Acta Med Croatica. 2014 Dec;68(4-5):345-51.
[Article in Croatian]
Abstract
The
use of complementary and alternative medicine (CAM) is widespread
around the world including Croatia. The number of studies that
investigate both quantitative and qualitative use of CAM in Croatia is
limited. The aim of this study was to investigate the use of CAM among
family medicine patients in the town of Čakovec and the rate they report
it to their family doctor. This was a cross-sectional study in a sample
of 300 patients that visited primary health center for any reason. We
used anonymous questionnaire already employed in a previous
investigation (Čižmešija et al. 2008), which describes socioeconomic
characteristics, modalities of CAM use, and reasons for use. We also
added questions on the type of herbs used and use of over-the-counter
vitamin and mineral supplements. On data analysis we used descriptive
statistics, χ2-test and Fisher's exact test, while the level of
statistical significance was set at p ≤ 0.05. The response rate was 76%.
Out of the total number of patients, 82% used some modality of CAM.
Women, patients with secondary school education, employed and retired
persons used CAM more often. Students and pupils reported least use of
CAM. The most commonly used were herbs (87%), bioenergy (29%), diet
therapy (28%), chiropractics (22%), and homeopathy
and acupuncture (11% each). Vitamin and mineral supplements were used
by 77% of study subjects. CAM was most frequently used for respiratory,
urinary and musculoskeletal problems, as well as to improve overall
health condition. Of the respondents that reported CAM use, 55% believed
it would help them, 43% used it because they wanted to try something
new, while only 2% indicated dissatisfaction with their physician as the
reason for using CAM. Statistically, there were more subjects that used
CAM and did not notify their family doctor about it, which could
indicate poor communication between family doctors and health care
users. Our results are consistent with a previous quantitative study
conducted in Croatia and with literature data on the countries with a
predominant use of western medicine. Qualitative data from previous
studies in Croatia could explain the cultural and socioeconomic context
of CAM use. Dissatisfaction with their physician as the reason for using
CAM was rarely indicated, suggesting that CAM most probably fills the
gap between successful and unsuccessful treatment, and perception that
evidence based medicine has its own limitations. The arguments to turn
to CAM therapy could involve poor doctor to patient ratio, i.e. 1750
patients per family medicine doctor on average, and the 20% increase in
the number of diseases and conditions diagnosed by family medicine
units. In conclusion, these results suggest that the use of CAM is
common among patients in family medicine. When taking patient history,
doctors should ask about CAM use and be aware of the patient beliefs and
lifestyle. When patients strongly believe in CAM methods, there is the
need of making compromise in therapy, with explanation of the possible
side effects and at the same time continuous follow up. There is the
need of additional education of family doctors and population about good
and bad effects of CAM. In Croatia, accent should be on herbalism
because this modality is most widespread.
