA. Results Of 300 patients (mean age: 62 ± 10 years), majority were male (68%), in age group 61–70 years (37.3%), with monthly income <10.000 Pakistani Rupees (75.3%) and educational level from grade 6–10 (48%). Most patients were from urban areas (51.3%) belonging to the Punjab province (83.3%). Complementary health approaches were used by 45.3% of the patients. Most individuals used single therapy at a time (58.1%) and preferred therapeutic massage (63.2%). Nutritional supplements were used in 13.2%. Patients adopted these therapies chiefly based on self-knowledge (33.8%), primarily for pain relief (85.3%) and used them in combination with conventional medicines on a daily basis or at least five times a week (in 75%). The use of complementary health approaches was significantly more common in rural population (p = 0.023), in individuals who were illiterate or had education from grade 1–5 (p = 0.038) and individuals falling in age group of 41–50 years (p = 0.008). Conclusions The use of complementary health approaches is common in Pakistani KOA patients who are primarily rural-based, young and less educated. Massage is the preferred complementary health approach and most patients practice a single approach at a time in combination with conventional medicines.
    Egyptian Rheumatologist 10/2015; DOI:10.1016/j.ejr.2015.08.003
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    • "The acceptance and use of complementary alternative medicine (CAM) in general populations has been increasing in both Asian and Western countries [1] [2] [3] [4] [5]. A populationbased survey in the United Kingdom showed that use of one or more CAM therapies during the life course was 46% [3]. A high prevalence of CAM use has also been noted in the United States among patients with breast cancer [5]. "
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    ABSTRACT: Background. This study investigates the prevalence of and factors associated with users of folk therapy in Taiwan. Methods. Using data from the 2005 National Health Interview Survey and the National Health Insurance Research Database, we identified 16,750 adults aged 20 years and older. Sociodemographic factors, lifestyle, medical utilization, and health behaviors were compared between people using and not using folk therapy. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of factors associated with folk therapy were analyzed. Results. The one-month prevalence of folk therapy use was 6.8%, which was significantly associated with ages of 30-59 years (OR = 1.98, 95% CI = 1.49-2.63), women (OR = 1.63, 95% CI = 1.40-1.90), nonindigenous population (OR = 1.90, 95% CI = 1.14-3.17), having two or more unhealthy lifestyle habits (OR = 1.51, 95% CI = 1.26-1.81), high density of traditional Chinese medicine (TCM) physicians (OR = 1.40, 95% CI = 1.20-1.62), and being ill without receiving medical care in past six months (OR = 2.11, 95% CI = 1.76-2.53). Medical care utilization of TCM and Western medicine were also associated factors for folk therapy. Conclusions. The use of folk therapy is correlated with sociodemographics, lifestyle and health behaviors.
    Evidence-based Complementary and Alternative Medicine 07/2015; 2015:1-9. DOI:10.1155/2015/649265 · 1.88 Impact Factor
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    • "This demand may be due, amongst other things, to the dissatisfaction with biomedicine because of the side-effects of drugs and their lack of effectiveness in many chronic conditions; the belief that CAM is less invasive and more natural; the greater involvement by the patient in the treatment; and the different relationship between CAM practitioner and client [11]. Although the figures are not up-to-date, it has been estimated that about 10% of the overall contacts with CAM practitioners in England are publicly funded as part of the NHS [12]. Access to CAM in the NHS can be through the referrals of General Practitioners (GPs) and, in NHS hospitals , by NHS-employed healthcare professionals as part of an integrated approach to cancer care and as part of end of life care [6]. "
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    ABSTRACT: Despite the unproven effectiveness of many practices that are under the umbrella term 'complementary alternative medicine' (CAM), there is provision of CAM within the English National Health Service (NHS). Moreover, although the National Institute for Health and Care Excellence was established to promote scientifically validated medicine in the NHS, the paradox of publicly funded, non-evidence based CAM can be explained as linked with government policy of patient choice and specifically patient treatment choice. Patient choice is useful in the political and policy discourse as it is open to different interpretations and can be justified by policy-makers who rely on the traditional NHS values of equity and universality. Treatment choice finds expression in the policy of personalised healthcare linked with patient responsibilisation which finds resonance in the emphasis CAM places on self-care and self-management. More importantly, however, policy-makers also use patient choice and treatment choice as a policy initiative with the objective of encouraging destabilisation of the entrenched healthcare institutions and practices considered resistant to change. This political strategy of system reform has the unintended, paradoxical consequence of allowing for the emergence of non-evidence based, publicly funded CAM in the NHS. The political and policy discourse of patient choice thus trumps evidence based medicine, with patients that demand access to CAM becoming the unwitting beneficiaries. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Health Policy 03/2015; 119(10). DOI:10.1016/j.healthpol.2015.03.007 · 1.91 Impact Factor
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