Examining the interface between complementary and alternative medicine (CAM) use and provision and rural general practice

Jonathan Wardle (2011). Examining the interface between complementary and alternative medicine (CAM) use and provision and rural general practice PhD Thesis, School of Population Health, The University of Queensland.

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Author Jonathan Wardle
Thesis Title Examining the interface between complementary and alternative medicine (CAM) use and provision and rural general practice
School, Centre or Institute School of Population Health
Institution The University of Queensland
Publication date 2011-11
Thesis type PhD Thesis
Supervisor Professor Jonathan Adams
Professor David Sibbritt
Total pages 263
Total colour pages 4
Total black and white pages 259
Language eng
Subjects 111717 Primary Health Care
1117 Public Health and Health Services
1104 Complementary and Alternative Medicine
Abstract/Summary Background The majority of Australians now use some form of complementary and alternative medicine (CAM). General practice is one branch of medicine where CAM is making its presence felt, with evidence of significant levels of referral from family doctors to CAM practitioners and also a growing level of personal CAM practice amongst GPs. Despite such developments, CAM integration is still an evolving and highly contested practice issue within primary care. This may be particularly relevant in rural areas where it is suggested that CAM use is highest and where issues embracing primary care may be most prevalent. Aim The aim of the project is to examine the practices and perspectives of rural GPs in New South Wales (NSW) regarding patient consumption of CAM, non-conventional practitioner CAM provision and conventional practitioner CAM provision. Methods This project utilises a mixed methodology study design with three stages: 1) A CAM practitioner census of rural NSW Divisions was conducted using data from registration boards and professional associations, and compared to data from NSW Divisions of General Practice. Geographic information system software was used to create maps to compare GP and CAM practitioner numbers in rural NSW. 2) A 27-item questionnaire was developed to explore GPs' assumptions on CAM use by patients in their area; GPs' personal use and knowledge of CAM; GPs' professional relationships with CAM and CAM practitioners; GPs' information seeking behaviours on CAM; GPs' specific opinions on specific CAM and CAM practices; as well as demographic data. The questionnaire was sent to all 1486 GPs in rural NSW Divisions. Questionnaire data was analysed using the statistical software program STATA. Descriptive statistics along with chi-square tests were used to compare categorical variables, ANOVA and student t-tests to compare continuous and categorical variables, and Pearson and Spearman correlation coefficients to compare continuous and categorical variables, respectively. 3) Semi-structured qualitative interviews were conducted with a total of 30 rural NSW GPs drawn from (Stage 2) questionnaire respondents. Questions were open-ended establishing the topic or issue for discussion. Participants were encouraged to talk about topics in their own terms. A systematic approach to data analysis was employed, involving familiarisation, identification of themes, indexing, charting and mapping and interpretation. Results CAM providers form a significant part of the healthcare system in rural NSW, with chiropractors and naturopaths the most dominant CAM practitioners. CAM practitioners outnumbered GPs in 4 Divisions, and did not number less than half GP numbers in any of the 17 Divisions. There was no relationship between GP and CAM practitioner numbers. In Stage 2, 586 questionnaires were returned (40.7% response rate). GPs believed that 49% of their patients were using CAM, though they had only discussed CAM with 20% of their patients. GPs generally had poor self-identified knowledge about all CAM modalities. CAM was prescribed at least weekly by 19% of GPs and at least a few times per year by 72% of GPs. Referrals to CAM practitioners were made weekly by 21% of GPs and at least a few times per year by 83% of GPs. Half of the GPs identified a formal relationship with a CAM provider. GP responses differed significantly amongst CAM modalities, and were generally more favourable to specific CAM therapies than they were for alternative systems of medicine. Interview respondents fell into three ideal types: acceptors, non-acceptors and belligerent tolerators. Acceptors and belligerent tolerators generally did not see CAM as a homogenous entity, whilst non-acceptors did. GPs acknowledged a high impact of CAM on rural general practice. Most GPs were supportive of patient CAM use as long as GPs believed the patient was not being financially, physically or otherwise harmed. Risk dominated GPs' discussions of CAM, with most GPs believing they had a moral authority to protect patients against inappropriate CAM use. Support for patient use of CAM did not translate to support for CAM more generally, and even those supportive of CAM generally thought of it as a "lower level" discipline or practice. Some GPs suggested that rural-specific factors may account for higher CAM use in rural areas, including increased word-of-mouth, the rural population's emphasis on self-reliance and the general inventiveness of rural populations, who were always willing to give something a go, and judge on results. Conclusions CAM has a significant presence and role in rural NSW and a significant impact on rural general practice and primary health care, and as such provides support for further investigation and policy attention in this area. Given the important role that CAM appears to play in rural primary health care, further understanding of CAM use and practice is essential in aiding the informed decision-making of rural practitioners, patients and policy-makers with regards to both CAM and wider conventional care options. Such understandings serve not only to uncover how CAM affects rural primary practice, but may also help to uncover ways to make primary practice increasingly relevant to rural communities.
Keyword complementary medicine
alternative medicine
general practice
primary care
rural health
Additional Notes Following pages should be printed in colour: 66, 72, 77, 79. Following pages should be printed in landscape: 54-56, 78, 91, 237-240

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Created: Fri, 11 May 2012, 17:01:49 EST by Jonathan Wardle on behalf of Library - Information Access Service