Received date January 05, 2015; Accepted date February 24, 2015; Published date February 27, 2015
Citation: Sharma A, Agrawal A (2015) Complementary and Alternative Medicine (CAM) Use among Patients Presenting in Out-patient Department at Tertiary Care Teaching Hospital in Southern Rajasthan, India - A Questionnaire Based Study. Altern Integr Med 4:187. doi:10.4172/2327-5162.1000187
Copyright: © 2015 Sharma A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.
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Abstract Study background: Use of CAM is increasing not only in adult population, but also in pediatric age groups. Concurrent use of CAM with conventional medicine is also widespread and poses a potential risk of drug interaction. Studies regarding CAM use have been done in other countries, but only few have been reported in India and very few have observed CAM use among patients attending outpatient department of a general hospital. Objective: To find out the pattern of CAM use in patients as well as their attitude and perception regarding CAM therapies. Methods: A cross sectional, observational, questionnaire based study was conducted from May 2013 to May 2014 and included 1000 patients attending OPD of different departments of hospital. A pre-decided questionnaire was provided to them which included thirteen questions for assessment of pattern of CAM use and attitude of patients towards CAM therapy. All data collected were analyzed using appropriate statistical tests. Results: Ayurveda (56%) was the most commonly used CAM therapy followed by homeopathy (34%). 76% patients did not inform their physicians about CAM use. 57.2% patients started using CAM on advice of a relative or friend. 'No or less adverse effects' (69.6%) was the most common reason for CAM preference over conventional medicines. 59% patients were ignorant about the fact that CAM and conventional medicines can interact, and 65.5% patients believed that CAM therapy do not cause any adverse effect. Conclusion: Disclosure rate to concerned physicians about CAM use is low. Patients are largely unaware about the fact that CAM medicines can cause adverse effects and can interact when combined with conventional medicines
CAM; Ayurveda; Conventional medicines; Attitude; Perception
National center for complementary and alternative medicine (NCCAM) defines CAM as a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine . Conventional medicine (allopathic medicine) is medicine as practiced by holders of M.D. and M.B.B.S degrees and by allied health professionals, such as physical therapists, psychologists, and registered nurses. Wide variety of alternative medicine is practiced all over India i.e. Ayurveda, Homeopathy, Unani, Herbal, Chinese, Acupuncture, Yoga etc. In India commonly used CAM therapies have been given official recognition and a separate department was established in 2003 by the Government of India named as ‘AYUSH’.
Use of CAM is increasing not only in adult population, but also in pediatric age groups. According to a survey done by National Institute of Health (NIH) in USA approximately 38% of adults in the United States and 12% of children use some form of complementary and alternative medicine (CAM) . Usually the patients of chronic and intractable diseases end up using CAM after taking conventional medicine, but in some diseases they may use CAM as initial treatment.
There can be many reasons why patients opt for CAM. It has been reported by some studies that conventional healthcare is perceived as ineffective, having too many adverse effects or too expensive [3,4]. However dissatisfaction with conventional system may not be the only reason why patients turn to CAM. Concurrent use of CAM with conventional medicine is also widespread and poses a potential risk of drug interaction. This risk of drug interaction further increases because many a time’s patients do not inform their physician about CAM use. There are also many misconceptions among patients regarding CAM use.
Studies regarding CAM use have been done in other countries, but only few studies have been reported in India [5-7]. Also most of the studies on CAM utilization have focused on special patient group, very few studies have observed CAM use among patients attending outpatient department of a general hospital. Thus this study was planned to find out the pattern of CAM use among patients presenting in outpatient department of a tertiary care teaching hospital in Southern Rajasthan, India, as well as their attitude and perception regarding CAM therapies.
Type of study: This was a cross sectional, observational, questionnaire based study.
Place of study: The study was conducted in a Tertiary Care Teaching Hospital of Rajasthan, India.
Duration of study: 12 months, starts from May 2013 to May 2014.
Sample size: 1000.
Inclusion Criteria: All patients visiting out-patient department of the hospital who were using CAM.
Exclusion Criteria: (1) Patients of age less than eighteen years. (2) All those who denied participation in the study
Procedure: Approval from Institutional Ethics Committee was taken before starting the study.
Patients attending the out-patient department of hospital were randomly contacted personally.
The study was explained to them in brief in a language they can understand. Patients who were using CAM were included in the study.
Consent of participants was taken in written informed consent form. (Appendix 2).
A pre-decided questionnaire was provided to them which included thirteen questions for assessment of pattern of CAM use and attitude of patients towards CAM therapy. They were asked to fill the questionnaire, with the help of the investigator if they were not able to understand it. It required approximately 10 to 15 minutes in filling the questionnaire (Appendix 1).
All data collected were analyzed using appropriate statistical tests.
A total of 1000 patients who were using CAM were recruited in the study. Out of these 435 (43.5%) were males and 565 (56.5%) patients were females. 535 (53.5%) patients belonged to age group 20-40 years, 440 (44%) were from 40-60 years and 80 (08%) patients were of age more than 60 years. 430 (43%) patients were illiterate, 260 (26%) were educated up to senior secondary level, 165 (16.5%) were undergraduate and 195 (19.5%) were postgraduate.
Pattern of CAM use
Ayurveda was most commonly used CAM therapy; out of 1000 patients 560 patients (56%) were using Ayurveda medicines. Second most common CAM therapy used was homeopathy, which was used by 340 (34%) patients. Out of 1000 patients contacted 925 (92.5%) were such who have used CAM in past also. Cardiovascular problems (n=165, 16.5%) were the most common conditions for which CAM was used followed by allergic conditions (n=160, 16%) (Figure 1).
Reporting to concerned physician
760 (76%) patients did not inform to their physician about their CAM use. Only 240 (24%) patients informed to their physician about their CAM use. 635 (63.5%) patients admitted that their physician have asked them about CAM utilization, while 315 (31.5%) patients informed that their physician did not inquire about CAM use. Source of information regarding CAM
572 (57.2%) patients started using CAM on advice of a relative or a friend, while 340 (34%) patients were using CAM on advice of a CAM practitioner. 60 (6%) patients were using CAM after reading CAM related books or other literature (Figure 2).
Preference and reasons
280 (28%) patients preferred CAM over conventional medicine, while 720 (72%) patients gave preference to conventional medicine over CAM therapy.
Among 280 patients who preferred CAM, no or less side effects (69.3%) was the most common reason given followed by low cost (10.7%) (Table 1).
|S. No.||Reason||Patients who preferred CAM therapy over conventional system (n=280)|
|1.||No/less adverse effects||194 (69.28%)|
|3.||Easy to take||16 (5.71%)|
|4.||No relief by conventional treatment||20 (7.14%)|
|5.||Just to explore other option||20 (7.14%)|
Table 1: Table showing frequency of reasons for CAM preference.
Among 720 patients who preferred conventional medicine, no relief by CAM therapy (67.36%) was the most common reason for their preference followed by no or less side effects (22.9%) (Table 2).
|S. No.||Reason||Patients who conventional system over CAM therapy (n=720)|
|1.||No/less adverse effects||165 (22.91%)|
|3.||Easy to take||15 (2.08%)|
|4.||No relief by CAM therapy||485 (67.36%)|
|5.||Any other reason||35 (4.86%)|
Table 2: Table showing frequency of reasons for preference of conventional medicine.
Perception regarding adverse effects and interactions
Out of 1000 patients, 655 (65.5%) believed that CAM therapy do not cause any adverse effect, 45 (4.5%) patients admitted that CAM can also cause adverse effect while 300 (30%) patients were not sure about adverse effect with CAM therapy
Regarding interaction between CAM and Conventional medicines, 590 (59%) patients were ignorant about this fact. 32.5 (32.5%) patients believed that these two therapies do not interact when taken together, while 85 (8.5%) patients said that CAM and Conventional medicines can interact when given together.
In the present study pattern of CAM use and attitude and misconceptions of patients regarding CAM was assessed in patients attending outpatient departments of a general hospital associated with a tertiary care teaching institute of southern Rajasthan, India
Ayurveda (56%) was found to be the most commonly used CAM therapy. This is in consensus with other studies done in India that have also reported ayurveda as the most commonly used CAM therapy . As ayurveda is the indigenous medicine system of India, it is the most commonly used CAM therapy. Homeopathy (34%) was the next commonly used CAM therapy. Other Indian studies have also reported homeopathy as one of the commonly used CAM therapy in India . Studies done in other countries have reported massage, spiritual practices, acupuncture etc. as the most commonly used CAM therapies. Use of CAM therapies varies from country to country depending upon their cultural beliefs and indigenous medicines prevalent e.g. in China, traditional Chinese medicine such as herbal medicine, acupuncture, acupressure, qi gond and t'ai chi chu'an are widely used, while in Japan kampong and acupuncture are commonly used as CAM therapy .
Cardiovascular problems were the most common conditions for which CAM was used followed by allergic conditions. Studies have shown that CAM usage is more in patients suffering from chronic diseases . As common cardiovascular as well as allergic conditions are chronic in nature, high CAM utilization is found in such patients.
76% of patients did not inform their physicians regarding CAM usage. This figure is alarming and is higher than reported by other studies. Other studies have found that about 60% of patients do not disclose their CAM use to concerning physician . This trend can be dangerous as modern medicines and CAM medicines can have potential interactions when taken together and physician’s unawareness can result into serious consequences. Interestingly 63.5% patients admitted that their physician had asked them about CAM usage. This figure is reassuring, but shows that some percentage of patients did not disclose their CAM use even after physician’s questioning. Patients may find it hard to report their CAM use for fear of anticipating a negative response and disapproval from their doctor .
More than half of the patients (57.2%) started CAM on advice of a friend or a relative. Other studies have also reported similar results where CAM therapy was started under influence of some friend or relative [11,12]. Only 34% patients were using CAM on advice of a CAM practitioner. This trend is again undesirable as CAM and modern medicine can interact and there can be adverse effects by CAM therapies, CAM usage should be under guidance of an authorized practitioner.
65.5% patients believed that CAM therapies do not cause any adverse effect or cause minimum adverse effect, while 59% patients were ignorant that CAM and modern medicines can interact. CAM therapies are generally considered devoid of adverse effects by the patients. This is further strengthened by the finding that the most common reason for CAM preference in the present study was ‘no or less side effects by CAM’. However this misconception among patients can be dangerous as many studies have reported that CAM therapies can cause serious adverse effects [8,9]. Thus physicians need to be more vigilant and inquire about CAM; simultaneously there is a need to remove misconceptions in patients regarding adverse effects with CAM therapy. This can be done through awareness campaigns and better establishment of ‘AYUSH’ centers, so that most of the CAM utilization occurs in guidance of authorized practitioners.
There were some limitations in the present study. The study findings could not be applied to general public as the study was limited to patients attending the hospital OPD. Therefore it is recommended that several studies of similar kind especially in community setup need to be conducted to know the extent and pattern of CAM use in the society as well as attitude and perceptions of people towards CAM therapies.
The results of the present study show that Ayurveda is the most commonly used CAM therapy. Disclosure rate to concerned physicians about CAM use is low. Patients are largely unaware about the fact that CAM medicines can cause adverse effects and can interact when combined with conventional medicines. Thus physicians should be more vigilant about CAM utilization of their patients and there is a need to increase awareness among patients regarding safety of CAM.
We acknowledge ICMR as this study was conducted under STS, ICMR.
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