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Table 1.  
Disclosure of CAM Use by 7493 US Adults in the Past Year, NHIS 2012
Disclosure of CAM Use by 7493 US Adults in the Past Year, NHIS 2012
Table 2.  
Reasons for Not Disclosing Past-Year CAM Use to Primary Care Physicians by 3094 Respondents, NHIS 2012
Reasons for Not Disclosing Past-Year CAM Use to Primary Care Physicians by 3094 Respondents, NHIS 2012
1.
Clarke  TC, Black  LI, Stussman  BJ, Barnes  PM, Nahin  RL.  Trends in the Use of Complementary Health Approaches Among Adults: United States, 2002-2012. Hyattsville, MD: National Center for Health Statistics; February 2015.
2.
Ben-Arye  E, Frenkel  M, Klein  A, Scharf  M.  Attitudes toward integration of complementary and alternative medicine in primary care: perspectives of patients, physicians and complementary practitioners.  Patient Educ Couns. 2008;70(3):395-402.PubMedGoogle ScholarCrossref
3.
Jong  MC, van de Vijver  L, Busch  M, Fritsma  J, Seldenrijk  R.  Integration of complementary and alternative medicine in primary care: what do patients want?  Patient Educ Couns. 2012;89(3):417-422.PubMedGoogle ScholarCrossref
4.
Shelley  BM, Sussman  AL, Williams  RL, Segal  AR, Crabtree  BF; Rios Net Clinicians.  “They don’t ask me so I don’t tell them”: patient-clinician communication about traditional, complementary, and alternative medicine.  Ann Fam Med. 2009;7(2):139-147.PubMedGoogle ScholarCrossref
5.
Frenkel  MA, Borkan  JM.  An approach for integrating complementary-alternative medicine into primary care.  Fam Pract. 2003;20(3):324-332.PubMedGoogle ScholarCrossref
Research Letter
April 2016

Nondisclosure of Complementary and Alternative Medicine Use to Primary Care PhysiciansFindings From the 2012 National Health Interview Survey

Author Affiliations
  • 1Division of Health Policy & Management, University of Minnesota, Minneapolis
  • 2Center for Spirituality & Healing, University of Minnesota, Minneapolis
JAMA Intern Med. 2016;176(4):545-546. doi:10.1001/jamainternmed.2015.8593

Although one-third of US adults report using complementary and alternative medicine (CAM), integration of CAM into the conventional medical system is inconsistent.1 Patients have shown a desire for their primary care physicians to inquire about CAM and refer to CAM practitioners (acupuncturist, massage therapists, etc), but primary care physicians rarely initiate conversations with patients about their use of CAM.2,3 Patients have also expressed concerns about discussing the use of CAM with their physicians, fearing disapproval.4 These communication barriers may prevent CAM from becoming fully integrated into patients’ treatment and self-care routines, especially if patients do not disclose their use of CAM to their primary care physicians. Using data from the 2012 National Health Interview Survey (NHIS), we identified patterns of CAM use in the United States and reasons for its nondisclosure from January 1 through December 31, 2012.

Methods

The NHIS is an annual survey conducted by the National Center for Health Statistics about health and health care use. The 2012 NHIS contains responses from 108 131 individuals in 42 366 households, of whom 34 525 adults completed the Sample Adult component and the Adult Alternative Medicine supplement. Our sample consists of 7493 civilian, noninstitutionalized US adults 18 years and older who completed the CAM supplement and indicated having used CAM during the past 12 months and having a personal primary care physician.

Respondents were asked whether they told their physician about using the CAM modality identified as most important to their health during the previous year. Those who did not were asked whether their nondisclosure was due to one of the following: (1) belief that their physician did not need to know about their CAM use, (2) past discouragement of CAM use by their physician, (3) potential discouragement of CAM use by their physician, (4) a potentially negative response from their physician, (5) doubts concerning their physician’s knowledge about their most used CAM modality, (6) their physician not asking about CAM use, (7) not having time to discuss CAM use during visits with their physician, or (8) not using CAM at the time of their visit.

One- and 2-way tabulations were used to elucidate nondisclosure rates and reasons for nondisclosure according to respondents’ most-used CAM modality. All analyses were weighted to be nationally representative and were done with Stata, version 11.2 (Stata Corp). All analyses were limited to publicly available, deidentified data, which does not meet the definition of human subjects research as determined by the University of Minnesota Institutional Review Board and therefore did not require board review.

Results

Of the 34 525 adults who completed the CAM supplement to the 2012 NHIS, 10 158 (29.6%) reported using CAM at least once in the past year, and 22 765 (66.3%) had a primary care physician. Of 7493 respondents who fit both criteria, 3094 (42.3%) did not disclose the use of their most used CAM modality (Table 1). Nondisclosure was most common among those using yoga (537 [64.7%]) and meditation (312 [64.0%]), and least common among users of herbs and/or supplements (564 [24.9%]) and acupuncture (66 [35.5%]). Nondisclosure was most often due to physicians not asking about CAM (1759 [57.0%]) and respondents believing that physicians did not need to know about their CAM use (1432 [46.2%]), and least often due to past (68 [2.0%]) or potential (96 [2.8%]) discouragement of CAM use by physicians (Table 2).

Discussion

One-third of the US adult population use CAM; however, 42.3% of CAM users do not discuss CAM use with their primary care physicians. Contrary to earlier findings, our results attribute most nondisclosure to physicians not asking about CAM use or to concerns about physician knowledge regarding CAM rather than to physician discouragement or negativity about the use of CAM. Consequently, physicians should consider more actively inquiring about patients’ use of CAM, especially for modalities likely to be medically relevant. Incorporating more education about CAM into medical curricula can better equip physicians to initiate conversations with patients relating to their use. In addition, including CAM physicians in groups such as accountable care organizations can improve communication between physicians and streamline patient records.5 Clinical and organizational incentives that encourage patient disclosure of CAM use may facilitate better coordination of care, reduce the risk of adverse interactions between conventional medications and CAM products, and lead to better patient outcomes.

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Article Information

Corresponding Author: Judy Jou, MA, Division of Health Policy & Management, University of Minnesota, 420 Delaware St SE, MMC 729, Minneapolis, MN 55455 (jouxx008@umn.edu).

Published Online: March 21, 2016. doi:10.1001/jamainternmed.2015.8593.

Author Contributions: Ms Jou had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Both authors.

Acquisition, analysis, or interpretation of data: Both authors.

Drafting of the manuscript: Jou.

Critical revision of the manuscript for important intellectual content: Both authors.

Statistical analysis: Both authors.

Obtained funding: Johnson.

Study supervision: Johnson.

Conflict of Interest Disclosures: None reported.

Funding/Support: This study was supported in part by the Integrative Health & Wellbeing Research Program at the Center for Spirituality & Healing, University of Minnesota.

Role of the Funder/Sponsor: The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

References
1.
Clarke  TC, Black  LI, Stussman  BJ, Barnes  PM, Nahin  RL.  Trends in the Use of Complementary Health Approaches Among Adults: United States, 2002-2012. Hyattsville, MD: National Center for Health Statistics; February 2015.
2.
Ben-Arye  E, Frenkel  M, Klein  A, Scharf  M.  Attitudes toward integration of complementary and alternative medicine in primary care: perspectives of patients, physicians and complementary practitioners.  Patient Educ Couns. 2008;70(3):395-402.PubMedGoogle ScholarCrossref
3.
Jong  MC, van de Vijver  L, Busch  M, Fritsma  J, Seldenrijk  R.  Integration of complementary and alternative medicine in primary care: what do patients want?  Patient Educ Couns. 2012;89(3):417-422.PubMedGoogle ScholarCrossref
4.
Shelley  BM, Sussman  AL, Williams  RL, Segal  AR, Crabtree  BF; Rios Net Clinicians.  “They don’t ask me so I don’t tell them”: patient-clinician communication about traditional, complementary, and alternative medicine.  Ann Fam Med. 2009;7(2):139-147.PubMedGoogle ScholarCrossref
5.
Frenkel  MA, Borkan  JM.  An approach for integrating complementary-alternative medicine into primary care.  Fam Pract. 2003;20(3):324-332.PubMedGoogle ScholarCrossref
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