Complementary and alternative medicines (CAMs) and adherence to mental health medications

BACKGROUND: Medication regimes are often poorly adhered to, and the negative consequences of this are well recognised. The dynamics underlying non-adherence are less understood. This paper examines adherence to prescription medications for mental health difficulties in relation to the use of complementary and alternative medicines (CAMs). This was based on suggestions that within medical pluralism, CAMs may reduce adherence to conventional prescription medications for reasons such as their further complicating the medication regime or their being perceived as a substitute with less adverse side effects than conventional prescription medications. METHODS: Data used was from the National Comorbidity Study Replication (NCS-R), specifically those 1396 individuals who reported taking a prescription drug for mental health difficulties within the last 12 months and under the supervision of a health professional. This subsample was selected due to their being the only subgroup questioned regarding their medication adherence. Other demographic and health factors were also considered. RESULTS: The use of complementary medicines alongside the conventional medicines bore no significant relation to odds of reporting adherence versus non adherence. Ethnicity and medication count were significant predictors of adherence versus non-adherence. CONCLUSIONS: The above findings are discussed from the point of both promoting the use of CAMs and increasing health professionals’ understanding of the dynamics underlying adherence, or the lack thereof, and subsequently informing interventions to reduce the problems associated with this issue in terms of increased health care needs and reduced quality of life

A qualitative study of culturally embedded factors in complementary and alternative medicine use

Abstract Background Within the intercultural milieu of medical pluralism, a nexus of worldviews espousing distinct explanatory models of illness, our research aims at exploring factors leading to complementary and alternative medicine (CAM) use with special attention to their cultural context. Methods The results are based on medical anthropological fieldwork (participant observation and in-depth interviews) spanning a period from January 2015 to May 2017 at four clinics of Traditional Chinese Medicine in Budapest, Hungary. Participant observation involved 105 patients (males N = 42); in-depth interviews were conducted with patients (N = 9) and practitioners (N = 9). The interviews were coded with Interpretative Phenomenological Analysis; all information was aggregated employing Atlas.ti software. Results In order to avoid the dichotomization of “push and pull factors,” results obtained from the fieldwork and interviews were structured along milestones of the patient journey. These points of reference include orientation among sources of information, biomedical diagnosis, patient expectations and the physician-patient relationship, the biomedical treatment trajectory and reasons for non-adherence, philosophical congruence, and alternate routes of entry into the world of CAM. All discussed points which are a departure from the strictly western therapy, entail an underlying socio-cultural disposition and must be scrutinized in this context. Conclusions The influence of one’s culturally determined explanatory model is ubiquitous from the onset of the patient journey and exhibits a reciprocal relationship with subjective experience. Firsthand experience (or that of the Other) signifies the most reliable source of information in matters of illness and choice of therapy. Furthermore, the theme of (building and losing) trust is present throughout the patient journey, a determining factor in patient decision-making and dispositions toward both CAM and biomedicine

Medicinas alternativas e complementares: Uma metassíntese

O aumento do uso de Medicinas Alternativas e Complementares (MAC) motivou o crescimento do número de estudos qualitativos sobre o tema, justificando a realização de sínteses sobre esse material. Este artigo apresenta uma revisão sistemática de pesquisas qualitativas sobre MAC publicadas em periódicos internacionais. Esta revisão se orientou pela metodologia dos metaestudos. Foi realizada busca em revistas do Portal Periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior e foram selecionados 32 artigos para análise. Os estudos revisados apresentam questões que têm como foco: o paciente, suas experiências terapêuticas e seus contextos sociais e culturais; o profissional, as relações profissionais e o processo de profissionalização das MAC; a MAC e sua relação com a biomedicina. Conclui-se que as pesquisas qualitativas sobre as MAC ensejam um olhar exploratório sobre o tema, procurando identificar as experiências de pacientes e profissionais com essas terapêuticas, assim como buscam discutir as conseqüências desse uso para a Medicina Convencional ou biomedicina.<br>The growing use of Complementary and Alternative Medicines (CAM) has led to an increase in the number of qualitative studies on the subject, thus justifying a meta-synthesis of the resulting material. The current article presents a systematic review of qualitative studies on CAM published in international journals. The review was conducted according to the meta-synthesis methodology. A search was performed in journals through the Periodicals Periodical of CAPES, the National Agency for the Evaluation of Graduate Studies, and 32 articles were selected for analysis. The reviewed studies raise questions focusing on: patients, their therapeutic experiences, and their social and cultural contexts; professionals, professional relations, and the process of professionalization of CAM; and CAM and their relationship to biomedicine. The article concludes that qualitative studies on CAM call for an exploratory view of the theme, seeking to identify the experiences of patients and professionals with these therapies and discussing the impact of their use on conventional medicine or biomedicine