HMO MDs/Nurses Want Alternative Care for their Patients

The intriguing findings of three surveys of Kaiser Permanente primary care physicians, OB/GYNs, and nurse practitioners in northern California have been published in the September Western Journal of Medicine.¹

"Two thirds of adult primary care physicians and three fourths of obstetrics-gynecology clinicians were at least moderately interested in using alternative therapies with patients, and nearly 70% of young and middle-aged adult and half of senior adult members were interested in having alternative therapies incorporated into their health care."

Twenty-five percent of the adult HMO members reported using at least one form of alternative care in the past year, and nearly 90 percent of the physicians reported recommending at least one form of alternative care.

Attitudes among Physicians

When asked to express their level of interest in alternative care, two-thirds of the primary care respondents and three-fourths of the OB/GYN physicians expressed at least "moderate interest" in "the use of alternative therapies to treat health problems, alone or in combination with more conventional western medicine approaches." When queried if they were "very interested," 35 percent of the primary care physicians and 45.3 percent of the OB/GYN clinicians responded positively. In contrast, almost 80 percent of nurse practitioners expressed that they were "very interested" in alternative care.

The reason for all the interest appears to be "motivated by problems presented by patients who could not adequately be treated with more conventional methods (60 percent indicated this as motivating interest 'a great deal')." The authors report:

"The belief that many health problems could be more effectively treated using a holistic approach in lieu of a more conventional western approach was indicated as motivating interest by nearly 85% (with about a third indicating this as motivating interest 'a great deal'). A substantial proportion of clinicians also indicated that growing patient request for these methods and the belief that the HMO must start offering these methods to remain competitive were making them more interested in alternative therapies, but most providers rated these last factors as only somewhat motivating interest."

Perhaps the most telling statistic was the use of "alternative therapies" by physicians:

"Overall, 93% of both adult primary care physicians and obstetrics-gynecology clinicians had used or recommended to patients at least one of 20 alternative therapies during the previous 12 months, or 89% if we exclude psychological counseling, 12-Step or support groups, religious healing or prayer, and special diet."

Looking at the various forms of alterative care in three groupings, this is how each of the medical providers reported using or recommending a form of care in each group over the last 12 months:

When asked specifically about chiropractic, 33.6 percent of primary care and 37.6 percent OB/GYN physicians reported using or recommending chiropractic to their patients in the last year.

When asked if they wanted to have "greater opportunity to use alternative therapies to treat their patients' health problems," over 65 percent of the primary care physicians and over 74 percent of OB/GYN clinicians expressed interest. This is in sharp contrast to the 14 percent of the primary care physicians and 10 percent of the OB/GYN clinicians that did not want greater access.

When asked which alternative therapies they would like to have available, the physicians responded:

[TWO VERTICAL BAR GRAPHS, ONE FOR PRIMARY CARE CLINICIANS AND ONE FOR OB/GYN CLINICIANS]

Alternative Therapies that Adult Primary Care and Obstetrics-Gynecology Clinicians Would Like the HMO to Make Available to Members

Attitudes among HMO Patients

When the Kaiser members were asked about their current use of alternative care, 31 percent had used some form in the last year. The percentage drops to 25 percent when special diet, prayer and psychological care is excluded. When asked if they had ever used any form of alternative care, the response rate was 50 percent, dropping to 43 percent with the same exclusions.

The use rate for chiropractic differed by age group:

When asked which forms of alternative care they would like to have covered by their health plan, chiropractic was clearly the most popular:

[ANOTHER VERTICAL GRAPH - PLS KEEP SAME COLORS FOR FORMS OF CARE AMONG ALL THREE GRAPHS]

Alternative Therapies HMO Members Would Like to Have Covered by the Health Plan

Additional Comments

The authors made some interesting additional comments about their findings:

"The study also found that a substantial proportion of adult primary care physicians and obstetrics-gynecology clinicians practicing in a traditional HMO are interested in incorporating alternative therapies into patient care and that most members are interested in having them do so. The primary factors motivating clinician interest in alternative therapies are their beliefs that not all problems can be effectively treated with conventional western medicines and that, at least for some problems, taking a more holistic (mind-body) approach to treatment might yield better results that using conventional treatment approaches.

"Although most clinicians downplayed factors of patient demand and concern that the HMO might need to offer alternative therapies to stay competitive, there was a significant association between clinicians' reports of the frequency with which patients are mentioning alternative therapy and the level of clinician interest in using these therapies.

"Because both members and clinicians showed the greatest interest in having manipulative therapies like chiropractic, acupuncture and massage therapy and mind-body therapies like relaxation techniques and meditation covered by the health plan, these therapies would be expected to show the greatest increase in demand if they were made more accessible through a health plan.

"Patients are increasingly presenting providers with symptoms and chronic health problems that are often not totally resolved by conventional western medicines and treatments, such as stress-related disorders, pain, fatigue, PMS, and menopausal symptoms, and some patients are also expressing concern about the iatrogenic effects of the long-term use of pharmaceuticals. As more information about alternative therapies reaches people around the country suffering from these problems through media exposure, Internet searches, and disease-specific networking efforts, interest in alternative therapies among both health care professionals and the public will likely begin to mirror the current experience of this HMO. The results of this study suggest which alternative therapies are likely to be in greatest demand by these dual constituencies and should therefore be a focus for further research regarding the health conditions for which these therapies appear to be effective and ineffective and the possible costs of incorporating them into a traditional health care delivery system."

Editor's note: Copies of this study study, are available from the Institute for Scientific Information, a document delivery service of over 7,000 journals. Tel: (215) 386-4399; fax: (215) 386-4343 or (215) 222-0840; e-mail: ids@isinet.com; Internet: [url=http://www.isinet.com/prodserv/ids/idsfm.html]http://www.isinet.com/prodserv/ids/idsfm.html[/url]

Reference

1. Gordon NP, Sobel DS, Tarazona EZ. Use of and interest in alternative therapies among adult primary care clinicians and adult members in a large health maintenance organization. West J Med 1998;169:153-161.