Wade Christine, Chao Maria, Kronenberg Fredi, Cushman Linda, Kalmuss Debra
Richard & Hinda Rosenthal Center for Complementary and Alternative Medicine, Columbia University, New York, New York, USA.
J Womens Health (Larchmt). 2008 Jun;17(5):829-40. doi: 10.1089/jwh.2007.0579.
Medical pluralism can be defined as the employment of more than one medical system or the use of both conventional and complementary and alternative medicine (CAM) for health and illness. American women use a variety of health services and practices for women's health conditions, yet no national study has specifically characterized women's medical pluralism. Our objective was to describe medical pluralism among American women.
A nationally representative telephone survey of 808 women >or=18 years of age was conducted in 2001. Cross-sectional observations of the use of 11 CAM domains and the use of an additional domain--spirituality, religion, or prayer for health--during the past year are reported. Women's health conditions, treatments used, reasons for use, and disclosure to conventional physicians are described, along with predictors of CAM use.
Over half (53%) of respondents used CAM for health conditions, especially for those involving chronic pain. The majority of women disclosed such practices at clinical encounters with conventional providers. Biologically based CAM therapies, such as nutritional supplements and herbs, were commonly used with prescription and over-the-counter (OTC) pharmaceuticals for health conditions.
Medical pluralism is common among women and should be accepted as a cultural norm. Although disclosure rates of CAM use to conventional providers were higher than in previous population-based studies, disclosure should be increased, especially for women who are pregnant and those with heart disease and cancer. The health risks and benefits of polypharmacy should be addressed at multiple levels of the public health system.
医学多元主义可定义为采用一种以上医疗体系，或为了健康与疾病问题同时使用传统医学以及补充与替代医学（CAM）。美国女性针对女性健康状况会采用多种健康服务和做法，但尚无全国性研究专门描述女性的医学多元主义情况。我们的目标是描述美国女性中的医学多元主义。
2001年对808名年龄≥18岁的女性进行了一项具有全国代表性的电话调查。报告了过去一年中对11个补充与替代医学领域的使用情况以及另外一个领域——利用灵性、宗教或祈祷促进健康——的使用情况的横断面观察结果。描述了女性的健康状况、所采用的治疗方法、使用原因、向传统医生的披露情况，以及补充与替代医学使用的预测因素。
超过半数（53%）的受访者将补充与替代医学用于健康问题，尤其是那些涉及慢性疼痛的问题。大多数女性在与传统医疗服务提供者的临床接触中披露了此类做法。基于生物的补充与替代医学疗法，如营养补充剂和草药，常与处方药和非处方药一起用于健康问题。
医学多元主义在女性中很常见，应被视为一种文化规范。尽管向传统医疗服务提供者披露补充与替代医学使用情况的比例高于以往基于人群的研究，但仍应提高披露率，尤其是对于孕妇以及患有心脏病和癌症的女性。应在公共卫生系统的多个层面探讨多药并用的健康风险和益处。
