Jaya K. Rao, MD, MHS; Kimberly Mihaliak, BS; Kurt Kroenke, MD; John Bradley, MD; William M. Tierney, MD; Morris Weinberger, PhD
Acknowledgments: The authors thank the following rheumatologists, who allowed recruitment of their patients for this study: Drs. Mary Rochelle Jacobs and Steven Hugenberg, Division of Rheumatology, Indiana University School of Medicine, Indianapolis, Indiana; Dr. David Batt, Arthritis Care Center, Indianapolis, Indiana; Dr. Douglas Smith, Rheumatology Associates, Indianapolis, Indiana; and Dr. James Ehlich, Eastside Rheumatology, Indianapolis, Indiana. They also thank Maureen Reindl, BS, for assistance with patient recruitment and data collection and Lorrie Mamlin, MPH, for assistance with statistical analyses. This work is dedicated to the memory of Koppaka Visweswara Rao, PhD, DSc, who inspired and encouraged this study.
Grant Support: By the Commonwealth Fund, New York, New York (no. 97066), and the Health Services Research Career Development Program, Department of Veterans Affairs (Drs. Rao and Weinberger). Dr. Rao was a 1996 Picker/Commonwealth Faculty Scholar in Patient-Centered Care.
Requests for Reprints: Jaya K. Rao, MD, MHS, Health Services Research and Development (152), Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC 27705.
Current Author Addresses: Dr. Rao: Health Services Research and Development (152), Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC 27705.
Ms. Mihaliak and Dr. Weinberger: Health Services Research and Development (11H), Roudebush Veterans Affairs Medical Center, 1481 West 10th Street, Indianapolis, IN 46202.
Drs. Kroenke and Tierney: Regenstrief Institute for Health Care, RG-6, 1001 West 10th Street, Indianapolis, IN 46202.
Dr. Bradley: Rheumatology Department, Wishard Hospital M-200, 1001 West 10th Street, Indianapolis, IN 46202.
Use of complementary and alternative medicine (CAM) is common among persons with chronic conditions.
To identify correlates of and describe patients' perspective on use of CAM for rheumatologic conditions.
Three university practices and three private rheumatology practices.
232 of 428 eligible consecutive patients (54%) with scheduled appointments.
Patients answered questions on CAM use, functional status, pain, provider satisfaction, and health services utilization. Chart reviews provided demographic information and rheumatologic diagnoses. Bivariate analyses identified correlates of four CAM outcomes (history, magnitude, and frequency of CAM use and communication about CAM use with a physician), and multiple logistic regression identified independent correlates of regular CAM use.
Approximately two thirds of the respondents (n = 146) had used CAM. Of these 146 respondents, 82 (56%) currently used CAM and 132 (90%) regularly used CAM or had done so in the past. Fifty-five respondents (24%) had used three or more types of CAM. In multivariate analyses, persons who used CAM regularly were more likely to have osteoarthritis (odds ratio, 5.6 [95% CI, 1.9 to 16.8]), severe pain (odds ratio, 2.5 [CI, 1.4 to 4.8]), and a college degree (odds ratio, 2.6 [CI, 1.3 to 5.4]) than patients who had never used CAM. Nearly half of the respondents discussed CAM use with their physicians. The most common reasons for not disclosing CAM use were that the physician had not asked about it and that the patient forgot to tell the physician; fear of disapproval was rarely cited. Discussions about CAM use between patient and physician occurred more frequently among patients with fibromyalgia and persons who regularly used CAM or used several types of CAM.
Patients with rheumatologic conditions frequently use CAM. Severe pain and osteoarthritis predict regular use of CAM but do not predict a greater likelihood of discussing CAM use with physicians. Routine inquiry by physicians will probably detect CAM use.
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Rao JK, Mihaliak K, Kroenke K, Bradley J, Tierney WM, Weinberger M. Use of Complementary Therapies for Arthritis among Patients of Rheumatologists. Ann Intern Med. 1999;131:409-416. doi: 10.7326/0003-4819-131-6-199909210-00003
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Published: Ann Intern Med. 1999;131(6):409-416.
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