Wagner P J, Jester D, LeClair B, Taylor A T, Woodward L, Lambert J
Department of Family Medicine, Medical College of Georgia, Augusta 30912-3500, USA.
J Fam Pract. 1999 Aug;48(8):615-9.
The number of visits to alternative medicine practitioners in this country is estimated at 425 million, which is more than the number of visits to allopathic primary care physicians in 1990. Patients' use of St. John's Wort (SJW) has followed this sweeping trend. The purpose of our study was to examine the reasons people choose to self-medicate with SJW instead of seeking care from a conventional health care provider.
We used open-ended interviews with key questions to elicit information. Twenty-two current users of SJW (21 women; 20 white; mean age = 45 years) in a Southern city participated. All interviews were transcribed, and descriptive participant quotes were extracted by a research assistant. Quotes were reviewed for each key question for similarities and contextual themes.
Four dominant decision-making themes were consistently noted. These were: (1) Personal Health Care Values: subjects had a history of alternative medicine use and a belief in the need for personal control of health; (2) Mood: all SJW users reported a depressed mood and occasionally irritability, cognitive difficulties, social isolation, and hormonal mood changes; (3) Perceptions of Seriousness of Disease and Risks of Treatment: SJW users reported the self-diagnosis of "minor" depression, high risks of prescription drugs, and a perception of safety with herbal remedies; and (4) Accessibility Issues: subjects had barriers to and lack of knowledge of traditional health care providers and awareness of the ease of use and popularity of SJW. Also of note was the fact that some SJW users did not inform their primary care providers that they were taking the herb (6 of 22). Users reported moderate effectiveness and few side effects of SJW.
SJW users report depression, ease of access to alternative medicines, and a history of exposure to and belief in the safety of herbal remedies. Users saw little benefit to providing information about SJW to primary care physicians.
据估计，该国看替代医学从业者的就诊次数达4.25亿次，这超过了1990年看全科初级保健医生的就诊次数。患者使用圣约翰草（SJW）也顺应了这一普遍趋势。我们研究的目的是探究人们选择自行服用圣约翰草而非寻求传统医疗服务提供者治疗的原因。
我们通过开放式访谈并提出关键问题来获取信息。南方一座城市的22名圣约翰草现任使用者（21名女性；20名白人；平均年龄 = 45岁）参与了研究。所有访谈均进行了转录，一名研究助理提取了描述性的参与者引述内容。针对每个关键问题对引述内容进行审查，以找出相似之处和背景主题。
始终注意到四个主要的决策主题。它们分别是：（1）个人医疗保健价值观：受试者有使用替代医学的历史，并且相信需要个人掌控健康；（2）情绪：所有圣约翰草使用者均报告有情绪低落，偶尔还有易怒、认知困难、社交孤立以及激素引起的情绪变化；（3）对疾病严重性和治疗风险的认知：圣约翰草使用者报告自我诊断为“轻度”抑郁症，认为处方药风险高，且觉得草药疗法安全；（4）可及性问题：受试者在接触传统医疗服务提供者方面存在障碍且缺乏相关知识，同时了解圣约翰草使用方便且受欢迎。还值得注意的是，一些圣约翰草使用者未告知其初级保健医生他们正在服用这种草药（22人中有6人）。使用者报告圣约翰草疗效中等且副作用较少。
圣约翰草使用者报告有抑郁症、易于获取替代药物，以及接触过草药且相信其安全性的经历。使用者认为向初级保健医生提供有关圣约翰草的信息没有什么好处。
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