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Up to one-half of patients seeing complementary and alternative medicine providers are also seeing conventional physicians

A new study supported in part by the Agency for Healthcare Research and Quality (HS09565 and HS08194) describes the types of patients who visit complementary and alternative medicine (CAM) providers in the United States, the reason for visits, and insurance coverage for them. The study was led by Daniel C. Cherkin, Ph.D., of Group Health Cooperative, Richard A. Deyo, M.D., M.P.H., of the University of Washington, and David M. Eisenberg, M.D., of Harvard University.

The investigators collected data on 20 consecutive visits to randomly sampled licensed acupuncturists, chiropractors, massage therapists, and naturopathic physicians (providers of health care emphasizing natural therapeutics) practicing in four States. They were able to collect data on more than 1,800 visits and at least 99 practitioners in each profession.

More than 80 percent of visits to CAM providers were by young and middle-aged adults, and roughly two-thirds were by women. Children accounted for 10 percent of visits to naturopathic physicians but only 1 to 4 percent of visits to other CAM providers. Only 4 to 12 percent of visits were the result of conventional physician referrals (mostly to acupuncturists).

Chiropractors and massage therapists primarily saw musculoskeletal problems, while acupuncturists and naturopathic physicians saw a broader range of conditions. Typical reasons for visits to CAM providers were back or neck symptoms, anxiety or depression, fatigue, and headache.

About half of visits to acupuncturists and one-third to one-half of visits to naturopathic physicians were for problems that the CAM practitioners believed were concurrently being cared for by conventional physicians. Yet, CAM practitioners had discussed the care of their patients with a conventional physician in only 5 to 15 percent of visits, raising concerns about the coordination and safety of concurrent care. For instance, acupuncturists and naturopathic physicians might prescribe herbs that interact with medications prescribed by conventional physicians. Most visits to chiropractors and naturopathic physicians, but less than one-third of visits to acupuncturists and massage therapists, were covered by insurance.

See "Characteristics of visits to licensed acupuncturists, chiropractors, massage therapists, and naturopathic physicians," by Dr. Cherkin, Dr. Deyo, Karen J. Sherman, Ph.D., M.P.H., and others, in the November 2002 Journal of the American Board of Family Practice 15, pp. 463-472.

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