Watch out for alternative therapies being used by your clients

Many patients don’t tell physicians about their use

Two recent studies have shown that more people are turning to complementary and alternative therapies, and few are telling their doctors about it.

In fact, patients tend to view medical doctors as members of a larger, patient-selected health care team that may include practitioners of complementary and alternative therapies, researchers in one study concluded.

Case managers should work with physicians to find out what alternative treatments their clients are using and take steps to make sure the non-traditional therapies don’t interfere with or change the effectiveness of their conventional treatments, advises Kathleen Moreo, RN, Cm, BSN, BPSHSA, CCM, CDMS, CEAC, co-founder of Professional Resources in Management Education, an international health care education and case management company.

"Case managers have a rising challenge with polypharmacy among patients, especially older patients. Now coupled with the issue of polypharmacy is the potential for patients to be using self-prescribed alternative medicines as part of the repertoire of drugs and treatment, Moreo says.

Some alternative methods of treatment are not only ineffective but they can cause harm because patients use them instead of more conventional and effective treatments, she adds.

After the first news reports surfaced about anthrax exposure, Moreo came across a web site promoting the use of herbs and herbal blends to combat anthrax—a concept that clearly would offer no protection.

"This is the type of misinformation that preys on a confused, vulnerable society while damaging rather than promoting the good things that alternative medicine can do, she says.

Case managers should be subtle when asking their clients about complementary and alternative medicine during the assessment step of case management, Moreo advises.

That’s because patients may feel uncomfortable discussing alternative medicine or avoid telling the truth if they feel that the physician or other health care professionals would not approve.

"Any targeted questions about complementary or alternative medicine can give the perception that the inquirer is digging for unpleasant facts or disapproves of the concept in general," she adds.

Once you find out a client is using alternative medicine, advise the client that you will provide this information to the patient’s physician. Explain that it is in the best interest of the patient because of the many potential side effects or the possibility of change in potency or action of a prescription drug when it is used in conjunction with non-prescribed medicine, herbs, and other remedies.

Here is some of the information you need to gather:

Accurate information about the types of prescribed drugs the patient is taking;

How and when they are being taken;

What over-the-counter medicines are being taken, when and how;

What types of alternative medicine are being used, when and how.

Here are the results of the recent studies:

A Johns Hopkins study of 200 patients with Parkinson’s disease showed more than 40% used at least one type of alternative therapy, such as vitamins, herbs, massage and acupuncture, and that more than half of them failed to inform their physician of the uses.

"While the public generally assumes that vitamins and herbs are safe, a rapidly growing number of studies show that they can have potentially harmful effects and interactions with other drugs," says Stephen Reich, MD, associate professor of neurology at Johns Hopkins and co-author of the study.1

The researchers found no relationship between the severity of disease and use of alternative therapies, suggesting that people are not turning to alternative therapies out of desperation, Reich added.

Most patients (48%) said they learned about alternative treatments from family and friends, 23% from the media, and 11% reported that a health care provider suggested alternative therapy.

The Parkinson’s patients who use alternative therapies tended to be younger, more educated and have higher incomes than patients who did not use the therapies, the researchers reported.

A nationwide survey conducted by the Center for Alternative Medical Research and Education at Beth Israel Deaconess Medical Center found that 79% of the respondents thought that a combination of traditional and alternative therapies is superior to either one alone.2

A majority of respondents in that survey did not share their use of alternative therapies with their physicians believing "it is not important for the doctor to know" (61%), or "the doctor never asked" (60%). In addition, 31% believed that their use of alternative therapies was none of the doctor’s business, and 20% believed their physician would not understand.

"Medical doctors and other conventional caregivers who are knowledgeable about complementary and alternative medicine practices have a unique opportunity to advise patients about the use or avoidance of these therapies," points out David M. Eisenberg, MD, lead author of the study and director of the Division for Research and Education in Complementary and Integrative Medical Therapies and associated professor of medicine at Harvard Medical School.

Nearly four-fifths of the respondents in the study expressed support for a combination of complementary and alternative medicine and traditional therapies, while only 21% considered alternative therapies to be superior.

The researchers concluded that the popularity of complementary and alternative therapies cannot be attributed to dissatisfaction with orthodox care but is more likely because patients increasingly view medical doctors as members of a larger patient-selected health team.

References

  1. Rajendran, P, Thompson, R and Reich, S: The use of alternative therapies by patients with Parkinson’s disease; Neurology 2001 57:790-794
  2. Eisenberg, D, Kessler, R, Van Rompay, M, Kaptchuk, T, Wilkey, S, Appel, S, Davis, R: Perceptions About Complementary Therapies Relative to Conventional Therapist Among Adults Who Use Both: Results from a National Survey; Annals of Internal Medicine 2001: 135:344-351.