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
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, whattypes, 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)
Survey Results • Most of the patients were from Mexico (66.3%), followed by El Salvador (17.2%), and Guatemala (10.4%)
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%) • Manzanilla, hierba buena, sábila, té de 7 azahares, ruda, árnica, nopal • Orthomolecular (8.3%) • Vitamin B12, calcium, masurium, multivitamins • Biologically-based (2.8%) • Liver, hormones, glucosamine • Special Diet (1.9%) • Cortislim
Survey Results : Types of CAM
Survey Results: Illnesses & Conditions • CAM substances used for many conditions • 12 system-categories
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 Sábila Nopales Ruda
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
