282649
Complementary and alternative medicine (CAM) use and its disclosure to providers among ethnically diverse safety net patients with diabetes in san francisco
Margaret Handley, PhD, MPH,
Department of Medicine, Division of General Internal Medicine, University of California San Francisco, San Francisco, CA
Maria Chao, DrPH,
Department of Medicine, Division of General Internal Medicine, University of California San Francisco, San Francisco, CA
Judy Quan, PhD,
Department of Medicine, Division of General Internal Medicine, University of California San Francisco, San Francisco, CA
Urmimala Sarkar, MD, MPH,
Department of Medicine, Division of General Internal Medicine, University of California San Francisco, San Francisco, CA
Neda Ratanawongsa, MD, MPH,
Department of Medicine, Division of General Internal Medicine, University of California San Francisco, San Francisco, CA
Catalina Soria,
Department of Medicine, Division of General Internal Medicine, University of California San Francisco, San Francisco, CA
Dean Schillinger, MD,
Center for Vulnerable Populations and Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA
Background: Explicit knowledge of CAM use can help clinicians and patients make informed treatment plans. However, CAM use among patients with chronic illnesses is poorly understood, as is the extent to which CAM use is self-disclosed to providers. Objective: To report the prevalence of CAM use and disclosure to providers among ethnically diverse safety-net patients with diabetes enrolled in a diabetes self-management support program. Methods: Within a Medicaid managed care program providing language-concordant health coaching to patients with poorly controlled diabetes, the San Francisco Health Plan's Smart Steps Program enrolled 362 participants between 2009-2011. Six and twelve month telephone interviews collected self-reported CAM use in the preceding 30 days, based on a 12-domain validated instrument in English, Spanish and Cantonese. Results: Seventy-seven percent (n=278) of participants completed follow-up interviews including demographics and CAM use. Participants were predominantly Asian (60.1%) or Latino (22.6%), female (74.1%), and non-English-speaking (71.9%). Mean age was 55 years, with a mean of 7.0 years with diabetes. Any CAM use was reported by 51.4% of participants. Specific modalities included: vitamins/nutritional supplements (25.9%), natural remedies/herbs (24.5%), massage/acupressure (11.5%), and meditation/yoga/tai chi (10.4%) at a median monthly cost of $33 (range 0-$1200). Nearly a third (30.0%) used CAM specifically for diabetes; 47.2% did not disclose CAM use to a clinician, for reasons including no one asked' and didn't think they needed to know'. Conclusions: CAM use is common among this diverse safety net population, for general health and for diabetes, but disclosure to clinicians is incomplete. Barriers to disclosure should be explored to improve health communication around diabetes care.
Learning Areas:
Chronic disease management and prevention
Communication and informatics
Diversity and culture
Social and behavioral sciences
Learning Objectives:
Describe complementary and alternative medicine (CAM) use and its disclosure to providers among ethnically diverse safety net patients with diabetes enrolled in a diabetes self-management support program in San Francisco.
Keyword(s): Alternative Medicine/Therapies, Diabetes
Presenting author's disclosure statement:Qualified on the content I am responsible for because: I have been a co-investigator on this project for several years and have conducted the epidemiolgical and statistical analysis, written the survey items, and written the abstract.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines,
and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed
in my presentation.
