Background Portugal has a strong tradition of conventional western healthcare. So it provides a natural case study for the relationship between Complementary/Alternative Medicine (CAM) and Western Medicine (WM). This work aims to test the relationship between CAM and WM users in the diagnosis and treatment stages and to estimate the determinants of CAM choice.
Methods The forth Portuguese National Health Survey is employed to estimate two single probit models and obtain the correlation between the consumption of CAM and WM medicines in the diagnosis and treatment stages.
Results Firstly, both in the diagnosis and the treatment stage, CAM and WM are seen to be complementary choices for individuals. Secondly, self-medication also shows complementarity with the choice of CAM treatment. Thirdly, education has a non-linear relationship with the choice of CAM. Finally, working status, age, smoking and chronic disease are determinant factors in the decision to use CAM.
Conclusion The results of this work are relevant to health policy-makers and for insurance companies. Patients need freedom of choice and, for the sake of safety and efficacy of treatment, WM and CAM healthcare ought to be provided in a joint and integrated health system.
Commentaries Published on this Paper
New Scope for Research in Traditional and Non-conventional Medicine; Comment on “Substitutes or Complements? Diagnosis and Treatment with Non-conventional and Conventional Medicine”
CAMbrella Project. CAMbrella project funded by the 7th Framework Programme of the European Commission (FP7-HEALTH-2009-3.1-3) [internet]. [cited 31 January 2015]. Available from: http://www.cambrella.eu/home.php
Harris P, Rees R. The prevalence of complementary and alternative medicine use among the general population: a systematic review of the literature. Complement Ther Med 2000; 8: 88-96. doi: 10.1054/ctim.2000.0353
Pagán JA, Pauly MV. Access to conventional medical care and the use of complementary and alternative medicine. Health Affairs 2005; 24: 255-62. doi: 10.1377/hlthaff.24.1.255
Astin JA.Why patients use alternative medicine: results of a national study. JAMA 1998; 20: 279: 1548-53. doi: 10.1001/jama.279.19.1548
Silva BA. Optar pelo uso de terapias alternativas e complementares: representações sociais da Medicina Alternativa e/ou Complementar e da Medicina Oficial/Convencional [master thesis in Social Psicology]. Oporto, Portugal: Faculty of Psychology and Educational Sciences, University of Oporto; 2008.
Akinci AC, Zengin N, Yildiz H, Sener E, Gunaydin B. The complementary and alternative medicine use among asthma and chronic obstructive pulmonary disease patients in the southern region of Turkey. Int J Nurs Pract 2011; 17: 571-82. doi: 10.1111/j.1440-172x.2011.01976.x
Houssen ME, Ragab A, Mesbah A, El-Samanoudy AZ, Othman G, Moustafa AF, et al. Natural anti-inflammatory products and leukotriene inhibitors as complementary therapy for bronchial asthma.Clin Biochem 2010; 43: 887-90. doi: 10.1016/j.clinbiochem.2010.04.061
Beuth J, van Leendert R, Schneider B, Uhlenbruck G. Reduced side-effects of adjuvant hormone therapy in breast cancer patients by complementary medicine. In Vivo 2010; 24: 799-802.
Nahas R, Moher M. Complementary and alternative medicine for the treatment of type 2 diabetes. Can Fam Physician 2009; 55: 591-96.
Langhorst J, Wulfert H, Lauche R, Klose P, Cramer H, Dobos GJ, et al. Systematic Review of Complementary and Alternative Medicine Treatments in Inflammatory Bowel Diseases. J Crohns Colitis 2015; 9: 86-106. doi: 10.1093/ecco-jcc/jju007
De Silva V, El-Metwally A, Ernst E, Lewith G, Macfarlane GJ. Evidence for the efficacy of complementary and alternative medicines in the management of fibromyalgia: a systematic review. Rheumatology (Oxford) 2010; 49: 1063-8. doi: 10.1093/rheumatology/keq025
Furlan AD, Yazdi F, Tsertsvadze A, Gross A, Van Tulder M, Santaguida L, et al. Complementary and alternative therapies for back pain II. AHRQ Publication No. 10(11)-E007, Agency for Healthcare Research and Quality U.S. Department of Health and Human Services. Evid Rep Technol Assess (Full Rep) 2010; 194: 1-764.
Zhou S, Chan E, Pan SQ, Huang M, Lee EJ. Pharmacokinetic of interactions of drugs with St.John’s wort. J Psychopharmacol 2004; 18: 262-76. doi: 10.1177/0269881104042632
Rispler DT, Sara J. Impact of complementary and alternative treatment modalities on the care of orthopaedic patients. J Am Acad Orthop Surg 2011; 19: 634-43.
Woodward KN. The potential impact of the use of homeopathic and herbal remedies on monitoring the safety of prescription products. Hum Exp Toxicol 2005; 24: 219-33. doi: 10.1191/0960327105ht529oa
Hu Z, Yang X, Ho PC, Chan SY, Heng PW, Chan E, et al. Herb-drug interactions: a literature review. Drugs 2005; 65: 1239-82. doi: 10.2165/00003495-200565090-00005
Ulbricht C, Chao W, Costa D, Rusie-Seamon E, Weissner W, Woods J. Clinical evidence of herb-drug interactions: a systematic review by the natural standard research collaboration. CurrDrugMetab 2008; 9: 1063-120. doi: 10.2165/00003495-200565090-00005
Miranda, AS. Terapêuticas não convencionais: Perspectivas dos médicos de medicina geral e familiar [master thesis in Medicine]. Covilha, Portugal; Faculty of Health Sciences, University of Beira Interior; 2010.
Antunes JL. A Profissão de Médico. Análise Social 2003; XXXVIII: 77-99.
Grossman M. On the concept of health capital and the demand for health. J Polit Econ 1972; 80: 403-20. doi: 10.1086/259880
Belloc NB, Breslow L. Relationship of physical health status and health practices. Prev Med 1972; 1: 409-21. doi: 10.1016/0091-7435(72)90014-x
Breslow L, Enstrom J. Persistence of health habits and their relationship to mortality. Prev Med 1980; 9: 469-83. doi: 10.1016/0091-7435(80)90042-0
Schoenborn CA. Health habits of US adults, 1985: the Alameda Seven revisited. Public Health Reports 1986; 101: 571-80.
Zhao XF, Du Y, Liu PG, Wang S. Acupuncture for stroke: evidence of effectiveness, safety, and cost from systematic reviews. TopStrokeRehabil 2012; 19: 226-33. doi: 10.1310/tsr1903-226
Marchisio P, Bianchini S, Galeone C, Baggi E, Rossi E, Albertario G, et al. Use of complementary and alternative medicine in children with recurrent acute otitis media in Italy. Int J Immunopathol Pharmacol 2011; 24: 441-9.
Kooreman P, Baars EW. Patients whose GP knows complementary medicine tend to have lower costs and live longer. European Journal Health Economics 2012; 13: 769-76. doi: 10.1007/s10198-011-0330-2
Shuval JT, Gross R, Ashkenazi Y, Schachter L. Integrating CAM and Biomedicine in Primary care settings, physicians perspectives on boundaries and boundary work. Qual Health Res 2012; 22: 1317-29. doi: 10.1177/1049732312450326
Das T, Choudhury D. Are complementary and alternative medicines alternative to conventional medical system? An economic evaluation. Applied Economic Letters 2007; 14: 697-700. doi: 10.1080/13504850600592580
Wolsko PM, Eisenberg DM, Davis RB, Ettner SL, Phillips RS. Insurance coverage, medical conditions, and visits to alternative medicine providers, results of a national survey. Arch Intern Med 2002; 162: 281-7. doi: 10.1001/archinte.162.3.281
Tom Xu K, Farrell TW. The Complementarity and substitution between unconventional and mainstream medicine among racial and ethnic groups in the United States. Health Serv Res2007; 42: 811-26. doi: 10.1111/j.1475-6773.2006.00628.x
Chan YM, Huang H, Mei H. Socioeconomic status, attitudes on use of health information, preventive behaviours, and complementary and alternative medical therapies: using a US national representative sample. Natural and Applied SciencesPart I 2012; 3: 15-23.
Eardley S, Bishop FL, Prescott P, Cardini F, Brinkhaus B, Santos-Rey K, et al. Final Report of CAMbrella Work Package 4 CAM use in Europe – The patients’ perspective. Part I: A systematic literature review of CAM prevalence in the EU [internet]. CAMbrella project funded by the 7th Framework Programme of the European Commission (FP7-HEALTH-2009-3.1-3), 2012. [cited 31 January 2015]. Available from: http://phaidra.univie.ac.at/
Nissen N, Johannessen H, Schunder-Tatzber S, Lazarus A, Weidenhammer W. Final Report of CAMbrella Work Package 3 Citizens’ needs and attitudes towards CAM [internet]. CAMbrella project funded by the 7th Framework Programme of the European Commission (FP7-HEALTH-2009-3.1-3), 2012. [cited 31 January 2015]. Available from: http://phaidra.univie.ac.at/
Eardley S, Bishop FL, Prescott P, Cardini F, Brinkhaus B, Santos-Rey K, et al. A Systematic Literature Review of Complementary and Alternative Medicine Prevalence in EU. Forsch Komplementmed 2012; 19: 18-28. doi: 10.1159/000342708
von Ammon K, Frei-Erb M, Cardini F, Daig U, Dragan S, Hegyi G, et al. Complementary and alternative medicine provision in Europe – first results approaching reality in an unclear field of practices. Forsch Komplementmed 2012; 19: 37-43. doi: 10.1159/000343129
Hämeen-Anttila KP, Niskala UR, Siponen SM, Ahonen RS. The use of complementary and alternative medicine products in preceding two days among Finnish parents – a population survey. BMC Complement Altern Med 2011; 11: 107-14. doi: 10.1186/1472-6882-11-107
Giannelli M, Cuttini M, Arniani S, Baldi P, Buiatti E. Non-conventional medicine in Tuscany: attitudes and use in the population. Epidemiology Prevenzione 2004; 28: 27-33.
Barbadoro P, D’Errico MM, Minelli A, Pennacchietti L, Ponzio E. Complementary and alternative medicine (CAM) among adults in Italy: use and related satisfaction. Eur J Integr Med 2011; 3: e325-32. doi: 10.1016/j.eujim.2011.09.001
Bücker B, Groenewold M, Schoefer Y, Schäfer T. The use of complementary alternative medicine (CAM in 1001 German adults: results of a population based telephone survey. Gesundheitswesen 2008; 70: e29-36. doi: 10.1055/s-2008-1081505
Al-Windi A, Elmfeldt D, Svärdsudd K. The relationship between age, gender, well-being and symptom and the use of pharmaceuticals, herbal medicines and self-care products in a Swedish municipality. Eur J Clin Pharmacol 2000; 56: 311-7. doi: 10.1055/s-2008-1081505
Al-Windi A. Determinants of complementary and alternative medicine (CAM) use. Complement Ther Med 2004; 12: 99-111. doi: 10.1016/j.ctim.2004.09.007
Thomas K, Coleman P. Use of complementary and alternative medicine in general population in Great Britain. Results from the National Omnibus survey. J Public Health (Oxf) 2004; 26: 152-7. doi: 10.1093/pubmed/fdh139
Adams J, Easthope G, Sibbritt D. Exploring the relationship between women’s health and the use of complementary and alternative medicine. Complement Ther Med 2003; 11: 156-8. doi: 10.1016/s0965-2299(03)00062-1
Colebunders R, Dreezen C, Florence E, Pelgrom Y, Schrooten W; Eurosupport Study Group. The use of complementary and alternative medicine by persons with HIV infection in Europe. Int J STD AIDS 2003; 14: 672-4. doi: 10.1258/095646203322387929
Molassiotis A, Scott JA, Kearney N, Pud D, Magri M, Selvekerova S, et al. Complementary and alternative medicine use in breast cancer patients in Europe. Support. CareCancer 2006; 14: 260-7. doi: 10.1258/095646203322387929
Decker SL. Cigarettes and alcohol: substitutes or complements? NBER Working Paper, WP/7535, Cambridge; 2000.
Ganz ML. Family Health effects: complements or substitutes. Health Econ 2001; 10: 699-714. doi: 10.1002/hec.612
Rask K, Rask K. Delivering public health care services: substitutes, complements or both? Contemp Econ Policy 2005; 23: 28-39. doi: 10.1093/cep/byi003
Atella V, Deb P. Are primary care physicians, public and private sector specialists substitutes or complements? Evidence from a simultaneous equations model for count data. J Health Econ 2008; 27: 770-85. doi: 10.1016/j.jhealeco.2007.10.006
Tavares, A. I. (2015). Substitutes or Complements? Diagnosis and Treatment with non-Conventional and Conventional Medicine. International Journal of Health Policy and Management, 4(4), 235-242. doi: 10.15171/ijhpm.2015.45
Aida Isabel Tavares. "Substitutes or Complements? Diagnosis and Treatment with non-Conventional and Conventional Medicine". International Journal of Health Policy and Management, 4, 4, 2015, 235-242. doi: 10.15171/ijhpm.2015.45
Tavares, A. I. (2015). 'Substitutes or Complements? Diagnosis and Treatment with non-Conventional and Conventional Medicine', International Journal of Health Policy and Management, 4(4), pp. 235-242. doi: 10.15171/ijhpm.2015.45
Tavares, A. I. Substitutes or Complements? Diagnosis and Treatment with non-Conventional and Conventional Medicine. International Journal of Health Policy and Management, 2015; 4(4): 235-242. doi: 10.15171/ijhpm.2015.45