Complementary and Alternative Medicine Use by Recent Immigrants

Brett White, MD; Monica Zepeda, MPH; Barbara Sarter, PhD, NP; Felix Nunez, MD, MPH; Dennis Mull, MD, MPH; Lyndee Knox, PhD

LA Net 3 rd Annual Provider Forum December 2, 2006

University of Southern California

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 utilization  Are providers uncomfortable asking?

 Patients do not disclose utilization  Provider never asked  Thought it was not important for doctor to know  It was none of the doctor's business  The doctor would not understand  Fear that provider might disapprove of or discourage CAM use

Purpose

 What we want to know  What they are using  What they are using it for  Literature gap  Immigrant 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 contact  Place of birth  Years in U.S.

 If any CAM use within the last year  If 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) 30 25 20 15 10 5 0 Mean = 45.82

Std. Dev. = 13.008

N = 158 20 40

Age

60 80

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 Guatemala United States Nicaragua Other

Total

28 17 5 1 4 163 17.2

10.4

3.1

0.6

2.4

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 products  43 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

Digestive No Illness Nervous Immune Endocrine Circulatory Reproductive Skeletal Urinary Muscular Cardiovascular Other 8 4 3 1 2 18 12 12 10 Frequency (n=108) 51 25 19 Percent (%) 7.4

3.7

2.8

0.9

1.9

47.2

23.1

17.6

16.7

11.1

11.1

9.3

 CAM substances used for many conditions  12 system categories

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

Ruda

Sábila Nopales

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 CAM

more

likely to use 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 discussion  Include 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!

Mercado

in Cuernavaca, Morelos, México

Discussion