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It is important to know for each and every patient what herbal and traditional medicines they may be taking and how they are using them so that we can learn about them and be aware of any possible problems they may be causing.
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University of Southern California
Brett White, MD; Monica Zepeda, MPH; Barbara Sarter, PhD, NP; Felix Nunez, MD, MPH; Dennis Mull, MD, MPH; Lyndee Knox, PhD
LA Net3rd Annual Provider Forum
December 2, 2006
Complementary and Alternative Medicine Use by Recent Immigrants
Background
Selected by LANet members at March 2005 Forum 1 of 3 ideas thought of as important by clinicians
Why South Central Family Health Center?
In immigrant, Latino communities, faith in herbal medicines is very common Reinforced by Spanish language television
We believe that a high percentage of patients are using herbal medicines
Clinicians at the site reported that patients were revealing use of herbal medicines instead of their prescribed medications
Background: Why South Central Family Health Center?
Documented cases of patients having adverse reactions to herbal medicines they were
taking
Conclusion: It is important to know for each and every patient what herbal and traditional medicines they may be taking and how they are using them so that we can learn about them and be aware of any possible problems they may be causing.
Why Important?
Most providers do not ask about utilizationAre providers uncomfortable asking?
Patients do not disclose utilizationProvider never askedThought it was not important for doctor to know It was none of the doctor's businessThe doctor would not understand Fear that provider might disapprove of or
discourage CAM use
Purpose
What we want to knowWhat they are usingWhat they are using it for
Literature gapImmigrant status
Methods: Find a Tool
Literature searches Previously validated surveys (CHBQ, etc.)
Did not address target population issues Length (MA’s should conduct in 3-5 minutes)
Created a survey to meet our needs Informal poll for appropriate terminology in
Spanish• Recommendation to ask about Remedios Caseros,
Medicinas Naturales, Tés, Hierbas
Methods: Survey Development
Drafted survey includes:Identifying data for future contactPlace of birthYears in U.S.If any CAM use within the last yearIf CAM use, what types, for what
condition and where did you get them
Survey Instrument
Survey Results
MA’s at SCFHC administered surveys to patients (April 24- May 6)163 responses
• 79.1% Female
Survey Results
Age range 19 to 85 years (M = 45.8, SD = 13.0)
80604020
Age
30
25
20
15
10
5
0
Fre
qu
ency
Mean = 45.82Std. Dev. = 13.008N = 158
Survey Results
Most of the patients were from Mexico (66.3%), followed by El Salvador (17.2%), and Guatemala (10.4%)
Frequency Percent (%)
Mexico 108 66.3
El Salvador 28 17.2
Guatemala 17 10.4
United States 5 3.1
Nicaragua 1 0.6
Other 4 2.4
Total 163 100.0
Survey Results
On average, of those who immigrated to the United States (n = 150, 92% of sample), they had been in the United States 19.4 years (SD = 10.5)
Survey Results
108 reported using CAM (66.3%)• Excluded OTC
There were no gender differences in CAM usage (p= .24)
Of those who used CAM products43 reported using one product (39.8%)35 reported using two products (32.4%)24 reported using three (22.2%)8 reported using five or more (7.4%)
Survey Results
75 different CAM substances reported as being used by the patients
The most popular products were manzanilla tea (chamomile) and yerba buena
Survey Results: Types of CAM
Herbal (95.4%) Manzanilla, hierba buena, sábila, té de 7 azahares,
ruda, árnica, nopal Orthomolecular (8.3%)
Vitamin B12, calcium, masurium, multivitamins Biologically-based (2.8%)
Liver, hormones, glucosamine Special Diet (1.9%)
Cortislim
Survey Results : Types of CAM
Survey Results: Illnesses & Conditions
CAM substances used for many conditions
12 system-categories
Frequency
(n=108)Percent (%)
Digestive 51 47.2
No Illness 25 23.1
Nervous 19 17.6
Immune 18 16.7
Endocrine 12 11.1
Circulatory 12 11.1
Reproductive 10 9.3
Skeletal 8 7.4
Urinary 4 3.7
Muscular 3 2.8
Cardiovascular 1 0.9
Other 2 1.9
Survey Results
Survey Results:Source of CAM
Most of the CAM products were bought at a store/market (n = 81; 75.0%)
Fifty-three of the products were grown at home (22.5%)
Yerba Buena Sábila Nopales
Ruda
Survey Results:Source of CAM
The rest came from a variety of sources, including out of the country, pharmacies, yerberías, boticas, TV commercials, and from their doctors
Does length of time in US affect usage?
Testing hypothesis: New immigrants are more likely to use CAM than long-term immigrants (10+ years) those born in US This was NOT supported There is no statistical difference in # of patients using
CAM by length of time in US (born, 0-9, 10+) However, there was a slight trend for immigrants here
longer (who by default are older) to be more likely to use CAM
Unable to determine if this is age effect or immigration effect due to small sample size
Next Steps
Further data collection, survey reconstruction, statistical analysis, and discussionInclude more/different questions
Publication
Suggested Outcomes
Develop intervention/tool to improve quality of care regarding CAM use in this population
Reference card for lab coat Ultimate Goal
To improve practice!
Discussion
Mercado in
Cuernavaca,
Morelos,
México