Patel Sejal J, Kemper Kathi J, Kitzmiller Joseph P
College of Public Health, The Ohio State University.
Center for Integrative Health and Wellness, The Ohio State Wexner University Medical Center.
Adv Med Educ Pract. 2017 Jul 25;8:499-503. doi: 10.2147/AMEP.S138572. eCollection 2017.
Over recent decades, the demand for complementary and alternative medicine (CAM) has continued to rise in the US. Like the practice of traditional Western medicine, CAM is associated with not only significant health benefits but also significant risks. Unlike traditional Western medicine, however, much of CAM use is less regulated and often occurs unbeknownst to a patient's medical doctor. The use of herbals, dietary supplements, and over-the-counter (OTC) medications can result in adverse effects, and many significant interactions can occur when their use is combined with allopathic medications. Even the more peripheral CAM practices (eg, acupuncture, massage, yoga, and Reiki) have associated risk (eg, adverse effects or worsening of physical injury and conditions). There is, however, impetus for change: both patients and physicians favor increasing physician knowledge of CAM and the synergistic implementation of CAM into routine clinical practice. Although improvement has been achieved from contemporary physician educational efforts, recently published results from patient and physician surveys strongly indicate that additional effort to increase physician knowledge of CAM is needed. Utilizing a 37-item survey and convenience-sampling methodology, we collected detailed information from 114 physicians, fellows, and residents from the Ohio State University Medical Center regarding impediments to increasing physician knowledge of CAM and its implementation in routine clinical practice. The aggregate results of our survey data showed that most physicians 1) desired to increase their knowledge of CAM, 2) believed that less than half of their patients were spontaneously reporting their use of CAM therapies, 3) were not aware of available evidence-based resources on CAM, 4) preferred case-based lectures for learning about CAM, and 5) reported insufficient time during patient encounters as the primary barrier for increasing the implementation of CAM in routine clinical practice.
近几十年来，美国对补充和替代医学（CAM）的需求持续上升。与传统西医一样，补充和替代医学不仅带来显著的健康益处，也存在重大风险。然而，与传统西医不同的是，补充和替代医学的许多应用监管较少，而且患者的医生往往并不知晓。草药、膳食补充剂和非处方（OTC）药物的使用可能会产生不良反应，当它们与对抗疗法药物联合使用时，还可能发生许多严重的相互作用。即使是更边缘化的补充和替代医学疗法（如针灸、按摩、瑜伽和灵气疗法）也有相关风险（如身体损伤和病情恶化的不良反应）。然而，变革的动力是存在的：患者和医生都赞成增加医生对补充和替代医学的了解，并将补充和替代医学协同应用于常规临床实践。尽管当代医生教育努力已取得了一些进展，但最近公布的患者和医生调查结果强烈表明，仍需要进一步努力来增加医生对补充和替代医学的了解。我们采用一项包含37个项目的调查问卷和便利抽样方法，从俄亥俄州立大学医学中心的114名医生、研究员和住院医师那里收集了关于增加医生对补充和替代医学的了解及其在常规临床实践中的应用所面临障碍的详细信息。我们调查数据的汇总结果显示，大多数医生：1）希望增加对补充和替代医学的了解；2）认为不到一半的患者会主动告知他们使用补充和替代医学疗法的情况；3）不了解现有的关于补充和替代医学的循证资源；4）更喜欢通过基于病例的讲座来了解补充和替代医学；5）表示在患者诊疗过程中时间不足是在常规临床实践中增加补充和替代医学应用的主要障碍。
