National Center for Complementary and Integrative Health (NCCIH), National Institutes of Health, Bethesda, MD, USA.
National Center for Health Statistics, Hyattsville, MD, USA.
J Integr Complement Med. 2022 Aug;28(8):651-663. doi: 10.1089/jicm.2022.0493. Epub 2022 May 12.
To examine the reasons why office-based physicians do or do not recommend four selected complementary health approaches to their patients in the context of the Andersen Behavioral Model. Descriptive estimates of physician-level data from the 2012 National Ambulatory Medical Care Survey (NAMCS) Physician Induction Interview, a nationally representative survey of office-based physicians ( = 5622, weighted response rate = 59.7%). The United States. Reasons for the recommendation or lack thereof to patients for: herbs and other non-vitamin supplements, chiropractic/osteopathic manipulation, acupuncture, and mind-body therapies (including meditation, guided imagery, and progressive relaxation). Differences by physician sex and medical specialty were described. For each of the four complementary health approaches, more than half of the physicians who made recommendations indicated that they were influenced by scientific evidence in peer-reviewed journals (ranging from 52.0% for chiropractic/osteopathic manipulation [95% confidence interval, CI = 47.6-56.3] to 71.3% for herbs and other non-vitamin supplements [95% CI = 66.9-75.4]). More than 60% of all physicians recommended each of the four complementary health approaches because of patient requests. A higher percentage of female physicians reported evidence in peer-reviewed journals as a rationale for recommending herbs and non-vitamin supplements or chiropractic/osteopathic manipulation when compared with male physicians (herbs and non-vitamin supplements: 78.8% [95% CI = 72.4-84.3] vs. 66.6% [95% CI = 60.8-72.2]; chiropractic/osteopathic manipulation: 62.3% [95% CI = 54.7-69.4] vs. 47.5% [95% CI = 42.3-52.7]). For each of the four complementary health approaches, a lack of perceived benefit was the most frequently reported reason by both sexes for not recommending. Lack of information sources was reported more often by female versus male physicians as a reason to not recommend herbs and non-vitamin supplements (31.4% [95% CI = 26.8-36.3] vs. 23.4% [95% CI = 21.0-25.9]). There are limited nationally representative data on the reasons as to why office-based physicians decide to recommend complementary health approaches to patients. Developing a more nuanced understanding of influencing factors in physicians' decision making regarding complementary health approaches may better inform researchers and educators, and aid physicians in making evidence-based recommendations for patients.
为了在安德森行为模型的背景下研究基层医疗机构医生向患者推荐四种特定补充性健康疗法的原因，我们对 2012 年全国门诊医疗调查（NAMCS）医生诱导访谈中医生水平数据进行了描述性评估，该调查是一项针对基层医疗机构医生的全国代表性调查（ = 5622 名，加权应答率 = 59.7%）。美国。医生向患者推荐或不推荐以下四种补充性健康疗法的原因：草药和其他非维生素补充剂、整脊/顺势疗法、针灸和身心疗法（包括冥想、引导意象和渐进性放松）。描述了按医生性别和医学专业划分的推荐差异。对于这四种补充性健康疗法中的每一种，超过一半的推荐医生表示，他们受到同行评议期刊中的科学证据的影响（范围从整脊/顺势疗法的 52.0%（95%置信区间，CI=47.6-56.3）到草药和其他非维生素补充剂的 71.3%（95%CI=66.9-75.4%））。超过 60%的医生因患者要求而推荐这四种补充性健康疗法中的每一种。与男性医生相比，更多的女性医生报告说，在同行评议期刊中有证据表明推荐草药和非维生素补充剂或整脊/顺势疗法是合理的（草药和非维生素补充剂：78.8%（95%CI=72.4-84.3）vs.66.6%（95%CI=60.8-72.2）；整脊/顺势疗法：62.3%（95%CI=54.7-69.4）vs.47.5%（95%CI=42.3-52.7））。对于这四种补充性健康疗法中的每一种，无论男女医生都认为缺乏感知益处是不推荐的最常见原因。缺乏信息来源被更多的女性医生报告为不推荐草药和非维生素补充剂的原因（31.4%（95%CI=26.8-36.3）vs.23.4%（95%CI=21.0-25.9））。关于基层医疗机构医生决定向患者推荐补充性健康疗法的原因，目前仅有有限的全国代表性数据。更深入地了解影响医生在补充性健康方法决策中的因素，可以为研究人员和教育工作者提供更好的信息，并帮助医生为患者提供基于证据的建议。
