The CAMELOT study: Complementary therapy use among people with type 2 diabetes or CVD

Transcription

1 Rachel Canaway, Lenore Manderson, Vivian Lin The CAMELOT study: Complementary therapy use among people with type 2 diabetes or CVD 3 October

2 Care seeking, use of complementary & alternative medicine (CAM), and self-management by people with cardiovascular disease (CVD) and / or type 2 diabetes (T2DM): Drivers, costs & benefits

3 Aims Explore social, cultural and economic factors influencing the use of CAMs Investigate relationships between use of CAM, integrative & biomedical therapies Discern whether people with CVD or type 2 diabetes who use CAMs are more successful at sustaining diet & lifestyle modifications Generate information transferable to future health policy and practice

4 The CAMELOT study Mixed methods, multidisciplinary Phase I: In-depth interviews with consumer (x 69) with practitioners (x 20), participant observation Phase II: 2,915 valid surveys from consumer approx 22% response Phase III: Discrete choice experiment All Victorian-based NHMRC funded Data collected

5 CAMELOT investigators Prof Lenore Manderson Chief Investigator Prof Brian Oldenburg Prof Vivian Lin Prof Bruce Hollingsworth A/Prof Maximilian de Courten Rachel Canaway Research Fellow, Manager Jean Spinks Nalika Unantenne Dr Milica Markovic Dr Pauline McCabe Dr Stephen Bunker Partner organisations Chronic Illness Alliance Diabetes Australia Victoria Heart Support Australia Reference group Australasian Acupuncture and Chinese Medicine Association (AACMA) Australian Homoeopathic Association (AHA) Australasian Integrative Medicine Association (AIMA) Australian Naturopathic Practitioners Association (ANPA) Australian Natural Therapists Association (ANTA) Australian Traditional-Medicine Society (ATMS) General Practice Victoria (GPV) Health Issues Centre (HIC) National Herbalists Association of Australia (NHAA)

6 Survey respondents 45% female Average age 65 years (20-96 years) 99% visited doctor in last 12 months 91% had T2DM, 34% CVD, 48% CVD risk factors 76 % lived with spouse, partner or family 75% household income <$75,000 (11% unknown) 67% Australian born (ATSI 0.6%) 67% not working 60% lived in major city 57% highest education was secondary school 37% had private health insurance with Extras

7 Survey respondents locations

8 CAM use 48% used CAM in their lifetime 43% used CAM in last 12 months of these: 95% used CAM product(s) median monthly $30 54% visited CAM practitioner(s) median monthly $20 68% used CAM for chronic condition(s) 51% used CAM to prevent illness, improve health and wellbeing 28% - 37% used CAM for T2DM/CVD 12% given advice from CAM practitioner contradicting doctor Cost had prevented 37% CAM users (ever) & 16% non-users from accessing CAM product/practitioners

9 Comparison of CAM vs non-cam users Little difference in (p>0.5) Income Employment status Where resides (regional or metro) Whether born in Australia Length of time with T2DM/CVD BMI Self reported health (excellent to poor) Frequency GP visits Smoking

10 Predictors of CAM use OR P-value Having other chronic conditions: 2.4 <.001 Education (secondary 1): Postgraduate 2.3 <.001 Female (male 1) 1.9 <.001 Pain: (none 1): Moderate 1.8 <.001 Attendance at social or support group 1.8 <.001 Education (Secondary=1): Undergraduate 1.7 <.001 Having anxiety or depression 1.5 <.001 Attendance at fitness or exercise program

11 Most used practitioners for DM or CVD N=101 % Manipulative or massage-based 44 Naturopath 29 Integrative GP 14 Acupuncturist 13 Chinese medicine practitioner 13 Nutritionist 11 Reiki practitioner 9 Kinesiologist 7 (List incomplete)

12 CAM disclosure to doctor 36% always discuss CAM use 20% never, 38% sometimes Reasons not discussed (n=818) % Not necessary 37 Doctor did not ask 28 Didn t think to mention 20 Doctor may not be happy 12 Reasons discussed (n=997) % Doctor did not ask, but I thought necessary 53 Doctor advised me to use 37 Doctor asked 14 CAM practitioner advised to tell 12

13 Motivations to use CAM Used CAM Product* % Practitioner** % Improve general health and wellbeing Doctor, pharmacist, health professional suggested Believed CAM would be effective for condition To take more control of own health Preferred natural things Dissatisfaction with mainstream medicine / services 9 27 * N=527 ** N=645 (List incomplete)

14 Benefits of CAM Outcomes of visiting CAM practitioner N=580* % n=101** % Condition resolved Symptoms relieved General health and well-being improved Enabled more confidence in managing condition(s) Increased knowledge and understanding of condition(s) No effect 7 4 *All practitioner users **Used CAM practitioner for DM or CVD

15 Factors increasing likelihood of using CAM for CVD/DM Never used* Used CAM** Doctor suggesting it Medicare covering CAM consultations More information on how it helps Greater belief that CAMs worked Having private health insurance coverage Cheaper consultations fees or products Less concern about CAM interacting with other treatments If doctor didn t object * N=1519 ** N= 1396 (incomplete list) More scientific research about CAM 18 23

16 Key findings Compared to CAM non-users, CAM users tended to: Have worse quality of life (AQoL) measures Have greater numbers of chronic conditions Consult doctors at similar frequency Use same number of pharmaceutical medications Have more positive perceptions about illness / health Concern about depersonalisation of mainstream healthcare People perceived benefits of CAM use on DM/CVD even when CAM not used specifically for these conditions People with chronic illness use CAM pragmatically, in addition to mainstream medicine, to fill needs not met by mainstream health services

17 Publications 1. Are the economics of complementary and alternative medicine different to conventional medicine? Expert Review of Pharmacoeconomics and Outcomes Research, (2009) 9(1) 2. Integration of complementary and alternative medicine information and advice in chronic disease management guidelines. Australian Journal of Primary Health, (2011) 17(2) 3. Type 2 diabetes, cardiovascular disease and the utilisation of primary care in urban and rural setting. Rural and Remote Health (2011) Article Policy implications of complementary and alternative medicine (CAM) use in Australia: data from the National Health Survey. Journal of Alternative and Complementary Medicine (2012) 18(4) 5. Care-seeking, use of complementary therapies, and self-management among people with type 2 diabetes and cardiovascular disease: CAMELOT Phase I, an ethnographic approach Australian Journal of Herbal Medicine (2012) 24(1) 6. Care seeking, complementary therapy and herbal medicine use among people with type 2 diabetes and cardiovascular disease: CAMELOT Phase II, surveying for diversity. Australian Journal of Herbal Medicine (2012) 24(2).

18 Publications 7. The strength to cope: Spirituality and faith in chronic disease Journal of Religion and Health (2011, e-publication) doi: /s Taking Control: Complementary and alternative medicine in managing chronic disease Health (in press) doi: / Costs and drivers of complementary and alternative medicine (CAM) use in people with type 2 diabetes or cardiovascular disease. European Journal of Integrative Medicine (in press) doi: /j.eujim Quality of life, perceptions of health and illness, and complementary therapy use among people with type 2 diabetes and cardiovascular disease (under review) 11. Barriers, facilitators and predictors of exercise among people with diabetes in Australia (under review) 12. Benefits of complementary therapy use among people with diabetes or cardiovascular disease (under review) 13. Serious decisions: chronic conditions and choice of provider (under review) 14. Room for Improvement: complementary therapies users and the Australian health system (under review)

19 Contacts Prof Lenore Manderson Chief Investigator Phone: Rachel Canaway Project Manager, Researcher Phone: Prof Vivian Lin Phone: Jean Spinks Phone: Prof Brian Oldenburg Phone: Postal Address School of Psychology & Psychiatry CAMELOT Project, Rm F4.46 Monash University PO Box 197 Caulfield East, Victoria 3145 Web:

20 Additional information

21 Survey respondent

22 Findings: CAMs used for T2DM or CVD Q20 Long answer CAM Products used last 12 months, n=236 Vitamins & minerals CoQ10 (33), Vit D (28), Vit B (28), Cr (19), Mg (26), Vit E (17), Zn (8) Fish oil 127 Herbal medicines: Includes garlic (11), cinnamon (9), fenugreek (5), milk thistle, (4), hawthorn (3), olive leaf (3), bitter melon (2), gymnema (1), etc Proprietary remedies: for diabetes (23), cholesterol (8), cardio (6), etc 44 Frequency Superfoods & fibre (9) Includes: probiotics (4), goji berry (3), lecithin (3), chia seed (2), etc 34 Chinese herbal medicines 11 Weight loss products Includes detox or laxative products Homeopathics 6 8