Is there a role for Western herbal medicine in treating cyclic perimenstrual pain and discomfort?

Conventional treatments for cyclic perimenstrual pain and discomfort, while numerous and diverse, have drawbacks including side effects, interference with women's reproductive function and, importantly, failure to address symptoms. Many women turn to herbal medicine to treat a myriad of menstrual symptoms. Clinical evidence supports the efficacy of Vitex agnus-castus but other medicinal herbs typically used by Western herbalists for treating menstrual symptoms are unsupported by clinical trials. This raises concerns around the efficacy and safety of these herbs. Women's treatment options need to be extended and individualised, where current conventional strategies fail, requiring appropriate clinical trials of potentially useful herbal medicines.

Primary care practitioner perceptions and attitudes of complementary medicine: a content analysis of free-text responses from a survey of non-metropolitan Australian general practitioners.

AimThis study examines GP perceptions, attitudes and knowledge of complementary medicine (CM), and to understand contextual factors that influence these perceptions, attitudes and knowledge. BACKGROUND: CM use is increasing, and its influence on primary care becoming increasingly significant. Although general practitioners (GPs) often have central primary care gate-keeper roles within health systems, few studies have looked specifically at GPs' perceptions, attitudes and knowledge of CM. METHODS: A questionnaire was mailed to all 1486 GPs registered as practicing in non-metropolitan areas of New South Wales. The survey included one free-text qualitative question, where respondents were invited to highlight issues associated with CM in their own words. Free-text responses were analyzed qualitatively using thematic analysis.FindingsIn total, 585 GPs responded to the survey (adjusted response rate 40.1%), with 152 (26.0%) filling in the free-text question. Central themes which emerged were risk as a primary concern; opposition to, resistance to and the inappropriateness of complementary therapies; struggles with complexity and ambivalent tolerance. CONCLUSION: GPs in Australia have a wide variety of perceptions toward CM. A minority of GPs have absolute views on CM, with most GPs having numerous caveats and qualifications of individual CM. Efficacy is only one aspect of CM critically evaluated by GPs when gauging support for individual therapies - risk, alignment with medical principles and an openness to exploring new avenues of treatment where others have failed, all appear to be equally important considerations when GPs form their views around CM.

Health care utilization among young Australian women with severe tiredness: Results from the Australian Longitudinal Study on Women's Health (ALSWH).

In this article, we explore the use of health services and self-prescribed treatments among 8088 young Australian women with severe tiredness. Data were obtained from the Australian Longitudinal Study on Women's Health. The prevalence of severe tiredness was 49.2%. The frequency of visits to healthcare practitioners was greater among women who sought help for their severe tiredness, compared to women who did not seek help for their severe tiredness or who did not report severe tiredness. Given the impact of this health problem on Australian women, we call for further research on the optimal treatment for severe tiredness.

A critical review of manual therapy use for headache disorders: prevalence, profiles, motivations, communication and self-reported effectiveness.

BACKGROUND: Despite the expansion of conventional medical treatments for headache, many sufferers of common recurrent headache disorders seek help outside of medical settings. The aim of this paper is to evaluate research studies on the prevalence of patient use of manual therapies for the treatment of headache and the key factors associated with this patient population. METHODS: This critical review of the peer-reviewed literature identified 35 papers reporting findings from new empirical research regarding the prevalence, profiles, motivations, communication and self-reported effectiveness of manual therapy use amongst those with headache disorders. RESULTS: While available data was limited and studies had considerable methodological limitations, the use of manual therapy appears to be the most common non-medical treatment utilized for the management of common recurrent headaches. The most common reason for choosing this type of treatment was seeking pain relief. While a high percentage of these patients likely continue with concurrent medical care, around half may not be disclosing the use of this treatment to their medical doctor. CONCLUSIONS: There is a need for more rigorous public health and health services research in order to assess the role, safety, utilization and financial costs associated with manual therapy treatment for headache. Primary healthcare providers should be mindful of the use of this highly popular approach to headache management in order to help facilitate safe, effective and coordinated care.

A cross-sectional analysis of traditional medicine use for malaria alongside free antimalarial drugs treatment amongst adults in high-risk malaria endemic provinces of Indonesia.

BACKGROUND: The level of traditional medicine use, particularly Jamu use, in Indonesia is substantial. Indonesians do not always seek timely treatment for malaria and may seek self-medication via traditional medicine. This paper reports findings from the first focused analyses of traditional medicine use for malaria in Indonesia and the first such analyses worldwide to draw upon a large sample of respondents across high-risk malaria endemic areas. METHODS: A sub-study of the Indonesia Basic Health Research/Riskesdas Study 2010 focused on 12,226 adults aged 15 years and above residing in high-risk malaria-endemic provinces. Logistic regression was undertaken to determine the significant associations for traditional medicine use for malaria symptoms. FINDINGS: Approximately one in five respondents use traditional medicine for malaria symptoms and the vast majority experiencing multiple episodes of malaria use traditional medicine alongside free antimalarial drug treatments. Respondents consuming traditional medicine for general health/common illness purposes every day (odds ratio: 3.75, 95% Confidence Interval: 2.93 4.79), those without a hospital in local vicinity (odds ratio: 1.31, 95% Confidence Interval: 1.10 1.57), and those living in poorer quality housing, were more likely to use traditional medicine for malaria symptoms. CONCLUSION: A substantial percentage of those with malaria symptoms utilize traditional medicine for treating their malaria symptoms. In order to promote safe and effective malaria treatment, all providing malaria care in Indonesia need to enquire with their patients about possible traditional medicine use.

Acute heart failure admissions in New South Wales and the Australian Capital Territory: the NSW HF Snapshot Study.

OBJECTIVE: The primary aim of the NSW Heart Failure (HF) Snapshot was to obtain a representative cross-sectional view of patients with acute HF and their management in New South Wales and Australian Capital Territory hospitals. DESIGN AND SETTING: A prospective audit of consecutive patients admitted to 24 participating hospitals in NSW and the ACT with a diagnosis of acute HF was conducted from 8 July 2013 to 8 August 2013. RESULTS: A total of 811 participants were recruited (mean age, 77 ± 13 years; 58% were men; 42% had a left ventricular ejection fraction ≥ 50%). The median Charlson Comorbidity Index score was 3, with ischaemic heart disease (56%), renal disease (55%), diabetes (38%) and chronic lung disease (32%) the most frequent comorbidities; 71% of patients were assessed as frail. Intercurrent infection (22%), non-adherence to prescribed medication (5%) or to dietary or fluid restrictions (16%), and atrial fibrillation/flutter (15%) were the most commonly identified precipitants of HF. Initial treatment included intravenous diuretics (81%), oxygen therapy (87%), and bimodal positive airways pressure or continuous positive airways pressure ventilation (17%). During the index admission, 6% of patients died. The median length of stay in hospital was 6 days, but ranged between 3 and 12 days at different hospitals. Just over half the patients (59%) were referred to a multidisciplinary HF service. Discharge medications included angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (59%), ß-blockers (66%) and loop diuretics (88%). CONCLUSIONS: Patients admitted to hospital with acute HF in NSW and the ACT were generally elderly and frail, with multiple comorbidities. Evidence-based therapies were underused, and there was substantial interhospital variation in the length of stay. We anticipate that the results of the HF Snapshot will inform the development of strategies for improving the uptake of evidence-based therapies, and hence outcomes, for HF patients.

Longitudinal analysis of associations between women's consultations with complementary and alternative medicine practitioners/use of self-prescribed complementary and alternative medicine and menopause-related symptoms, 2007-2010.

OBJECTIVE: This study aims to determine associations between consultations with complementary and alternative medicine (CAM) practitioners/use of self-prescribed CAM and menopause-related symptoms. METHODS: Data were obtained from the Australian Longitudinal Study on Women's Health. Generalized estimating equations were used to conduct longitudinal data analyses, which were restricted to women born in 1946-1951 who were surveyed in 2007 (survey 5; n = 10,638) and 2010 (survey 6; n = 10,011). RESULTS: Women with menopause-related symptoms were more likely to use self-prescribed CAM but were not more likely to consult a CAM practitioner. Overall, CAM use was lower among women who had undergone hysterectomy or women who had undergone oophorectomy, compared with naturally postmenopausal women, and decreased with increasing age of postmenopausal women. Weak associations between CAM use and hot flashes were observed. Women experiencing hot flashes were more likely to consult a massage therapist (odds ratio, 1.09; 95% CI, 1.00-1.20) and/or use self-prescribed herbal medicines (odds ratio, 1.13; 95% CI, 1.03-1.23) than women not experiencing hot flashes. CONCLUSIONS: Consultations with CAM practitioners and use of self-prescribed CAM among naturally or surgically postmenopausal women are associated with menopause-related symptoms. Our study findings should prompt healthcare providers, in particular family medicine practitioners, to be cognizant of clinical evidence for CAM typically used for the management of common menopause-related symptoms in their aim to provide safe, effective, and coordinated care for women.

Association between use of self-prescribed complementary and alternative medicine and menopause-related symptoms: a cross-sectional study.

OBJECTIVES: To examine the association between self-prescribed complementary and alternative medicine use and menopause-related symptoms, stratified by menopausal status. METHODS: Data were obtained from a cross-sectional survey of a nationally representative sample of 10,011 menopausal women from the Australian Longitudinal Study on Women's Health, conducted in 2010. Multivariable logistic regression models were applied to identify if the use of selected self-prescribed complementary and alternative medicine was significantly associated with a range of menopause-related symptoms. RESULTS: Vitamins/minerals were more likely to be used by natural menopausal women experiencing anxiety (adjusted OR=1.20) and/or stiff/painful joints (adjusted OR=1.16). Yoga/meditation was more likely to be used by women with hysterectomy (adjusted OR=1.76) or natural menopausal women (adjusted OR=1.38) experiencing anxiety. Herbal medicines were more likely to be used by natural menopausal women experiencing anxiety (adjusted OR=1.22), tiredness (adjusted OR=1.20), and/or stiff/painful joints (adjusted OR=1.17), and by women with oophorectomy experiencing tiredness (adjusted OR=1.45). Aromatherapy oils were more likely to be used by natural menopausal women experiencing night sweats (adjusted OR=1.25) and by women with hysterectomy experiencing anxiety (adjusted OR=2.02). Chinese medicines were more likely to be used by women with oophorectomy experiencing stiff/painful joints (adjusted OR=4.06) and/or palpitations (adjusted OR=3.06). CONCLUSIONS: Our study will help improve the patient-provider communication regarding complementary and alternative medicine use for menopause, and we conclude that menopausal status should be taken into account by providers for menopause care. The women's experience and motivations of such use warrant further research.

Women's use of herbal and alternative medicines for preconception care.

BACKGROUND: Use of complementary and alternative medicine (CAM), particularly herbal and alternative medicine supplements, for preconception care and fertility management is becoming increasingly common. AIMS: To determine the factors associated with the use of CAMs by women for preconception care. MATERIALS AND METHODS: 412 women who had visited an antenatal 'first visit' clinic situated at a Brisbane obstetric hospital or had visited a private ultrasound clinic in the same city for the purposes of a routinely indicated ultrasound scan in the first trimester were recruited into the study. Data were collected via a cross-sectional questionnaire. RESULTS: Complementary and alternative medicines (not including multivitamins) were used during preconception by 8.3% of women attending for obstetric care. Approximately half (55.8%) of women taking herbal and alternative medicines ceased these medications on discovery of their pregnancy, though fewer (17.4%) ceased taking multivitamin supplements. Baseline characteristics (age, education and income) are not significantly different between CAM users and those who did not take CAMs preconception. The results of statistical analyses showed that only visiting a practitioner to check for health (OR = 2.00; 95% CI: 1.33, 3.00) and trying to lose weight prior to pregnancy (OR = 1.53; 95% CI: 1.00, 2.36) were the key predictors for women using CAM during preconception. CONCLUSIONS: Women do consume CAMs to enhance preconception care to a certain extent, though CAM users remain in the minority. CAM users also tend to cease use once pregnant.

An integrative review of complementary and alternative medicine use for back pain: a focus on prevalence, reasons for use, influential factors, self-perceived effectiveness, and communication.

BACKGROUND CONTEXT: Back pain is the most prevalent of musculoskeletal conditions, and back pain sufferers have been identified as high users of complementary and alternative medicine (CAM). Despite lacking evidence, CAM treatments (e.g., acupuncture, chiropractic, and massage) and CAM products (eg, vitamins, supplements, and aromatherapy oils) for back pain care have become widely available internationally, and CAM use by back pain sufferers has become a significant health service issue. However, to date, there has been no integrative review on CAM use for back pain. PURPOSE: This study aims to conduct an integrative review on CAM use for back pain focusing on prevalence of use, commonly used CAM, characteristics of users, factors influencing decision making, self-perceived effectiveness, and communication with health-care providers. STUDY DESIGN/SETTING: The study is based on an integrative literature review. METHODS: A comprehensive search of international literature from 2000 to 2014 in MEDLINE, CINHAL, AMED, DARE, EMBASE, ExceptaMedica, psycINFO, and SCOPUS databases was conducted. The search was limited to peer-reviewed articles published in English language and reporting empirical research findings on CAM use for back pain. RESULTS: The review reveals a considerable variation in prevalences of CAM use for back pain internationally. Acupuncture, chiropractic, osteopathy, and massage therapy are the commonly used CAM treatments besides a range of self-prescribed CAM, and back pain sufferers use CAM alongside conventional medical treatments. Female gender, chronicity of back pain, and previous exposure to CAM are key predictors of CAM use for back pain as highlighted from the reviewed literature. Family, friends, and recommendation by doctors appear to influence decision making on CAM use for back pain. The review reveals that users of CAM for back pain tend to report CAM as beneficial, but there is little knowledge on communication between CAM users with back pain and health-care providers about such use. Existing literature is largely based on the research investigating CAM use for back pain among a range of other health conditions. Further rigorous research is needed to investigate the use of a wider range of CAM treatments, particularly self-prescribed CAM for back pain. CONCLUSIONS: The review findings provide insights for health-care providers and policy makers on the range of CAM treatments used by back pain sufferers. Conventional medical and CAM practitioners should be aware of back pain sufferers' decision making regarding a range of CAM treatments and be prepared to communicate with patients on safe and effective CAM treatments for back pain.

A critical review of traditional medicine and traditional healer use for malaria and among people in malaria-endemic areas: contemporary research in low to middle-income Asia-Pacific countries.

BACKGROUND: Malaria is a leading health threat for low to middle-income countries and around 1.8 billion people in the Southeast Asian region and 870 million people in the Western Pacific region remain at risk of contracting malaria. Traditional medicine/traditional healer (TM/TH) use is prominent amongst populations in low- to middle-income countries and constitutes an important issue influencing and potentially challenging effective, safe and coordinated prevention and treatment strategies around malaria. This paper presents the first critical review of literature on the use of TM/TH for malaria prevention and treatment in low- to middle-income countries in the Asia-Pacific region. METHODS: A comprehensive search of English language, peer-reviewed literature reporting TM and/or TH use for malaria or among people in malaria-endemic areas in low- to middle-income Asia-Pacific countries published between 2003 and 2014 was undertaken. RESULTS: Twenty-eight papers reporting 27 studies met the inclusion criteria. Prevalence of TM/TH use for malaria treatment ranged from 1 to 40.1%. A majority of studies conducted in rural/remote areas reported higher prevalence of TM/TH use than those conducted in mixed areas of urban, semi-urban, rural, and remote areas. Those utilizing TM/TH for malaria are more likely to be: women, people with lower educational attainment, people with lower household income, those with farming occupations, and those from ethnic minorities (identified from only three studies). The majority of adult participants delayed seeking treatment from a health centre or conventional providers while initially practicing TH use. The most common reasons for TM/TH use for malaria across the Asia-Pacific region are a lack of accessibility to conventional health services (due to geographical and financial barriers), faith in traditional treatment, and the perception of lower severity of malaria symptoms. CONCLUSION: This review has provided crucial insights into the prevalence and profile of TM/TH use for malaria. Those managing and providing conventional programmes, treatment and care for malaria in the Asia-Pacific should remain mindful of the possible use of TM/TH amongst community members and patients.

Health-related quality of life of patients after mechanical valve replacement surgery: an integrative review.

BACKGROUND: Heart valve replacement surgery is undertaken to improve cardiac function and health-related quality of life (HRQoL). Mechanical valves are typically used for younger people (aged <65 years). Implantation of these valves comes with life-long health self-management requirements which potentially impact on HRQoL. AIMS: The purpose of this study was to identify the short and long-term impact on HRQoL after mechanical valve replacement surgery. METHODS: Multiple electronic databases were searched for peer-reviewed studies published between 2000-2013, which focused on patients who had mechanical valve replacement, aged <65 years, and used a valid measure of HRQoL. RESULTS: Eight papers were included, all of which used the Short-Form 36 Health Survey (SF-36). Preoperatively, HRQoL was impaired, particularly in the SF-36 health domains of role-physical, physical-functioning, vitality and role-emotional. Postoperatively, most people had positive and sustained HRQoL improvement. In the early postoperative period all data showed significant improvement in at least four of eight health domains (physical function, role-physical, vitality, social function). Two-thirds of people also had significant improvement in an additional two health domains (general and mental-health). Whilst most people sustained HRQoL over time, one-third of younger adults (age <24 years) showed impairment in three domains (physical-function, mental-health and general-health). CONCLUSIONS: Mechanical valve replacement surgery results in important and sustained improvements in HRQoL. Future research should include investigation of HRQoL outcomes after mechanical valve replacement for specific groups such as younger adults and people in developing countries, and include evaluations of the potential impact of valve-specific factors and health self-management requirements.

Complementary/alternative and conventional medicine use amongst menopausal women: results from the Australian Longitudinal Study on Women's Health.

Large population-based studies of complementary and alternative medicine (CAM) and conventional medicine use amongst menopausal women are lacking. This study helps address this gap by analysing data from a nationally representative sample of 10011 Australian women aged 59-64 years. Overall, 39% of menopausal women consulted CAM practitioners, 75% used self-prescribed CAM, 95% consulted general practitioners (GP) and 50% consulted specialists during the previous year, and 12% were current hormone replacement therapy (HRT) users. Our findings suggest that CAM is a significant healthcare option utilized by women to treat menopausal symptoms, and so requires attention from GPs and specialists.

The interface with naturopathy in rural primary health care: a survey of referral practices of general practitioners in rural and regional New South Wales, Australia.

BACKGROUND: Naturopathy forms an increasingly significant part of the Australian healthcare setting, with high utilisation of naturopaths by the Australian public and a large therapeutic footprint in rural and regional Australia. However, despite these circumstances, there has been little exploration of the interface between naturopathy providers and conventional primary health care practitioners in rural and regional Australia. The study reported here examined the referral practices and factors that underlie referral to naturopaths amongst a sample of rural and regional Australian general practitioners (GPs). METHODS: A 27-item questionnaire was sent to all 1,486 GPs currently practising in rural and regional Divisions of General Practice in New South Wales, Australia. RESULTS: A total of 585 GPs responded to the questionnaire, with 49 questionnaires returned as "no longer at this address" (response rate: 40.7%). One-quarter of GPs (25.8%) referred to a naturopath at least a few times per year while nearly half (48.8%) stated that they would not refer to a naturopath under any circumstances. GPs were more likely to refer to a naturopath if the GP: was not initially from a rural area (OR=1.78; 95% CI: 0.95, 3.33); believes in the efficacy of naturopathy (OR=5.62; 95% CI: 2.42, 11.36); has seen positive results from naturopathy previously (OR=2.61; 95% CI: 1.35, 5.05); perceives a lack of other treatment options for their patient (OR=5.25; 95% CI: 2.42; 11.36); uses peer-reviewed literature as their major source of CAM information (OR=3.03; 95% CI: 1.65, 5.55); uses CAM practitioners as a major source of CAM information (OR=6.09; 95% CI: 2.91, 12.72); and does not have an existing relationship with any CAM provider (OR=3.03; 95% CI: 1.53, 6.25). CONCLUSIONS: There is little interaction (both via referrals as well as the development of professional relationships) between the naturopathic and GP communities in rural and regional Australia, with significant levels of both support and opposition for naturopathic referral amongst GPs. The significant presence and high utilisation of naturopathy in rural primary health care, which appears to work in parallel to conventional medical care rather than in conjunction with it, should serve as an impetus for increased research into naturopathy practice, policy and regulation in rural and regional health.

A qualitative study of influences on older women's practitioner choices for back pain care.

BACKGROUND: Back pain is an increasingly prevalent health concern amongst Australian women for which a wide range of treatment options are available, offered by biomedical, allied health and complementary and alternative medicine (CAM) providers. Although there is an emerging literature on patterns of provider utilisation, less is known about the reasons why women with back pain select their chosen practitioner. In this paper we explore the influences on back pain sufferers' decision-making about treatment seeking with practitioners for their most recent episode of back pain. METHODS: Drawing on 50 semi-structured interviews with women aged 60-65 years from the Australian Longitudinal Study on Women's Health (ALSWH) who have chronic back pain, we focus on the factors which influence their choice of practitioner. Analysis followed a framework approach to qualitative content analysis, augmented by NVivo 9 qualitative data analysis software. Key themes were identified and tested for rigour through inter-rater reliability and constant comparison. RESULTS: The women identified four predominant influences on their choice of practitioner for back pain: familiarity with treatment or experiences with individual practitioners; recommendations from social networks; geographical proximity of practitioners; and, qualifications and credentials of practitioners. The therapeutic approach or evidence-base of the practices being utilised was not reported by the women as central to their back pain treatment decision making. CONCLUSIONS: Choice of practitioner appears to be unrelated to the therapeutic approaches, treatment practices or the scientific basis of therapeutic practices. Moreover, anecdotal lay reports of effectiveness and the 'treatment experience' may be more influential than formal qualifications in guiding women's choice of practitioner for their back pain. Further work is needed on the interpersonal, collective and subjective underpinnings of practitioner choice, particularly over time, in order to better understand why women utilise certain practitioners for back pain.

The self-prescribed use of aromatherapy oils by pregnant women.

BACKGROUND: While some studies have reported effectiveness of aromatherapy oils use during labour there is no reported evidence of efficacy or risks of aromatherapy oils use for pregnancy-related symptoms or conditions. A number of aromatherapy oils are unsafe for use by pregnant women yet there is currently no research examining the prevalence and characteristics of women who use aromatherapy oils during pregnancy. AIM: To conduct an empirical study of the prevalence and characteristics of women who use aromatherapy oils during pregnancy. METHODS: The research was conducted as part of the Australian Longitudinal Study on Women's Health (ALSWH), focusing on the nationally representative sample of Australian women aged 31-36 years. Data were collected via a cross-sectional questionnaire (n=8200) conducted in 2009. RESULTS: Self-prescribed aromatherapy oils were used by 15.2% of pregnant women. Pregnant women were 1.57 (95% CI: 1.01, 2.43) times more likely to self-prescribe use of aromatherapy oils if they have allergies or hayfever, and 2.26 (95% CI: 1.34, 3.79) times more likely to self-prescribe use of aromatherapy oils if they have a urinary tract infection (UTI). CONCLUSION: Our study highlights a considerable use of aromatherapy oils by pregnant women. There is a clear need for greater communication between practitioners and patients regarding the use of aromatherapy oils during pregnancy, as well a need for health care practitioners to be mindful that pregnant women in their care may be using aromatherapy oils, some of which may be unsafe.

Critical review of complementary and alternative medicine use in menopause: focus on prevalence, motivation, decision-making, and communication.

OBJECTIVE: This study aims to undertake the first critical review of complementary and alternative medicine (CAM) use among menopausal women (a term here used to include premenopausal, perimenopausal and postmenopausal women) by focusing on the prevalence of CAM use and CAM users' characteristics, motivation, decision-making, and communication with healthcare providers. METHODS: A comprehensive search of 2002-2012 international literature in the Medline, CINAHL, AMED, and SCOPUS databases was conducted. The search was confined to peer-reviewed articles published in English with abstracts and reporting new empirical research findings regarding CAM use and menopause. RESULTS: A considerable level of CAM use was observed among women in menopause. Many menopausal women use CAM concurrently with their conventional medicine. However, communication regarding CAM between menopausal women and healthcare providers seems less than optimal, with a demand for further information on the safety and efficacy of medicines. Existing literature is of variable methodological rigor, often presenting small sample sizes and low-quality data collection. Further rigorous research on this topic-including quantitative and qualitative methods using large national samples, where relevant-is required. CONCLUSIONS: The findings of this critical review provide insights for those practicing and managing health care in this area of women's health. Healthcare providers should prepare to inform menopausal women about all treatment options, including CAM, and should be aware of the possible adverse effects of CAM and potential interactions between CAM and conventional medicine among women in menopause who are under their care.

Health care utilisation and out-of-pocket expenditure associated with back pain: a nationally representative survey of Australian women.

BACKGROUND: Back pain impacts on a significant proportion of the Australian population over the life course and has high prevalence rates among women, particularly in older age. Back pain care is characterised by multiple practitioner and self-prescribed treatment options, and the out-of-pocket costs associated with consultations and self-prescribed treatments have not been examined to date. OBJECTIVE: To analyse the extent of health care practitioner consultations and self-prescribed treatment for back pain care among Australian women, and to assess the self-reported costs associated with such usage. METHODS: Survey of 1,310 women (response rate 80.9%) who reported seeking help for back pain from the '1946-51 cohort' of the Australian Longitudinal Study on Women's Health. Women were asked about their use of health care practitioners and self-prescribed treatments for back pain and the costs associated with such usage. RESULTS: In the past year 76.4% consulted a complementary and alternative practitioner, 56% an allied health practitioner and 59.2% a GP/medical specialist. Overall, women consulted with, on average, 3.0 (SD = 2.0) different health care practitioners, and had, on average, 12.2 (SD = 9.7) discrete health care practitioner consultations for back pain. Average self-reported out-of-pocket expenditure on practitioners and self-prescribed treatments for back pain care per annum was AU$873.10. CONCLUSIONS: Multiple provider usage for various but distinct purposes (i.e. pain/mobility versus anxiety/stress) points to the need for further research into patient motivations and experiences of back pain care in order to improve and enhance access to and continuity of care. Our results suggest that the cost of back pain care represents a significant burden, and may ultimately limit women's access to multiple providers. We extrapolate that for Australian working-age women, total out-of-pocket expenditure on back pain care per annum is in excess of AU$1.4 billion, thus indicating the prominence of back pain as a major economic, social and health burden.

Referral to massage therapy in primary health care: a survey of medical general practitioners in rural and regional New South Wales, Australia.

OBJECTIVES: Massage therapists are an important part of the health care setting in rural and regional Australia and are the largest complementary and alternative medicine (CAM) profession based on both practitioner numbers and use. The purpose of this study was to survey medical general practitioners (GPs) in rural and regional New South Wales, Australia, to identify their knowledge, attitudes, relationships, and patterns of referral to massage therapy in primary health care. METHODS: A 27-item questionnaire was sent to all 1486 GPs currently practicing in rural and regional Divisions of General Practice in New South Wales, Australia. The survey had 5 general areas: the GP's personal use and knowledge of massage, the GP's professional relationships with massage practice and massage practitioners, the GP's specific opinions on massage, the GP's information-seeking behavior in relation to massage, and the GP's assumptions on massage use by patients in their local areas. RESULTS: A total of 585 questionnaires were returned completed, with 49 survey questionnaires returned as "no longer at this address" (response rate of 40.7%). More than three-quarters of GPs (76.6%) referred to massage therapy at least a few times per year, with 12.5% of GPs referring at least once per week. The GP being in a nonremote location (odds ratio [OR], 14.28; 95% confidence interval [CI], 3.7-50.0), graduating from an Australian medical school (OR, 2.03; 95% CI, 1.09-3.70), perceiving a lack of other treatment options (OR, 2.64; 95% CI, 1.15-6.01), perceiving good patient access to a wide variety of medical specialists (OR, 11.1; 95% CI, 1.7-50.0), believing in the efficacy of massage therapy (OR, 2.75; 95% CI, 1.58-4.78), experiencing positive results from patients using massage therapy previously (OR, 13.95; 95% CI, 5.96-32.64), or having prescribed any CAM previously (OR, 1.83; 95% CI, 1.03-3.27) were all independently predictive of increased referral to massage therapy among the GPs in this study. CONCLUSIONS: There appears to be substantial interface between massage therapy and GPs in rural and regional Australia. There are high levels of support for massage therapies among Australian GPs, relative to other CAM professions, with low levels of opposition to the incorporation of these therapies in patient care.

The profile of women who consult midwives in Australia.

BACKGROUND: There is no Australian data on the characteristics of women who consult with midwives. AIM: To determine the profile of women who consult midwives in Australia. METHODS: This cross-sectional research was conducted as part of the Australian Longitudinal Study on Women's Health (ALSWH). Participants were the younger (31-36 years) cohort of the ALSWH who completed a survey in 2009, and indicated that they were currently pregnant (n=801). The main outcome measure was consultation with a midwife. FINDINGS: Of the 801 women who indicated that they were currently pregnant at the time of the survey, 19%, 42%, and 70% of women in the first, second and third trimesters respectively had consulted with a midwife. Women were more likely to consult a midwife if they: also consulted with a hospital doctor (OR=2.70, 95% CI: 1.66, 4.40); also consulted with a complementary and alternative medicine practitioner (OR=1.94, 95% CI: 1.25, 3.03); were depressed (OR=1.84, 95% CI: 1.03, 3.28); constipated (OR=1.80, 95% CI: 1.04, 3.13); or had been diagnosed or treated for hypertension during pregnancy (OR=2.78, 95% CI: 1.27, 6.09). Women were less likely (OR=0.34, 95% CI: 0.21, 0.56) to consult with a midwife if they had private health insurance. CONCLUSION: Women were more likely to consult with midwives in conjunction with consultations with hospital doctors or complementary and alternative medicine practitioners. Women with private health insurance were less likely to consult midwives. More research is necessary to determine the implications of the lack of midwifery care for these women.