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It is crucial that time of use of alternative medicine is reported in a study as it may have implication for the prevalence of use of alternative medicine reported.

Page | 36 A decline in the prevalence of use of alternative medicine has been reported in the same study carried among the general population. In two previous studies conducted in the general population setting in 1993, 1 in 3 (29%) and six years on in 1999 a subsequent trend study to 41% (Emslie et al., 1996; Emslie et al., 2002) was reported. Also, Thomas et al., (2001) reported 28.3% over the most recent 12 months which increased to 46.6% lifetime use of alternative medicine amongst UK adults visiting at least one therapist or self-care consultant using remedies purchased over the counter. Similarly there was evidence was from a study conducted in Northern Ireland, in which a lifetime prevalence of 47% dropping to 29% within the previous 12 months (McDonough et al., 2007) was reported.

The prevalence of use of alternative medicine reported in patients’ studies had also not been that consistent (Section 2.4, Summary of studies Table 2.4).

The time of use of alternative medicine for individuals could have implication for the prevalence of use of alternative medicine. For example in the general population Emslie et al. (1996) had reported that 56% of the respondents reported that they would consider use, while only a further 36% of those using alternative medicine indicated that they would possibly consider use (Emslie et al., 1996). Similar information was the potential use category in a study of patients, attending a musculoskeletal clinic, who found 63 out of 109 patients using alternative medicine would consider using alternative medicine (Chandola et al., 1999).

Page | 37 Table 2.4 Summary of published studies of prevalence of use of alternative medicine among patients attending a conventional healthcare setting in the UK

Studies by increasing year of publication Sample description and healthcare setting

Sampling Method of data collection Scope of alternative medicine covered Prevalence of use of alternative medicine Prevalent types of alternative medicine Demographic predictors of alternative medicine use

Common indications for using alternative medicine

Sources of recommendation Disclosure of use to healthcare professional Murray and Shepherd, 1993 233 patients (63% of 372 eligible patients) in an inner London general practice managed by three doctors

A series of six age group censuses, including all patients born in one year selected from six decades, 1910- 1960. The six census of age groups were 28, 35, 45, 54, 64 and 70 yrs.

Stage one: Postal questionnaire (brief questionnaire, explanatory letter signed by the GP to all registered patients)

Stage two: 20 extended interviews with registered patients known to be users of alternative treatments Questionnaire listed some of the better known forms of alternative treatment, and respondents were asked to indicate any they had tried

35 (34%) men and 60 (46%) women reported having tried some form of alternative medicine over the previous 10 yrs.

Most commonly used osteopathy (14 5), followed by homeopathy (13 %), massage (11 %), , acupuncture and herbalism (9 %), counselling (7 %), psycho analysis, meditation/ yoga (6 %), aromatherapy ( 3%), reflexology and alexander technique reported together ( 5)

In all age groups up to 64 yrs., women were more likely to have used non-orthodox treatments. Rise in usage with age, which peaks at 45 and thereafter declines. At 70 years, there was only one (male) user. Log linear analysis showed a significant interaction effect between attendance and alternative medicine use (G2 =46.67 with 2 df). There was also significance between these two variables and gender (G2 =18.629 with 2 df), showing that the effect is different in men than women

No significant differences in types of usage by gender or age group

Reasons for use reported for specific: like the use of osteopathy was reported as almost exclusive confined for musculoskeletal problems , massage tried for psychological difficulties and general health improvement as well as pain in the back or limbs, most frequent reason for acupuncture were back pain, headaches and as giving up smoking,.

Herbal and ‘natural’ medicine: coughs, and colds, ear nose and throat problems, skin conditions, asthma, gastrointestinal symptoms were each mentioned by up to 20 % of users.

Aromatherapy was used mainly for the promotion of general health (29 %) and to relief stress (43 %0) Counselling mainly for depression and anxiety, hypnosis most as an aid to behavioural changes: to give up smoking or to lose weight

Not included Not included

Clarke, 1998 50 patients with psoriasis from Hope Hospital Salford a specialist psoriasis clinic in the UK: 23 female and 27 male patients aged 13 to 79 years

Psoriasis Interview using structured interview Life time prevalence of use of alternative medicine Life-time prevalence 69%(34 patients) had tried 81 alternative medicine

Twenty-six per cent of the alternative

treatments (21) involved the use of sun- light and non-prescription tanning equip- ment. The remainder embraced a wider range of alternative treatments than those reported in other studies.

Not included Not included The most

common sources of information were mass media (21), friends and relatives (27), and own ‘experience’ (13). Ten rec- commendations were from other psoriasis patients and three were from health care professionals. Not included Chandola et al., 1999 166 patients (99%) attending Hospital clinic general rheumatology and orthopaedic (non- fractured) clinics. The actual location was not stated but

All patients attending clinics in the course of one week were invited and those who agreed to participate on same day Interview by means of structured questionnaire Types of therapies that had being considered (no further details was provided)

47 (28%) had tried out the chosen therapy 63 (39%) of the patients had considered the use of complementary therapies for their

Acupuncture, homeopathy, osteopathy and herbal therapy were the most popular types of treatments to be considered

Bivariate analysis: Patients of female gender (P=0.009) and those who expressed dissatisfaction with current therapies (P=0.01) emerged as most likely to have considered complementary

Not included

Except inquiry about use of complementary medicine for rheumatologic complaint

Advice from friends and relatives was the second most commonest reason for considering complementary therapies

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author addressed was London. Mean age (year) 50.4 (range 17-90) Female 103 (62%) White 121 (73%)

conditions medicine. Other variables did not show any significant differences between the two groups. In multivariable logistic regression model of analysis, both gender (odds ratio 2.738, 95% confidence interval 1.33- 5.64) and dissatisfaction (odds ratio 2.67, 95% confidence interval 1.32-5.41) remained independently associated with the consideration of complementary therapies

97% of those thinking about the use of complementary medicine had gained their information from sources other than healthcare professionals Lewith et al., 2001 162 responses in a 270 distributed questionnaire: 79 (48%) outpatients, 27 (17%) hospice patients and 56 (35%) hospital inpatient (from 270 (60%) questionnaires distributed: 49% from hospice patients, 63% outpatients and 62% inpatients)

Over the age of 18 and were receiving cancer treatment or palliative care as inpatient or outpatient at the Royal South Hants Hospital, Countess Mountbatten House and Oakhaven Hospice Average age of the patients was 59.5 years (range 19- 81) with inpatients averaging 54 years (19-81). 42% were male In the Hospice wards, outpatient department and three inpatient wards the over 3 months

Structured questionnaire distributed by the ward sister to NOTE : study was conducted also by a research nurse

Please put a cross to all therapies you are receiving: Twelve therapies were provided (homeopathy, acupuncture, healing, aromatherapy, reflexology, shiatsu, massage, meditation, relaxation, counselling, music therapy, art therapy, nutritional (vitamin & mineral supplements), Alexander technique) and an option for other

52 of the 162 (32%) respondents indicated they were using currently receiving some form of complementary medicine. Hospice 22 (88%), outpatient 16 (20%), inpatients 14 (25%).

Use of CAM varied in the three areas of patient. There was marked difference between the number of patients receiving CAM in the hospices compared to the outpatient and inpatients. See also sources of recommendation

59 patients would consider using CAM

Five most popular treatments were massage, nutrition, aromatherapy, relaxation and reflexology. Twelve of fourteen types were reported use. Alexander technique and Art therapy were not reported. Patients did not report any additional despite included in questionnaire ‘other please describe’. Nutrition (vitamin and supplement) and homeopathy was the oral administered CAM that was included.

No included.

Other questions were what might limit use and types of therapies they would consider

Not included, but reported expectations of CAM stated by 52 cancer patients: help to feel better, live longer, tolerate other treatment, improve specific symptoms, cure cancer and help in other ways

Not specifically Hospice and inpatients received CAM treatments within the context of their NHS care. Outpatient CAM treatment provided either within or outside the NHS; unfortunately we did not collect this information in relation to outpatient treatment Not included Featherstone et al., 2003 1174 adult patients (77% out of which were 348 incomplete from a total of 1987 eligible patients) from 6 Scottish Practices in the Grampian and Tayside regions Mean age (SD) 54 (17) 74.7% female and 35.3.% male Consecutive patients attending each practice in the same week in September 2000 were invited to complete a postal questionnaire Representative of health centre attenders in the respective practices

Postal questionnaire Complying with recommendations by Harris & Rees to include CAM remedies in prevalence studies- “ complementary and alternative medicines are: Any treatments, self- help techniques or remedies which are out normally provided by doctors and other healthcare professional in the Concerning lifetime use, 71% reported ever using CAM therapies/remedies, 48% had used 1 or more CAM therapies and 64% had used CAM remedies 39% concurrent use of CAM

therapies/remedies (concurrent use was defined as use within the previous month). Of these, 18% had used 1 or more CAM

Not specific, but see prevalence of use of alternative medicine

Significant linear trends in reported CAM use, the proportion of users declining with increasing age (X2_{, P<.005),} lower educational attainment and house old income and women were using CAM significantly more than women

Not included Not included But reported: One practice consistently showed the lowest CAM use; it was an inner-city practice in a deprived are where none of the general practitioners offered CAM

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[National Health service], many different therapies and remedies are available such as...

therapies and 36% had used 1 or more CAM remedies. The proportion of patients reporting concurrent CAM use varied between practices from 23% to 44% Shakeel et al., 2008 430 (from 450 (95%) patients admitted to general cardiothoracic and vascular surgery wards Royal infirmary, Scotland 237 (55%) male and half of the patients over 60 years (n=232; 54%) NOTE: reason for admission was recorded from medical notes Consecutive patients admitted to general cardiothoracic and vascular surgery wards during June and July 2005 (over 8-week period) Reported sample size calculation of 385 patients to detect a 20% prevalence (+- 95% confidence interval of CAM use) Questionnaire: self- administered and the remaining were too frail to complete questionnaires Questionnaire included: a tick-list of 48 common herbal preparations and alternative therapies Types of CAM were broadly categorised as herbal or non- herbal treatment. Of those using CAM, 52% (n=150) had used herbal preparations only, 13% (n=39) used non-herbal treatments and 35% (n=102) used both types of therapy. Number of therapies used ranged from one to 18.

The most commonly used herbal preparations were cod liver oil (n=150) and garlic (n=47); the most commonly used non-herbal therapies were acupuncture (n=39) and massage (n=31) A total of 291 (68%) patients had ever used CAM therapies. Of these, 196 had used CAM in the previous year and 95 had used therapies more than 12 months ago. The prevalence of ‘ever’ CAM use amongst patients admitted to general cardiothoracic and vascular surgery wards was 55%, 6% and 7% respectively

Most commonly used herbal preparations were cod liver oil (n = 150) and garlic (n=47); the most commonly used non-herbal therapies were acupuncture (n=39) and massage (n=31)

Descriptive statistics were used to explore ever versus never use of CAM by demographics, including age, sex, marital status and education (university or college, school qualification only or none). Chi-square tests were used and a P-value of 0.05 was considered statistically significant.

Respondents who reported using CAM use were significantly younger (less than 60 years (P < 0.003)), higher educated and (P < 0.001)more likely to be female (P < 0.001) (OR 3.03; 95% CI 1.95-4.70) and surgical specialty Females were significantly more likely to use three or more therapies (48% versus; P < 0.001), as did younger patients.

Was reported as most commonly cited reason: for use of non-herbal therapies musculoskeletal pain (acupuncture, massage, chiropractor, osteopathy, homeopathy, and spiritual healing), relaxation (aromatherapy, reflexology, yoga, hypnotherapy, and shiatsu), stress (counselling therapy and meditation). Others healing (reiki), general health (dowsing), irritable bowel syndrome (kinesiology). Most commonly cited reason for use of herbal products musculoskeletal problems (Traditional Chinese medicine), bone and joint (cod liver oil), joints (glucosamine), relaxation (Bach flower), and insomnia (valerian). Other herbal products had different most commonly cited reasons for use.

CAM uses learned about these therapies from a variety of sources, including family, or friends (62 %), healthcare professionals (26 %), broadcast media (27 %) from books and the internet (5 %)

Over 60% stated that their GP wa they were using alternative treat

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