Abstract
Background
There is growing interest in use of complementary and alternative medicine (CAM) among the general population. Little information is available, however, on CAM use in adults attending an otolaryngology outpatient clinic in the UK.
Objective
The purpose of this article is to study the prevalence and pattern of CAM use among adult patients attending the ear, nose, and throat (ENT) clinic in a UK teaching hospital.
Study design
A cross-sectional study was used.
Subjects and methods
All patients on their primary visit to an ENT clinic were asked to complete an anonymous questionnaire for a 14-week period from October 2005 to January 2006.
Results
Based on 1366 completed questionnaires, 53% (728/1366) were female and 47% (638/1366) were male. Twenty-nine percent (395/1366) were older than 60 years, and 56% (763/1366) were married. Twenty percent (275/1366) had a university education. Sixty-one percent (833/1366) had used CAM, almost 36% in the preceding 12 months. The popular remedies were cod liver oil (368/833), garlic (197/833), cranberry (181/833), aloe vera (176/833), primrose oil (174/833), and Echinacea (163/833). Nonherbal therapies included massage (230/833), acupuncture (186/833), aromatherapy (135/833), chiropractic (121/833), reflexology (119/833), and homeopathy (110/833). Seventeen percent (143/833) used CAM for their current illness. Only 8% (64/833) found CAM ineffective; yet, 57% (473/833) would recommend CAM to others. Fifty-one percent (421/833) failed to inform their primary physician of their CAM use.
Conclusion
Despite concerns over CAM efficacy, safety, and cost effectiveness, use of CAM is popular among patients attending an ENT clinic. Their use is not generally related to their presenting illness. Otolaryngologists should be aware of current trends in CAM use when managing patients, including possible interactions with other medication.
1
Introduction
Complementary and alternative medicine (CAM) is a term that encompasses health-related therapies and disciplines that are not considered to be part of mainstream medical care. Its use continues to grow, and it now represents a significant sector within the health care industry, mainly because of an increase in patient demand and in the number and diversity of providers that now exists .
In the UK, the overall prevalence of CAM use is approximately 25% as compared with 40% in the United States and almost 50% in Australia . This trend is prevalent across many medical and surgical specialties . The reasons for this use are varied and include cost, the nature of the illness (acute vs chronic), sex, age, accessibility of CAM, public perceived safety and efficacy of therapies, failure of conventional medical interventions, dissatisfaction with modern health care, and cultural backgrounds . New trends in CAM are also sensationalized by the media, making it an attractive option to the public .
There was once a dearth of robust scientifically validated evidence to support this increasing trend toward CAM, especially in otolaryngology, but recent attempts have been made at improving the research base of CAM interventions, including objective evaluation through randomized controlled trials . The reason this has been slow to evolve is in part because of the current legislation that does not require CAM therapies to go through the rigorous clinical testing that conventional medicines must do before marketing and merchandising to the public. Consequently, CAM practitioners have been accused of practicing opinion-based medicine as opposed to evidenced-based medicine . Indeed, there is concern about the safety profiles of some of the therapies they offer .
With an estimated 50 000 CAM practitioners in the UK, 10 000 of whom are registered health care professionals, it is vital that further knowledge is obtained if primary adverse effects related to CAM and secondary adverse effects related to interactions with conventional medicines and surgery are to be avoided . Oftentimes, health providers are unaware of such interactions or, indeed, that patients are taking herbal medicines when administering conventional drugs. With this in mind, this study was designed to estimate the use of CAM in a sample of patients attending a general otolaryngology outpatient setting.
3
Setting
This study was conducted in the Otolaryngology Outpatient Department (OPD) of the Aberdeen Royal Infirmary, Aberdeen, Scotland. This is a UK teaching hospital in an urban setting and provides secondary and tertiary health care to the population of both the city of Aberdeen and that of the rural northeast of Scotland, an estimated population number of 500 000.
5
Patients and study design
A cross-sectional questionnaire survey study of 1900 consecutive patients attending the ear, nose, and throat (ENT) OPD was undertaken for a 14-week period from October 2005 to January 2006. After verbal consent, patients were asked to fill in an anonymous questionnaire with a covering letter attached. This was done before the patient was seen by the otolaryngologist. Invitations were restricted to English-speaking patients, 16 years or older. A clinic nurse or investigator was always present to provide explanations if needed.
6
Main outcome measures
The questionnaire was composed of a tick list of 49 common herbal preparations and alternative therapies. It also contained a section for demographic data where patients were asked to input their age, sex, marital status, and level of education achieved. Ethnicity was not included. Specific enquiry was also made about their reason for attending the clinic, reason for CAM use, opinion on CAM efficacy, general practitioner (GP) knowledge of their use of CAM, and details on where they had purchased it.
7
Statistical analysis
Data were entered into and analyzed using SPSS (Chicago, IL) for Windows version 13.0 and Microsoft Excel 2003. Descriptive statistics were used to explore “ever vs never” use of CAM by demographics including age, sex, marital status, and occupation. Occupation was used as a guide to the patients’ socioeconomic class. Fisher exact χ 2 tests were used, and a P value of less than .05 was considered statistically significant.
8
Results
8.1
Sample characteristics
Of the 1900 patients who were interviewed via the questionnaire, 1366 completed it (72% response rate). Of those who failed to complete the questionnaire, the most common reason cited was lack of time in the clinic. Of the 1366 patients, 638 (46.7%) were male and 728 (53.3%) were female. Twenty-nine percent (n = 395) of patients were older than 60 years. Most patients (n = 763, 55.9%) gave a marital status of being married. Three hundred seventy-six patients (27.5%) professed to no formal education, whereas 275 patients (20.1%) had a university education ( Table 1 ).
| Demographics | n (%) |
|---|---|
| Sex | |
| Male | 638 (46.7) |
| Female | 728 (53.3) |
| Age (y) | |
| 16–20 | 63 (4.6) |
| 21–30 | 145 (10.6) |
| 31–40 | 198 (14.5) |
| 41–50 | 292 (21.4) |
| 51–60 | 273 (20) |
| >60 | 395 (28.9) |
| Marital status | |
| Single | 273 (20) |
| Married | 763 (55.9) |
| Cohabiting | 116 (8.5) |
| Divorced/separated | 104 (7.6) |
| Widow(er) | 104 (7.6) |
| Missing | 6 (0.4) |
| Education | |
| University or above | 275 (20.1) |
| High school/college (aged 18 y) | 357 (26.1) |
| High school (aged 16 y) | 324 (23.7) |
| None | 376 (27.5) |
| Missing | 34 (2.5) |
8.2
Use of CAM
We found that 61% of patients (n = 833) had used CAM, almost 36% (n = 487) within the past 12 months. Complementary and alternative medicine use tended to be more popular among females (59%, P < .001), but though the middle-aged group (aged 41–60 years) was found to use CAM more frequently than other age groups (65%), this was not found to be significant ( P = .06). We also found that married or cohabiting people were more likely to try CAM (64%, P = .009), and there was a definite linear trend between CAM use and the number of years of education undertaken ( P < .001). Overall, of the patients who had a tertiary education or higher, more were likely to use CAM than not (n = 204, 74%), whereas of those who answered “none” for education, more were likely not to use it (n = 193, 51%) ( Table 2 ).
| Ever user, n = 833 (%) | Never user, n = 531 (%) | Total, n = 1366 | P | |
|---|---|---|---|---|
| Sex | ||||
| Female | 503 (69) | 224 (31) | 727 | <.001 |
| Male | 329 (52) | 308 (48) | 637 | |
| Missing | 2 | |||
| Age | ||||
| ≤40 | 235 (58) | 171 (42) | 406 | .06 |
| 41–60 | 366 (65) | 199 (35) | 565 | |
| >60 | 233 (59) | 161 (41) | 394 | |
| Missing | 1 | |||
| Marital status | ||||
| Single | 146 (54) | 127 (46) | 273 | .009 |
| Married/cohabiting | 561 (64) | 318 (36) | 879 | |
| Divorced/separated/widowed | 123 (59) | 85 (41) | 208 | |
| Missing | 6 | |||
| Education | ||||
| University | 204 (74) | 71 (26) | 275 | <.001 |
| School/college | 436 (64) | 245 (36) | 681 | |
| None | 183 (49) | 193 (51) | 376 | |
| Missing | 34 | |||
8.3
Type of therapy used, reasons for use, and availability
The type of CAM used was divided into either herbal or nonherbal forms of therapy. Two hundred forty-eight patients (30%) used herbal remedies only, 143 (17%) used nonherbal remedies only, and 437 (53%) used both. Five patients said they used CAM but did not report specific forms.
In both forms of therapy, ENT ailments were cited as reasons for CAM use (n = 143, 17%) and were in fact the reason they had attended the OPD, but none of these ailments were within the most common reasons cited. ENT ailments treated with CAM included sinusitis, facial headaches, tinnitus, catarrh, and vertigo.
Of the herbal therapies, cod liver oil, garlic, cranberry, aloe vera, primrose oil, and Echinacea were most commonly cited. General health was the most commonly cited reason that herbal remedies were used ( Table 3 ). Vertigoheel was cited as being used for vertigo in one patient and Gingko biloba for tinnitus in others (n = 17).
| Herbal remedy used | n | Most commonly cited reason for use |
|---|---|---|
| Cod liver oil | 368 | Joints, general health |
| Garlic | 197 | General health, URTI, circulation |
| Cranberry | 181 | UTI |
| Aloe vera | 176 | Skin conditions |
| Primrose | 174 | PMT, general health |
| Echinacea | 163 | URTI, immunity |
| Herbal vitamin supplements | 104 | General health |
| G biloba | 80 | General health, memory |
| St John’s wort | 79 | Depression |
| Ginseng | 68 | General health, energy |
| Chinese herbal remedies | 44 | Joints, general health |
| Soy | 32 | Menopause, general health |
| Senna | 30 | Constipation |
| Valerian | 30 | Insomnia |
| Saw palmetto | 9 | Prostatism |
| Melatonin | 4 | Jet lag |
Massage, acupuncture, and aromatherapy were the most common nonherbal therapies used. The most common reasons for use included backache and stress relief ( Table 4 ). With regard to ENT ailments, acupuncture was used by patients for chronic rhinosinusitis (CRS) (n = 8) and tinnitus (n = 21).
| Nonherbal remedy used | n | Most commonly cited reason for use |
|---|---|---|
| Massage | 230 | Musculoskeletal aches and pains |
| Acupuncture | 186 | Musculoskeletal aches and pains |
| Aromatherapy | 135 | Relaxation and stress relief |
| Chiropractics | 121 | Musculoskeletal aches and pains |
| Reflexology | 119 | Relaxation and stress relief |
| Homeopathy | 110 | Joints and skin conditions |
| Osteopathy | 107 | Musculoskeletal aches and pains |
| Yoga | 87 | General health |
| Bach and flower remedy | 78 | Relaxation and stress relief |
| Reiki | 68 | Musculoskeletal aches and pains |
| Meditation | 52 | Relaxation and stress relief |
| Counseling | 49 | Stress relief |
| Spiritual healing | 36 | General health |
| Hypnotherapy | 35 | Stress relief and smoking cessation |
| Shiatsu | 27 | Musculoskeletal aches and pains |
| Nutritional medicine | 18 | General health |
| Crystal therapy | 16 | Relaxation |
| Traditional Chinese medicine | 16 | Miscellaneous |
| Kinesiology | 12 | Miscellaneous |
| Alexander technique | 11 | Musculoskeletal aches and pains |
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