Chao Maria T, Wade Christine, Kronenberg Fredi
Richard and Hinda Rosenthal Center for Complementary and Alternative Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
J Natl Med Assoc. 2008 Nov;100(11):1341-9. doi: 10.1016/s0027-9684(15)31514-5.
Complementary and alternative medicine (CAM) is often used alongside conventional medical care, yet fewer than half of patients disclose CAM use to medical doctors. CAM disclosure is particularly low among racial/ethnic minorities, but reasons for differences, such as type of CAM used or quality of conventional healthcare, have not been explored.
We tested the hypotheses that disclosure of CAM use to medical doctors is higher for provider-based CAM and among non-Hispanic whites, and that access to and quality of conventional medical care account for racial/ethnic differences in CAM disclosure.
Bivariate and multiple variable analyses of the 2002 National Health Interview Survey and 2001 Health Care Quality Survey were performed.
Disclosure of CAM use to medical providers was higher for provider-based than self-care CAM. Disclosure of any CAM was associated with access to and quality of conventional care and higher among non-Latino whites relative to minorities. Having a regular doctor and quality patient-provider relationship mitigated racial/ethnic differences in CAM disclosure.
Insufficient disclosure of CAM use to conventional providers, particularly for self-care practices and among minority populations, represents a serious challenge in medical encounter communications. Efforts to improve disclosure of CAM use should be aimed at improving consistency of care and patient-physician communication across racial/ethnic groups.
补充和替代医学(CAM)常常与传统医疗护理同时使用,但向医生透露使用CAM的患者不到半数。在种族/族裔少数群体中,CAM的披露率尤其低,但尚未探讨造成差异的原因,例如所使用的CAM类型或传统医疗保健的质量。
我们检验了以下假设:对于基于提供者的CAM以及在非西班牙裔白人中,向医生披露使用CAM的情况更高;获得传统医疗护理的机会和质量可以解释CAM披露方面的种族/族裔差异。
对2002年国家健康访谈调查和2001年医疗保健质量调查进行了双变量和多变量分析。
相对于自我护理CAM,基于提供者的CAM向医疗提供者披露使用情况的比例更高。披露任何CAM都与获得传统护理的机会和质量相关,并且相对于少数群体,非拉丁裔白人中的披露率更高。有一名固定的医生以及良好的医患关系可以减轻CAM披露方面的种族/族裔差异。
向传统医疗提供者披露使用CAM的情况不足,尤其是在自我护理实践中以及少数群体中,这在医疗交流中是一个严峻的挑战。改善CAM使用披露情况的努力应旨在提高不同种族/族裔群体之间护理的一致性和医患沟通。