Polypharmacy meets polyherbacy: pharmaceutical, over-the-counter, and natural health product use among Canadian adults.

OBJECTIVES: Natural health products (NHP) are increasingly being used to supplement prescription medications (PM) and over-the-counter (OTC) products. The objective of this study was to examine patterns of overall health product use and how these patterns are associated with social and health factors. METHODS: We used direct health measures data from the Canada Health Measures Survey (CHMS) Cycle 1.0 (2007/2009) to examine recent product use among adults aged 18-79 years (n=3,721). Latent class analyses were used to detect use (propensity) and intensity of use among users of all three product types. Associations between social and health covariates and product patterns were examined using linear and multinomial logit regression procedures. RESULTS: Three latent classes of health product use were identified. The largest (43%) was characterized by a high probability of PM and NHP but not OTC use. Class two (37%), in contrast, had a low probability of using any of the three health products. Class three (20%) had a high probability of PM and OTC but not NHP use. Age, gender, immigrant status, household size, co-morbidity, perceived health status, and having a regular doctor were associated with these patterns of use. Analyses of intensity of product use among users revealed seven distinct classes; these were differentiated by age, household size, co-morbidity and weight (BMI status). CONCLUSION: If defining polypharmacy or polyherbacy is based simply on number of health products used, then for Canadians under age 80 neither practice appeared to be widespread. More work needs to be done to define the "poly" in polypharmacy and polyherbacy. This will inform the conversation on appropriate product use, particularly given that about one half of Canadians used medications and NHPs concurrently.

Trends and predictors of publicly subsidized chiropractic service use among adults age 50+.

OBJECTIVES: This article examines trends in and predictors of publicly subsidized chiropractic use from 1991 to 2000, a decade characterized by health care system reforms throughout North America. SAMPLE: The sample included adults age 50+ who visited a publicly subsidized chiropractor in the Canadian province of British Columbia during the study period. DESIGN: Administrative claims data for chiropractic service use were drawn from the Medical Services Plan (MSP) Master file in the British Columbia Linked Health Data resource. The MSP Master file contains claims reported for every provincially insured medical service and supplementary health benefit including chiropractic visits. RESULTS: Joinpoint regression analyses demonstrate that while annual rates of chiropractic users did not change over the decade, visit rates decreased during this period. Predictors of a greater number of chiropractic visits include increasing age, female gender, urban residence, low to moderate income, and use of chiropractic services earlier in the decade. CONCLUSIONS: The trend toward decreasing visit rates over the 1990s both conflicts with and is consistent with findings from other North American chiropractic studies using similar time periods. Results indicating that low and moderate income and advancing age predict more frequent chiropractic service are novel. However, given that lower income and older individuals were exempted from chiropractic service limits during this period, these results suggest support for the responsive nature of chiropractic use to financial barriers.

Self-care dimensions of complementary and alternative medicine use among older adults.

BACKGROUND: There is a lack of understanding about the patterns and rates of CAM use among older adults owing to a lack of research on specific types of CAM. OBJECTIVES: This study examines several dimensions of self-care deemed to be associated with CAM. Unmet health care needs, self-care attitudes, and spirituality are interpreted as health belief structures underlying CAM. METHODS: Logistic regression analysis was used to examine use of three groups of practitioner-based CAM: (a) chiropractic; (b) massage, and (c) acupuncture, homeopathy and/or naturopathy use. We analyze a subsample of 4,401 older adults drawn from the 1996/1997 and 1998/1999 waves of the Canadian National Population Health Survey. RESULTS: The logistic regression analyses indicate that self-care attitude and spirituality represent important predictors of practitioner-based CAM use. The associations for unmet health care needs were not supported. The strongest factors associated with CAM use were the illness context variables, which suggest that measures of need are key factors in leading individuals to seek other forms of health care. DISCUSSION: Practitioner-based CAM use among older adults is influenced by self-care attitude and spirituality, in addition to health status, but to varying degrees depending on the type of CAM. Support of these self-care facets suggests that there is a desire on the part of consumers to exercise choice and to participate in health care decisions when considering CAM.