Weary patients often turn to CAM therapies
Weary patients often turn to CAM therapies
Here’s how to help patients make safe choices
Not too long ago, complementary and alternative medicine (CAM) was viewed as a counterculture activity, but CAM is now taking its place in the mainstream of American life. CAM therapies are particularly appealing to the 30% of the population that suffers from chronic illness. In fact, a recent survey from InterSurvey in Menlo Park, CA, found that roughly two-thirds of all Americans have tried at least one form of alternative medicine therapy or treatment.
"Our patients are coming back and teaching us about these new methods of health care," says Cynthia Jean Westley, RN, MSN, ANP-C, community care manager at the University of Virginia Health System in Charlottesville. "They are going out and learning. They have an expectation that they are going to feel well, not just experience an absence of symptoms."
Why are your patients turning to CAMs? Westley says the most common reasons given by patients include:
• frustration with conventional medicine;
• increasing awareness of other cultures;
• increasing evidence of the influence of nutrition, emotions, and lifestyle on disease;
• expectations of wellness rather than simply an absence of symptoms;
• desire to take less medication and cut health costs.
"Many of the elderly patients I work with have co-morbidities and can’t afford all of their medications," Westley says. "They can’t afford to have both their diabetes medicine and their hypertension prescriptions filled. They have to make difficult decisions about which prescriptions to fill. They begin to wonder if they can impact one of those conditions in another way and eliminate the need for one of those expensive prescriptions."
However, many CAM practitioners make outrageous claims, and case managers must educate their patients on how to separate reality from fiction, Westley told case managers at the 10th annual meeting of the Case Management Society of America held recently in Tampa. "CAM therapies won’t cure AIDS, cancer, diabetes or arthritis. They have real limitations. CAM therapies won’t keep you from ever getting sick. They won’t help you if you have a negative or skeptical attitude about the treatment," she warns.
In addition, Westley says, there are some red flags that case managers should raise when their patients are considering a CAM therapy or practitioner. Warn them about:
• herbs or other substances that can’t be identified by a pharmacists or physician;
• words such as "miraculous" or "amazing" in promotional materials;
• practitioners who refuse to tell you how long treatments will last;
• practitioners who refuse to tell you how much treatment will cost;
• practitioners who are hostile toward conventional medicine;
• practitioners who claim that there are no questions about the safety or efficacy of their modality;
• products with "secret" ingredients.
Ask the right questions
Some considerations Westley suggests case managers discuss with patients considering CAM therapies include:
• Is the therapy safe and effective?
• Is the practitioner experienced?
• Does the practitioner’s office provide a comfortable and competent atmosphere that promotes trust?
• Is the cost reasonable?
"Almost without exception, patients must pay for CAMs out of their own pockets. That makes selecting a CAM practitioner a very big decision for most patients," notes Westley. "Most states now have licensing boards for a variety of CAM practitioners. You can also look for national associations of a particular therapy or conduct an Internet search for a particular therapy." (A list of CAM resources appears on p. 135.)
CAM therapies place a strong emphasis on the mind/body/spirit connection, notes Westley. "If your patient feels good about a particular therapy or a particular CAM practitioner, the experience will be more healing. If the chemistry between the practitioner and the patient is right, the therapy is more likely to be effective.
However, [as with] any health care provider, it’s important ask questions before treatment begins."
Westley helps her patients develop a list of questions to ask CAM practitioners before agreeing to treatment. Questions on that list include:
• What will this involve, and how will it affect my life?
• Do the benefits outweigh the risks?
• Can I use this therapy with conventional therapy prescribed by my physician?
• Will you talk with my primary care physician about the treatment?
• Is there scientific evidence that this treatment is safe and effective?
• How many visits will I need, and how long will it be before I see results?
• How much does this treatment cost, and will my insurance reimburse it?
• Are there any possible side effects?
• Are there any activities or drugs I should avoid during this treatment?
"I also let my patients know upfront that a CAM practitioner is going to take a very lengthy health history," says Westley. "A great deal of emphasis is placed on past health history, past problems with treatments, and fears and concerns. In general, patients will be asked a lot more questions about who they are, and they need to be prepared for that intense questioning. The more prepared you can help them to be, the easier it will be for your patient to get through that intake visit with a CAM practitioner."
Westley has found that many of the elderly patients she works with are weary of repeating their health histories. "Many of the elderly people I work with have multiple chronic disease. They don’t want to tell their story over and over."
She now helps her patients write a health history book that they can give to any provider or CAM practitioner they see. "The health history book tells about every diagnosis, surgery, and allergic reaction that the patient has experienced. It lists every current medication. With those details out of the way, the provider and the patient can focus on the real story, which is how the disease or condition is affecting the patient’s life."
The exchange of information must flow both ways, says Westley. A 1997 study by Landmark Healthcare in Sacramento, CA, found that less than 40% of patients who had tried CAM therapies told their health care providers about them.
"Not only does the CAM practitioner need a thorough health history, but the case manager has a responsibility to encourage the patient to share any CAM therapies they are using with their physician. Many herbs and other treatments may cause harmful interactions with traditional medications," she notes. "I always ask patients what they are doing to improve their health. It’s amazing what spills out from that question. Patients who haven’t been feeling well and who are frustrated by their traditional providers have this increasing awareness of other cultures. They are having tremendous success with CAM."
(Editor’s note: The InterSurvey poll was conducted on-line and included a representative sample of 1,148 adults. More information, including graphical representation of the results, is available at www.inter-survey. com. The Landmark Healthcare study is available at www.LandmarkHealthcare.com.)
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