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      Knowledge and exposure to complementary and alternative medicine in paediatric doctors: a questionnaire survey

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          Abstract

          Background

          Complementary and alternative medicines are increasingly used by the general population. A survey was conducted to ascertain the knowledge of Complementary and Alternative Medicines (CAMs) amongst paediatric physicians, and whether seniority increases the likelihood of its use being considered in consultations, or of families discussing it.

          Methods

          Anonymous survey of general paediatric doctors in a large inner-city district general hospital (DGH) and tertiary children's centre (TC) using a questionnaire. Statistical analysis was calculated using Minitab.

          Results

          43/49 (88%) questionnaires were returned correctly. 13 (30%, CI 17 – 46%) doctors had personally used CAMs. 24 (56%, CI 40 – 71%) of their families had used CAMs. 13 (30%, CI 17 – 46%) had received formal CAMs education. 21 (49%, CI 40 – 71%) could name a total of 5 types of CAMs. Consultants were significantly more likely to ask about CAM use than middle-grades and juniors (p < 0.05, CI 48 – 93%, 35 – 90%, 8 – 33% respectively) and have had a clinical encounter where they felt it was significant. 32 (74%, CI 59 – 86%) of the clinicians had been asked about CAMs. 33 (77%, CI 61 – 88%) of doctors had successful CAM use reported to them, and 20 (47%, CI 31 – 62%) had failure of CAMs reported to them.

          Conclusion

          CAM use is relatively common in paediatric doctors and their families. They have received little formal CAMs education. Consultants were more likely than juniors to ask about CAM use and have had a clinical encounter where it played a significant part. Around half of all doctors irrespective of grade have been asked about CAMs in a clinical encounter.

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          Most cited references13

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          Use of complementary or alternative medicine in a general population in Great Britain. Results from the National Omnibus survey.

          A representative sample of the adults in England, Scotland and Wales was interviewed to estimate levels of use of complementary or alternative medicines (CAMs) and their socio-economic correlates. The Omnibus survey is a multi-purpose survey carried out in the United Kingdom by the Office for National Statistics on behalf of non-profit making organizations. The survey is carried out in 2 out of 3 months each quarter using a stratified random, probability sample of households. An eight-question module was added to the interview schedule of the survey in March 2001. Topics included practitioner-based use of 23 named CAM therapies in the past 12 months. The resulting data were analysed in conjunction with socio-economic and demographic variables. A response rate of 65 per cent (1794/2761) was achieved. An estimated 10.0 per cent of the population [95 per cent confidence interval (CI) 8.7-11.5 per cent] had received any CAM therapy from a practitioner in the past year. No individual therapy was used by more than 2 per cent of the sample. An estimated 6.5 per cent (95 per cent CI 5.4-7.6) had used one of the five main therapies: acupuncture, homeopathy, chiropractic, osteopathy or herbal medicine. Estimates of CAM use were similar in England, Scotland and Wales. There was a significant positive association between CAM use and non-manual social class (p < 0.002), age left full-time education (p < 0.001), and gross income over pounds sterling 15,600 (p < 0.001). More than half (52 per cent) of the respondents that had used CAM in the past year had not told their general practitioner. Strong correlations between the use of CAM and gross socio-economic indicators are demonstrated in the survey. Repeated national surveys of this type could provide a useful vehicle for collecting information about changing patterns of CAM use on a routine basis.
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            Physicians want education about complementary and alternative medicine to enhance communication with their patients.

            More than one third of patients in the United States use complementary and alternative medicine (CAM); most also visit conventional physicians. There is little information about how physicians and patients discuss CAM. We hypothesized that physicians frequently fielded questions about CAM treatments but felt uncomfortable discussing them owing to a lack of education. To survey physicians to see how they discussed CAM with their patients and what factors influenced discussions and referrals. A total of 751 physicians in the Denver, Colo, area were asked about their experience with CAM and communication about CAM with patients. Analyses were conducted using the SAS system (version 6, 1989; SAS Institute Inc, Cary, NC). Of the 705 deliverable surveys, 302 (43%) were returned: 76% of physicians reported having patients using CAM; 59% had been asked about specific CAM treatments; 48% had recommended CAM to a patient; and 24% had personally used CAM. Physician recommendation of CAM was most strongly associated with physician self-use (odds ratio, 6.98; P<.001). Few physicians felt comfortable discussing CAM with their patients, and the overwhelming majority (84%) thought they needed to learn more about CAM to adequately address patient concerns. Education about CAM modalities is a significant unmet need among Denver physicians, and education may help alleviate the discomfort physicians have when answering patients' questions about CAM. Physicians who use CAM treatments themselves are much more likely to recommend CAM for their patients than physicians who do not.
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              Use of complementary and alternative medicine by children in the United States.

              Current estimates of pediatric complementary and alternative medicine (CAM) use range from 10% to 15%. These estimates are derived from children sampled at health care facilities, with chronic conditions, and/or from countries other than the United States. To provide a population-based estimate of the prevalence of pediatric CAM use in the United States. We used the 1996 Medical Expenditure Panel Survey (MEPS), a nationally representative survey of the noninstitutionalized US population. The survey asks parents if their children used alternative care practitioners within the previous year. Our analysis included children younger than 18 years and accounted for the complex sampling design of MEPS. Weighted for the US population, pediatric CAM use was 1.8% (95% confidence interval, 1.3%-2.3%). Participants who used CAM were found in each age category, and the mean age was 10.3 years; 76.8% were white, 54% were female, 32% lived in the West, 66% lived in a metropolitan statistical area, and 36% lived at 100% to 199% of the poverty level. Bivariate chi2 analysis shows that CAM use increased with age (P =.006) and was twice as common in children not living in a metropolitan statistical area (P =.02). The use of CAM among US children, as measured by the MEPS, is far less prevalent than has previously been asserted. With such disparate estimates, future CAM research efforts would benefit from a consensus regarding what practices constitute CAM and how these practices should be measured.
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                Author and article information

                Journal
                BMC Complement Altern Med
                BMC Complementary and Alternative Medicine
                BioMed Central
                1472-6882
                2007
                29 November 2007
                : 7
                : 38
                Affiliations
                [1 ]Department of General Paediatrics, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham, B9 5SS, UK
                [2 ]Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6 NH, UK
                Article
                1472-6882-7-38
                10.1186/1472-6882-7-38
                2219994
                18021390
                0b5735a0-add1-4d3c-b8fa-46784e78d0eb
                Copyright © 2007 Fountain-Polley et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 13 September 2007
                : 29 November 2007
                Categories
                Research Article

                Complementary & Alternative medicine
                Complementary & Alternative medicine

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