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Australian Journal of Primary Health Australian Journal of Primary Health Society
The issues influencing community health services and primary health care
RESEARCH ARTICLE

Integration of complementary and alternative medicine information and advice in chronic disease management guidelines

Victoria Team A B , Rachel Canaway A and Lenore Manderson A
+ Author Affiliations
- Author Affiliations

A School of Psychology and Psychiatry, Faculty of Medicine, Nursing and Health Sciences, Monash University, 900 Dandenong Road, Caulfield East, Vic. 3145, Australia.

B Corresponding author. Email: victoria.team@monash.edu

Australian Journal of Primary Health 17(2) 142-149 https://doi.org/10.1071/PY10013
Submitted: 7 May 2010  Accepted: 9 December 2010   Published: 7 June 2011

Abstract

The growing evidence on the benefits and risks of complementary and alternative medicine (CAM) and its high rate of use (69% of Australians) – particularly for chronic or recurrent conditions – means increasing attention on CAM. However, few people disclose CAM use to their GP, and health professionals tend to inadequately discuss CAM-related issues with their patients, partly due to insufficient knowledge. As clinical and non-clinical chronic condition management guidelines are a means to educate primary health care practitioners, we undertook a content analysis of guidelines relevant to two common chronic conditions – cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) – to assess their provision of CAM-related information. Ten current Australian guidelines were reviewed, revealing scant CAM content. When available, the CAM-relevant information was brief, in some cases unclear, inconclusive and lacking in direction to the GP or health care provider. Although we focus on CVD and T2DM, we argue the value of all chronic condition management guidelines integrating relevant evidence-informed information and advice on CAM risks, benefits and referrals, to increase GP awareness and knowledge of appropriate CAM therapies, and potentially to facilitate doctor–client discussion about CAM.

Additional keywords: cardiovascular diseases, general practitioners, type 2 diabetes.


References

Adams J, Sibbritt D, Young AF (2009) A longitudinal analysis of older Australian women’s consultations with complementary and alternative medicine (CAM) practitioners, 1996–2005. Age and Ageing 38, 93–99.
A longitudinal analysis of older Australian women’s consultations with complementary and alternative medicine (CAM) practitioners, 1996–2005.Crossref | GoogleScholarGoogle Scholar | 19017675PubMed |

Al-Windi A (2004) Determinants of complementary alternative medicine (CAM) use. Complementary Therapies in Medicine 12, 99–111.
Determinants of complementary alternative medicine (CAM) use.Crossref | GoogleScholarGoogle Scholar | 15561519PubMed |

Anonymous (2010) New European information centre on complementary medicine. Complementary Therapies in Medicine 18, 57
New European information centre on complementary medicine.Crossref | GoogleScholarGoogle Scholar |

Arcury TA, Bell RA, Snively BM, Smith SL, Skelly AH, Wetmore LK, Quandt SA (2006) Complementary and alternative medicine use as health self-management: rural older adults with diabetes. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences 61, S62–S70.

Australian Centre for Diabetes Strategies (2005) National evidence based guidelines for the management of type 2 diabetes mellitus. Available at http://www.nhmrc.gov.au/publications/synopses/di7todi13syn.htm [Verified 5 May 2010]

Australian Medical Association (2002) Position statement: complementary medicine. Canberra, Australian Medical Association. Available at http://www.ama.com.au/node/2214 [Verified 14 December 2009]

Baer HA (2008) The emergence of integrative medicine in Australia: the growing interest of biomedicine and nursing in complementary medicine in a southern developed society. Medical Anthropology Quarterly 22, 52–66.
The emergence of integrative medicine in Australia: the growing interest of biomedicine and nursing in complementary medicine in a southern developed society.Crossref | GoogleScholarGoogle Scholar | 18610813PubMed |

Baer HA, Coulter I (2008) Introduction – taking stock of integrative medicine: broadening biomedicine or co-option of complementary and alternative medicine? Health Sociology Review 17, 331–341.
Introduction – taking stock of integrative medicine: broadening biomedicine or co-option of complementary and alternative medicine?Crossref | GoogleScholarGoogle Scholar |

Bell R, Suerken C, Grzywacz J, Lang W, Quandt S, Arcury T (2006) Complementary and alternative medicine use among adults with diabetes in the United States. Alternative Therapies in Health and Medicine 12, 16–22.

Ben-Arye E, Frenkel M (2008) Referring to complementary and alternative medicine-A possible tool for implementation. Complementary Therapies in Medicine 16, 325–330.
Referring to complementary and alternative medicine-A possible tool for implementation.Crossref | GoogleScholarGoogle Scholar | 19028332PubMed |

Braun L, Cohen M (2010) ‘Herbs and natural supplements: an evidence-based guide. 3rd Vol.’ (Elsevier: Sydney)

Bristol MN, Sonnad SS, Guerra C (2008) Uninformed complementary and alternative supplement use: a risky behavior for cardiovascular patients. Complementary Health Practice Review 13, 100–109.
Uninformed complementary and alternative supplement use: a risky behavior for cardiovascular patients.Crossref | GoogleScholarGoogle Scholar |

Brophy E (2003) Does a doctor have a duty to provide information and advice about complementary and alternative medicine? Journal of Law and Medicine 10, 271–284.

Brown J, Morgan T, Adams J, Grunseit A, Toms M, Roufogalis B, Kotsirilos V, Pirotta M, Williamson M (2008) ‘Complementary Medicines information use and needs of health professionals: general practitioners and pharmacists – December 2008.’ (National Prescribing Service: Sydney)

Cerritelli F, Carinci F, Pizzolorusso G, Turi P, Renzetti C, Pizzolorusso F, Orlando F, Cozzolino V, Barlafante G (2011) Osteopathic manipulation as a complementary treatment for the prevention of cardiac complications: 12-months follow-up of intima media and blood pressure on a cohort affected by hypertension. Journal of Bodywork and Movement Therapies 15, 68–74.
Osteopathic manipulation as a complementary treatment for the prevention of cardiac complications: 12-months follow-up of intima media and blood pressure on a cohort affected by hypertension.Crossref | GoogleScholarGoogle Scholar | 21147421PubMed |

Chang H-Y, Wallis M, Tiralongo E (2007) Use of complementary and alternative medicine among people living with diabetes: literature review. Journal of Advanced Nursing 58, 307–319.
Use of complementary and alternative medicine among people living with diabetes: literature review.Crossref | GoogleScholarGoogle Scholar | 17442034PubMed |

Chong CAKY, Diaz-Granados N, Hawker GA, Jamal S, Josse RG, Cheung AM (2007) Complementary and alternative medicine use by osteoporosis clinic patients. Osteoporosis International 18, 1547–1556.
Complementary and alternative medicine use by osteoporosis clinic patients.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2srosVGrug%3D%3D&md5=cdd1a6495d5c42686c2747893ed6cd66CAS | 17603742PubMed |

Colagiuri R, Girgis S, Eigenmann C, Gomez M, Griffiths R (2009) ‘National evidenced based guideline for patient education in type 2 diabetes.’ (Diabetes Australia and the NHMRC: Canberra)

Diabetes Australia, Royal Australian College of General Practitioners (2009) Diabetes management in general practice – guidelines for type 2 diabetes. Available at http://www.racgp.org.au/guidelines/diabetes [Verified 5 May 2010]

Dickinson HO, Beyer FR, Ford GA, Nicolson D, Campbell F, Cook JV, Mason J (2008) Relaxation therapies for the management of primary hypertension in adults. Cochrane Database of Systematic Reviews (Online) 1, CD004935

Eccles MP, Grimshaw JM (2004) Selecting, presenting and delivering clinical guidelines: are there any “magic bullets”? The Medical Journal of Australia 180, S52–S54.

Eisenberg DM, Kessler RC, Van Rompay MI, Kaptchuk TJ, Wilkey SA, Appel S, Davis RB (2001) Perceptions about complementary therapies relative to conventional therapies among adults who use both: results from a national survey. Annals of Internal Medicine 135, 344–351.

Engel GL (1977) The need for a new medical model: a challenge for biomedicine. Science 196, 129–136.
The need for a new medical model: a challenge for biomedicine.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaE2s7ltVOmsA%3D%3D&md5=81f1593534d3bd322237c51275d631f4CAS | 847460PubMed |

Ernst E (2007) ‘First, do no harm’ with complementary and alternative medicine. Trends in Pharmacological Sciences 28, 48–50.
‘First, do no harm’ with complementary and alternative medicine.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD2sXhtlCmu7w%3D&md5=e25d1ba752014dad3d7abffddc61f6f1CAS | 17222917PubMed |

Farmer A, Légaré F, Turcot L, Grimshaw J, Harvey E, McGowan J, Wolf F (2008) Printed educational materials: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews (Online) 12, CD004398

Gaylord SA, Mann JD (2007) Rationales for CAM education in health professions training programs. Academic Medicine 82, 927–933.
Rationales for CAM education in health professions training programs.Crossref | GoogleScholarGoogle Scholar | 17895650PubMed |

Gold PW, Novella S, Roy R, Marcus D, Bell I, Davidovitch N, Saine A (2008) Homeopathy – quackery or a key to the future of medicine? Homeopathy 97, 28–33.
Homeopathy – quackery or a key to the future of medicine?Crossref | GoogleScholarGoogle Scholar | 18194763PubMed |

Grace S, Vemulpad S, Reid A, Beirman R (2008) CAM practitioners in integrative practice in New South Wales, Australia: a descriptive study. Complementary Therapies in Medicine 16, 42–46.
CAM practitioners in integrative practice in New South Wales, Australia: a descriptive study.Crossref | GoogleScholarGoogle Scholar | 18346628PubMed |

Graneheim U, Lundman B (2004) Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Education Today 24, 105–112.
Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2c%2FmvVKquw%3D%3D&md5=f15819757ac45b8e2d19a3829dd3deaaCAS | 14769454PubMed |

Grol R, Buchan H (2006) Clinical guidelines: what can we do to increase their use? The Medical Journal of Australia 185, 301–302.

Hammerness P, Basch E, Ulbricht C, Barrette E, Foppa I, Basch S, Bent S, Boon H, Ernst E,, Natural Standard Research Collaboration (2003) St John’s Wort: a systematic review of adverse effects and drug interactions for the consultation psychiatrist. Psychosomatics 44, 271–282.
St John’s Wort: a systematic review of adverse effects and drug interactions for the consultation psychiatrist.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD3sXlslyrs70%3D&md5=cd1159e12870b07ee0c08f76a5ca06a9CAS | 12832592PubMed |

Hasan SS, Ahmed SI, Bukhari NI, Loon WCW (2009) Use of complementary and alternative medicine among patients with chronic diseases at outpatient clinics. Complementary Therapies in Clinical Practice 15, 152–157.
Use of complementary and alternative medicine among patients with chronic diseases at outpatient clinics.Crossref | GoogleScholarGoogle Scholar | 19595416PubMed |

Hsieh H-F, Shannon S (2005) Three approaches to qualitative content analysis. Qualitative Health Research 15, 1277–1288.
Three approaches to qualitative content analysis.Crossref | GoogleScholarGoogle Scholar | 16204405PubMed |

Jonas W (2001) Advising patients on the use of complementary and alternative medicine. Applied Psychophysiology and Biofeedback 26, 205–214.
Advising patients on the use of complementary and alternative medicine.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3Mrntleqtw%3D%3D&md5=493e4b88d6c814400591de00956cca0cCAS | 11680284PubMed |

Kerridge IH, McPhee JR (2004) Ethical and legal issues at the interface of complementary and conventional medicine. The Medical Journal of Australia 181, 164–166.

Koithan M (2009) Let’s talk about complementary and alternative therapies. The Journal for Nurse Practitioners 5, 214–215.
Let’s talk about complementary and alternative therapies.Crossref | GoogleScholarGoogle Scholar | 20160990PubMed |

Krippendorff K (2004) ‘Content analysis: an introduction to its methodology. 2nd Vol.’ (SAGE: Thousand Oaks, CA)

Langhorst J, Musial F, Klose P, Dobos GJ (2009) Integration of CAM in medical guidelines. European Journal of Integrative Medicine 1, 217–218.
Integration of CAM in medical guidelines.Crossref | GoogleScholarGoogle Scholar |

Lin V, McCabe P, Bensoussan A, Myers SP, Cohen M, Hill S, Howse G (2009) The practice and regulatory requirements of naturopathy and western herbal medicine in Australia. Risk Management and Healthcare Policy 2009, 21–33.

Liu JP, Zhang M, Wang W, Grimsgaard S (2002) Chinese herbal medicines for type 2 diabetes mellitus. Cochrane Database of Systematic Reviews (Online) 3, CD003642

MacLennan AH, Myers SP, Taylor AW (2006) The continuing use of complementary and alternative medicine in South Australia: cost and beliefs in 2004. The Medical Journal of Australia 184, 27–31.

Maha N, Shaw A (2007) Academic doctors’ views of complementary and alternative medicine (CAM) and its role within the NHS: an exploratory qualitative study. BMC Complementary and Alternative Medicine 7, 17
Academic doctors’ views of complementary and alternative medicine (CAM) and its role within the NHS: an exploratory qualitative study.Crossref | GoogleScholarGoogle Scholar | 17537248PubMed |

McGuire T, Walters J, Dean A, Van Driel M, Del Mar C, Kotsirilos V, Moses GM, Chong S, Deed G, Eldred B, Hardy J, Heussler H,Hollingworth S, Marron L, Mendel J, Pache D, Steadman K, TrenerryH, Brown J, Williamson M (2009) ‘Review of the quality of complementary medicines information resources: summary report.’ (National Prescribing Service: Sydney)

Myers SP (2002) Interactions between complementary medicines and warfarin. Australian Prescriber 25, 54–56.

Myers SP, Cheras PA (2004) The other side of the coin: safety of complementary and alternative medicine. The Medical Journal of Australia 181, 222–225.

National Aboriginal Community Controlled Health Organisation (2005) National guide to a preventive assessment in Aboriginal and Torres Strait Islander peoples. Available at http://www.racgp.org.au/guidelines/nationalguide [Verified 5 May 2010]

National Heart Foundation of Australia (2009) Guide to management of hypertension 2008 – Assessing and managing raised blood pressure in adults (Updated August 2009. Web version). Available at http://www.heartfoundation.org.au/Professional_Information/Clinical_Practice/Hypertension/Pages/default.aspx [Verified 5 May 2010]

National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand (2006) Guidelines for the prevention, detection and management of chronic heart failure in Australia, 2006. Available at http://www.heartfoundation.org.au/Professional_Information/Clinical_Practice/CHF/Pages/default.aspx [Verified 5 May 2010]

National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand (2008) Reducing risk in heart disease 2007 – Guidelines for preventing cardiovascular events in people with coronary heart disease. Available at http://www.heartfoundation.org.au/SiteCollectionDocuments/A [Verified 5 May 2010]

National Stroke Foundation (2005) Clinical Guidelines for Stroke Rehabilitation and Recovery. Available at www.nhmrc.gov.au/publications/synopses/cp105syn.htm [Verified 5 May 2010]

National Stroke Foundation (2008) Clinical Guidelines for Stroke and TIA Management – A guide for general practice. Available at www.racgp.org.au/guidelines/stroke [Verified 5 May 2010]

NCCAM (2006) United States National Centre for Complementary and Alternative Medicine. Gaithersburg, MD, US Department of Health and Human Services, National Institutes of Health. Available at http://nccam.nih.gov/health/whatiscam [Verified 3 November 2010]

O’Connor BB, Calabrese C, Cardena E, Eisenberg D, Fincher J, Hufford DJ, Jonas WB, Kaptchuk T, Martin SC, Scott AW, Zhang X (1997) Defining and describing complementary and alternative medicine – Panel on definition and description, CAM Research Methodology Conference, April 1995. Alternative Therapies in Health and Medicine 3, 49–57.

Robinson A, McGrail MR (2004) Disclosure of CAM use to medical practitioners: a review of qualitative and quantitative studies. Complementary Therapies in Medicine 12, 90–98.
Disclosure of CAM use to medical practitioners: a review of qualitative and quantitative studies.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2crosl2msw%3D%3D&md5=a77d3900528a21271911ec4956ac544dCAS | 15561518PubMed |

Robotin MC, Penman AG (2006) Integrating complementary therapies into mainstream cancer care: which way forward? The Medical Journal of Australia 185, 377–379.

Rolley J, Salamonson Y, Dennison C, Davidson P (2010) Nursing care practices following a percutaneous coronary intervention: results of a survey of Australian and New Zealand cardiovascular nurses. The Journal of Cardiovascular Nursing 25, 75–84.

Royal Australian College of General Practitioners (Ed.) (2009) ‘Guidelines for preventive activities in general practice (The Red Book).’ 7th edn. (The Royal Australian College of General Practitioners: Melbourne)

Royal Australian College of General Practitioners, Australasian Integrative Medicine Association (2004) Joint position statement of the RACGP and AIMA – Complementary Medicine (Endorsed 1 July 2005). South Melbourne, Royal Australian College of General Practitioners (RACGP). Available at http://www.racgp.org.au/policy/complementary_medicine.pdf [Verified 5 May 2010]

Schofield PE, Juraskova I, Butow PN (2003) How oncologists discuss complementary therapy use with their patients: an audio-tape audit. Supportive Care in Cancer 11, 348–355.

Schofield P, Diggens J, Charleson C, Marigliani R, Jefford M (2010) Effectively discussing complementary and alternative medicine in a conventional oncology setting: communication recommendations for clinicians. Patient Education and Counseling 79, 143–151.
Effectively discussing complementary and alternative medicine in a conventional oncology setting: communication recommendations for clinicians.Crossref | GoogleScholarGoogle Scholar | 19783116PubMed |

Shah SH, Engelhardt R, Ovbiagele B (2008) Patterns of complementary and alternative medicine use among United States stroke survivors. Journal of the Neurological Sciences 271, 180–185.
Patterns of complementary and alternative medicine use among United States stroke survivors.Crossref | GoogleScholarGoogle Scholar | 18485369PubMed |

Social Development Committee (1986) ‘Inquiry into alternative medicine and the health food industry, Vol. 1: Report.’ (Government Printer, Victorian Parliament Social Development Committee: Melbourne)

Stemler S (2001) An overview of content analysis. Practical Assessment, Research Evaluation 7, Available at http://PAREonline.net/getvn.asp?v=7&n=17

Verhoef MJ, Boon HS, Page SA (2008) Talking to cancer patients about complementary therapies: is it the physician’s responsibility? Current Oncology 15, s88–s93.
Talking to cancer patients about complementary therapies: is it the physician’s responsibility?Crossref | GoogleScholarGoogle Scholar | 18769581PubMed |

White P (2000) What can general practice learn from complementary medicine? The British Journal of General Practice 50, 821–823.

Williamson M, Tudball J, Toms M, Garden F, Grunseit A (2008) ‘Information use and needs of complementary medicines users – December 2008.’ (National Prescribing Service: Sydney)

Xue CCL, Zhang AL, Lin V, Da Costa C, Story DF (2007) Complementary and alternative medicine use in Australia: A national population-based survey. Journal of Alternative and Complementary Medicine (New York, N.Y.) 13, 643–650.
Complementary and alternative medicine use in Australia: A national population-based survey.Crossref | GoogleScholarGoogle Scholar | 17718647PubMed |