Transcript Slide 1
Complementary and
Alternative Medicine Use
by Recent Immigrants
Brett White, MD; Monica Zepeda, MPH; Barbara Sarter,
PhD, NP; Felix Nunez, MD, MPH; Dennis Mull, MD, MPH;
Lyndee Knox, PhD
LA Net
3rd Annual Provider Forum
December 2, 2006
University of Southern California
Background
Selected by LANet members at March 2005 Forum
1 of 3 ideas thought of as important by clinicians
Why South Central Family Health Center?
In immigrant, Latino communities, faith in herbal
medicines is very common
Reinforced by Spanish language television
We believe that a high percentage of patients are using
herbal medicines
Clinicians at the site reported that patients were
revealing use of herbal medicines instead of
their prescribed medications
Background: Why South
Central Family Health Center?
Documented cases of patients having adverse
reactions to herbal medicines they were
taking
Conclusion: It is important to know for each and
every patient what herbal and traditional
medicines they may be taking and how they are
using them so that we can learn about them and
be aware of any possible problems they may be
causing.
Why Important?
Most providers do not ask about utilization
Are providers uncomfortable asking?
Patients do not disclose utilization
Provider never asked
Thought it was not important for doctor to know
It was none of the doctor's business
The doctor would not understand
Fear that provider might disapprove of or
discourage CAM use
Purpose
What we want to know
What they are using
What they are using it for
Literature gap
Immigrant status
Methods: Find a Tool
Literature searches
Previously validated surveys (CHBQ, etc.)
Did not address target population issues
Length (MA’s should conduct in 3-5 minutes)
Created a survey to meet our needs
Informal poll for appropriate terminology in
Spanish
• Recommendation to ask about Remedios Caseros,
Medicinas Naturales, Tés, Hierbas
Methods: Survey Development
Drafted survey includes:
Identifying data for future contact
Place of birth
Years in U.S.
If any CAM use within the last year
If CAM use, what types, for what
condition and where did you get them
Survey Instrument
Survey Results
MA’s at SCFHC administered surveys to
patients (April 24- May 6)
163 responses
• 79.1% Female
Survey Results
Age range 19 to 85 years (M = 45.8, SD =
13.0)
30
25
20
Frequency
15
10
5
Mean = 45.82
Std. Dev. = 13.008
N = 158
0
20
40
60
Age
80
Survey Results
Most of the patients were from Mexico (66.3%),
followed by El Salvador (17.2%), and Guatemala
(10.4%)
Frequency
Percent (%)
Mexico
108
66.3
El Salvador
28
17.2
Guatemala
17
10.4
United States
5
3.1
Nicaragua
1
0.6
Other
4
2.4
Total
163
100.0
Survey Results
On average, of those who immigrated to
the United States (n = 150, 92% of sample),
they had been in the United States 19.4
years (SD = 10.5)
Survey Results
108 reported using CAM (66.3%)
• Excluded OTC
There were no gender differences in CAM
usage (p= .24)
Of those who used CAM products
43 reported using one product (39.8%)
35 reported using two products (32.4%)
24 reported using three (22.2%)
8 reported using five or more (7.4%)
Survey Results
75 different CAM substances reported as
being used by the patients
The most popular products were manzanilla
tea (chamomile) and yerba buena
Survey Results:
Types of CAM
Herbal (95.4%)
Orthomolecular (8.3%)
Vitamin B12, calcium, masurium, multivitamins
Biologically-based (2.8%)
Manzanilla, hierba buena, sábila, té de 7 azahares,
ruda, árnica, nopal
Liver, hormones, glucosamine
Special Diet (1.9%)
Cortislim
Survey Results :
Types of CAM
Survey Results:
Illnesses & Conditions
Frequency
(n=108)
Percent
(%)
Digestive
51
47.2
No Illness
25
23.1
Nervous
19
17.6
Immune
18
16.7
Endocrine
12
11.1
Circulatory
12
11.1
Reproductive
10
9.3
Skeletal
8
7.4
Urinary
4
3.7
Muscular
3
2.8
Cardiovascular
1
0.9
Other
2
1.9
CAM
substances
used for many
conditions
12 systemcategories
Survey Results
Survey Results:
Source of CAM
Most of the CAM products were bought at a store/market
(n = 81; 75.0%)
Fifty-three of the products were grown at home (22.5%)
Yerba Buena
Ruda
Sábila
Nopales
Survey Results:
Source of CAM
The rest came from a variety of sources,
including out of the country, pharmacies,
yerberías, boticas, TV commercials, and
from their doctors
Does length of time in US
affect usage?
Testing hypothesis: New immigrants are more likely to
use CAM than long-term immigrants (10+ years) those
born in US
This was NOT supported
There is no statistical difference in # of patients using
CAM by length of time in US (born, 0-9, 10+)
However, there was a slight trend for immigrants here
longer (who by default are older) to be more likely to use
CAM
Unable to determine if this is age effect or immigration
effect due to small sample size
Next Steps
Further data collection, survey
reconstruction, statistical analysis, and
discussion
Include more/different questions
Publication
Suggested Outcomes
Develop intervention/tool to improve quality
of care regarding CAM use in this
population
Reference card for lab coat
Ultimate Goal
To improve practice!
Discussion
Mercado in
Cuernavaca,
Morelos,
México