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908 PA R T V / Health Promotion and Disease Prevention
11
faculty. Fontaine suggests that nurses’ CAM use is related to the queried nonemergent patients visiting the emergency department
profession’s emphasis on self-care. of a major metropolitan medical center in the Western United
States. 18 Most patients were using some type of CAM, but less
CAM Use for Cardiovascular Health than half of those patients had mentioned this usage to their pri-
mary care provider; this is notable in that the sampling method
Patients with cardiovascular disease commonly use CAM ap- produced only subjects in the process of seeking conventional
proaches to treat their conditions, treat a coexisting noncardiovas- health care services. Another study, a survey of adults aged 50
cular problem, or for health promotion. Saydah and Eberhardt 12 years and older, revealed that only one in five CAM users had dis-
evaluated 2002 NHIS data to identify CAM use patterns among cussed their CAM usage with their providers. 19
chronically ill adults. They found that having a chronic illness di- Rationales for nondisclosure of CAM practices include the fol-
agnosis increased the likelihood that adults would use CAM. lowing: the provider does not need to know; the patient had not
Nearly half of adults with cardiovascular disease (46.4%) and seen their provider since starting the CAM treatment; the patient
more than half of adults with two or more chronic diseases (55%) did not think of telling the provider; the provider never asked; the
9
reported using CAM. Xu and Farrell evaluated survey data from patient perceived that the provider would not take the CAM ap-
46,673 persons; hypercholesterolemia and hypertension were proach seriously or would disapprove; there was insufficient time
among the top 10 conditions or diseases of persons using CAM. during the visit; and the provider lacked knowledge about
19
18
Using 2002 NHIS data, Bell et al. 13 noted that of those with hy- CAM. In the Brown study of patients aged 50 years and older,
pertension, less than 10% were using CAM to treat that condi- the few who had discussed CAM usage with their providers initi-
tion; rather, they sought other health improvements. ated the topic themselves.
In a telephone questionnaire, patients in a Canadian cardio- Patients who reported speaking to their physicians about CAM
19
vascular disease registry reported much higher CAM use than has asked specific questions. In Brown’s study, it was found that only
been reported in the United States: 64% of those surveyed used the minority of patients discussed CAM with their providers, but
CAM; most commonly used were herbal remedies and nutritional those who did sought specific advice. They sought CAM recom-
supplements. Acupuncture was used by 12% and chiropractic care mendations and had questions about CAM therapy effectiveness,
19
by 11% of the patients. Most cardiac patients were using CAM medication interactions, and safety of a CAM therapy. The ma-
treatments for cardiac or vascular disease, but some were using the jority of Brown’s subjects reported that they turned to family or
treatments for noncardiac conditions such as arthritis or psycho- friends for information and advice about CAM use rather than
logical symptoms. Patients generally reported believing that the talking to a health care professional. 19
treatments were safe, proven effective, and that their health was The common use of CAM as a complement to conventional
improving because of the treatments. 14 health practices, the increased use of multiple prescription drugs,
9
Xu and Farrell noted that patients with elevated cholesterol and the reluctance of patients to discuss their CAM practices with
commonly used nutritional (33%), herbal (32%), and massage their health care providers leaves patients vulnerable to poor
(28%) remedies. Those with hypertension reported using spiritual health outcomes related to drug interactions, side effects, or other
(31%), herbal (31%), and nutritional (26%) modalities. Another problems.
survey revealed that those individuals with hypertension com-
monly used nutritional supplements (coenzyme Q10, vitamin E),
herbal products (hawthorn), and relaxation techniques. 4 WHOLE MEDICAL SYSTEMS
Ai and Bolling 15 conducted a telephone survey of mixed gen-
der middle-aged and older patients on the day before scheduled Whole medical systems include multiple approaches and use var-
cardiac surgery to elicit information about CAM use. Of 225 pa- ious modalities to maintain or restore health. Some whole medical
tients, more than 80% used CAM. Most commonly used ap- systems (e.g., Ayurveda, TCM, Traditional Native American
proaches were relaxation techniques, lifestyle/diet modification, Healing, Traditional Korean Medicine) are based on ancient cul-
megavitamins, spiritual healing, massage, herbal remedies, and tural beliefs and practices of a population group; other whole
imagery. CAM usage was higher in those with more education medical systems (e.g., homeopathy, naturopathy, chiropractic) de-
and in those with better functional status; men and women used veloped concurrently with conventional Western medicine, but
CAM equally. Former cigarette smokers, patients with more co- are based on different principles and beliefs. Many whole medi-
morbidities, and those with heart failure were more likely to use cine systems incorporate beliefs about the mind–body–spirit con-
CAM than those with cardiac arrhythmias or coexisting cere- nection and are inherently holistic in approach. The following
brovascular disease. briefly summarizes some features of several common whole med-
ical systems.
Patient Disclosure of CAM Use
Ayurvedic Medicine (AM)
Many Americans use CAM, but they often do not inform their
primary care providers about their CAM use. 3,12 A small study of Literally, Ayurveda means “science of life.” This traditional medi-
older people, many with cardiac abnormalities, revealed that 35% cine system originated in India thousands of years ago; it is com-
had not told their providers about their CAM use. 16 Another monly practiced in South Asia and is growing in popularity in the
40% of the participants reported that their primary care provider West. Historically, AM was one of the first medical systems to ac-
was aware of the CAM use, but was not supportive. Montbriand 17 knowledge the importance of the mind–body connection. The hu-
reported that most health care providers believe that they are man body is considered a replica of the universe and composed of
aware of their patients’ CAM use, but in actuality only 50% of the same basic matter (earth, water, air, fire, space). Nonmaterial
their elderly patients had informed their providers. Another study aspects of the person include Sattva (consciousness, intelligence),