Attitudes toward integration of complementary and alternative medicine in primary care: perspectives of patients, physicians and complementary practitioners.

OBJECTIVE: Our study explored the attitudes of patients toward complementary and alternative medicine (CAM) use, their family physicians' role regarding CAM, and models for CAM referral and treatment. We compared patients' perspectives regarding integration of CAM into primary care with attitudes of primary care physicians (PCPs) and CAM practitioners. METHODS: We conducted a comprehensive literature review and focus group discussions to develop a questionnaire, which we gave to three groups: a random sample of patients receiving care at an academic family medicine clinic and PCPs and CAM practitioners employed in the largest health maintenance organization in Israel. RESULTS: A total of 1150 patients, 333 PCPs, and 241 CAM practitioners responded to our questionnaire. Compared with PCPs, patients expected their family physician to refer them to CAM, to have updated knowledge about CAM, and to offer CAM treatment in the clinic based on appropriate training. When asked about CAM integration into medical care, more patients expected to receive CAM in a primary care setting compared to PCPs' expectations of prescribing CAM (62% vs. 30%; p=0.0001). Patients, CAM practitioners, and PCPs expected family practitioners to generate CAM referrals in an integrative primary care setting (85.6% vs. 82.4% vs. 62.6%; p<0.0001). Patients supported CAM practitioners providing CAM treatments in the primary care setting, regardless of whether the practitioner held a medical degree (MD). Also, more patients than PCPs or CAM practitioners expected their family physician to provide CAM (28.2% vs. 14.5% vs. 3.8%; p<0.0001). CONCLUSION: Patients, PCPs, and CAM practitioners suggested that family physicians play a central role in CAM referral and, to a lesser extent, that they actually provide CAM treatment themselves. PRACTICE IMPLICATIONS: PCPs need to be aware of their present and future role in informed referral to CAM and, to a lesser degree, in providing CAM in integrative primary care clinics. With the increasing use of CAM, patients may expect their family physician to be more knowledgeable, skillful, and have a balanced approach regarding CAM use. In addition, practitioners should learn how to communicate effectively and better collaborate with CAM practitioners to the benefit of their patients.

How should complementary practitioners and physicians communicate? A cross-sectional study from Israel.

OBJECTIVES: The extensive use of complementary and alternative medicine for patients can complicate dialogue between physicians and complementary and alternative medicine practitioners, but not much data have been collected on the expectations and attitudes of physicians and complementary and alternative medicine practitioners concerning their communication and collaboration. In this study, we compared the results of a cross-sectional survey of both groups to elucidate the attitudes and expectations regarding communication and collaboration. METHODS: Questionnaires were mailed electronically or through the mail to 2532 primary care physicians and 450 complementary and alternative medicine practitioners employed by Clalit Health Services, the largest health maintenance organization in Israel. RESULTS: Questionnaires were returned by 333 physicians (response rate of 13%) and 241 practitioners (response rate of 54%). According to our results, the majority of both groups expressed an interest in clinical practice collaboration (69% and 77% of physicians and practitioners, respectively; P = .043); preferred using a medical letter to communicate with each other; and expected to consult with each other about mutual patients to formulate treatment plans. However, the practitioners were more interested than the physicians in collaborative scientific research (15% vs 42%, respectively; P < .0001) and collaborative medical education (2% vs 27%, respectively; P < .0001). The physicians also supported a physician-guided model of teamwork in clinical practice, whereas the practitioners supported a more collaborative model. CONCLUSIONS: Educational programs for primary care physicians and complementary and alternative medicine practitioners should focus on aspects of communication between the groups and practical methods for writing referral or medical letters.