University of Southern California

Brett White, MD; Monica Zepeda, MPH; Barbara Sarter, PhD, NP; Felix Nunez, MD, MPH; Dennis Mull, MD, MPH; Lyndee Knox, PhD

LA Net3rd Annual Provider Forum

December 2, 2006

Complementary and Alternative Medicine Use by Recent Immigrants

Background

Selected by LANet members at March 2005 Forum 1 of 3 ideas thought of as important by clinicians

Why South Central Family Health Center?

In immigrant, Latino communities, faith in herbal medicines is very common Reinforced by Spanish language television

We believe that a high percentage of patients are using herbal medicines

Clinicians at the site reported that patients were revealing use of herbal medicines instead of their prescribed medications

Background: Why South Central Family Health Center?

Documented cases of patients having adverse reactions to herbal medicines they were

taking

Conclusion: It is important to know for each and every patient what herbal and traditional medicines they may be taking and how they are using them so that we can learn about them and be aware of any possible problems they may be causing.

Why Important?

Most providers do not ask about utilizationAre providers uncomfortable asking?

Patients do not disclose utilizationProvider never askedThought it was not important for doctor to know It was none of the doctor's businessThe doctor would not understand Fear that provider might disapprove of or

discourage CAM use

Purpose

What we want to knowWhat they are usingWhat they are using it for

Literature gapImmigrant status

Methods: Find a Tool

Literature searches Previously validated surveys (CHBQ, etc.)

Did not address target population issues Length (MA’s should conduct in 3-5 minutes)

Created a survey to meet our needs Informal poll for appropriate terminology in

Spanish• Recommendation to ask about Remedios Caseros,

Medicinas Naturales, Tés, Hierbas

Methods: Survey Development

Drafted survey includes:Identifying data for future contactPlace of birthYears in U.S.If any CAM use within the last yearIf CAM use, what types, for what

condition and where did you get them

Survey Instrument

Survey Results

MA’s at SCFHC administered surveys to patients (April 24- May 6)163 responses

• 79.1% Female

Survey Results

Age range 19 to 85 years (M = 45.8, SD = 13.0)

80604020

Age

30

25

20

15

10

5

0

Fre

qu

ency

Mean = 45.82Std. Dev. = 13.008N = 158

Survey Results

Most of the patients were from Mexico (66.3%), followed by El Salvador (17.2%), and Guatemala (10.4%)

Frequency Percent (%)

Mexico 108 66.3

El Salvador 28 17.2

Guatemala 17 10.4

United States 5 3.1

Nicaragua 1 0.6

Other 4 2.4

Total 163 100.0

Survey Results

On average, of those who immigrated to the United States (n = 150, 92% of sample), they had been in the United States 19.4 years (SD = 10.5)

Survey Results

108 reported using CAM (66.3%)• Excluded OTC

There were no gender differences in CAM usage (p= .24)

Of those who used CAM products43 reported using one product (39.8%)35 reported using two products (32.4%)24 reported using three (22.2%)8 reported using five or more (7.4%)

Survey Results

75 different CAM substances reported as being used by the patients

The most popular products were manzanilla tea (chamomile) and yerba buena

Survey Results: Types of CAM

Herbal (95.4%) Manzanilla, hierba buena, sábila, té de 7 azahares,

ruda, árnica, nopal Orthomolecular (8.3%)

Vitamin B12, calcium, masurium, multivitamins Biologically-based (2.8%)

Liver, hormones, glucosamine Special Diet (1.9%)

Cortislim

Survey Results : Types of CAM

Survey Results: Illnesses & Conditions

CAM substances used for many conditions

12 system-categories

Frequency

(n=108)Percent (%)

Digestive 51 47.2

No Illness 25 23.1

Nervous 19 17.6

Immune 18 16.7

Endocrine 12 11.1

Circulatory 12 11.1

Reproductive 10 9.3

Skeletal 8 7.4

Urinary 4 3.7

Muscular 3 2.8

Cardiovascular 1 0.9

Other 2 1.9

Survey Results

Survey Results:Source of CAM

Most of the CAM products were bought at a store/market (n = 81; 75.0%)

Fifty-three of the products were grown at home (22.5%)

Yerba Buena Sábila Nopales

Ruda

Survey Results:Source of CAM

The rest came from a variety of sources, including out of the country, pharmacies, yerberías, boticas, TV commercials, and from their doctors

Does length of time in US affect usage?

Testing hypothesis:  New immigrants are more likely to use CAM than long-term immigrants (10+ years) those born in US This was NOT supported There is no statistical difference in # of patients using

CAM by length of time in US (born, 0-9, 10+) However, there was a slight trend for immigrants here

longer (who by default are older) to be more likely to use CAM

Unable to determine if this is age effect or immigration effect due to small sample size

Next Steps

Further data collection, survey reconstruction, statistical analysis, and discussionInclude more/different questions

Publication

Suggested Outcomes

Develop intervention/tool to improve quality of care regarding CAM use in this population

Reference card for lab coat Ultimate Goal

To improve practice!

Discussion

Mercado in

Cuernavaca,

Morelos,

México