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Care is rarely coordinated for patients with mental disorders seeing both doctors and CAM providers

A new study found that about 20 percent of visits to complementary and alternative medicine (CAM) providers were for mental health problems. About one-third of these patients were receiving concurrent mental health care from a conventional medical provider. Although the treating CAM provider was aware of concurrent medical treatment in 20 to 50 percent of visits, consultation or discussion with the treating conventional medical provider was reported in less than half of these visits. Also, referral to a conventional medical provider following a CAM visit was rare, according to the study which was supported in part by the Agency for Healthcare Research and Quality (HS09565 and HS08194).

Conventional medical providers should ask patients with mental disorders about use of CAM treatment and, when appropriate, make efforts to coordinate care with the CAM provider, suggests Gregory E. Simon, M.D., M.P.H., of Group Health Cooperative in Seattle. Dr. Simon and his colleagues analyzed 8,933 visits to representative samples of acupuncturists, chiropractors, massage therapists, and naturopathic physicians in four States. They examined demographic characteristics, presenting complaints, referral sources, treatments provided, disposition, and other sources of care for the presenting problem.

The proportion of visits for a mental health problem ranged from 7 to 11 percent for acupuncture, massage, and naturopathic physicians (similar to that in conventional primary care) to less than 1 percent for chiropractors. It could not be determined whether the low rate for chiropractic visits was due to a truly low rate of mental health problems or a lower rate of recording those problems by chiropractors. For acupuncturists, massage therapists, and naturopaths, 69 to 87 percent of patients making mental health visits were self-referred. The CAM provider discussed care with a conventional medical provider in 6-20 percent of cases and was aware of concomitant conventional medical care in an additional 10-30 percent of cases. Only 1-5 percent of CAM patients were subsequently referred to conventional providers.

See "Mental health visits to complementary and alternative medicine providers," by Dr. Simon, Daniel C. Cherkin, Ph.D., Karen J. Sherman, Ph.D., and others, in General Hospital Psychiatry 26, pp. 171-177, 2004.

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