Disclosure of complementary and alternative medicine (CAM) to conventional medical providers: Variation by race/ethnicity and type of CAM

Background: Complementary and alternative medicine (CAM) is often used alongside conventional medical care, yet less than half of patients disclose CAM use to medical doctors. CAM utilization can affect biomedical treatment outcomes, including herb-drug interactions, underscoring the importance of patient-provider communication about CAM use. CAM disclosure is particularly low among racial/ethnic minorities, but reasons for differences in disclosure rates, such as type of CAM used or quality of conventional healthcare received, have not been explored. Objective: This study tests the hypotheses that disclosure is higher for CAM modalities that are perceived to have greater legitimacy (i.e., provider-based domains); and that relative to non-Latino Whites, racial/ethnic minorities are less likely to disclose CAM use to medical doctors, but that access to and quality of conventional medical care account for racial/ethnic differences in CAM disclosure. Methods: Bivariate and multiple variable analyses of the 2002 National Health Interview Survey and 2001 Health Care Quality Survey were performed. All analyses were conducted using Stata 9.0 and employed survey estimation techniques to account for design effects when calculating standard errors. Results: Disclosure of CAM use to medical providers was higher for provider-based than self-care CAM (47% vs. 34%, respectively). Disclosure of any CAM was associated with factors of access to and quality of conventional care, including insurance status, source of conventional care, postponing care due to cost, having a regular doctor, and satisfaction with conventional care. CAM disclosure was higher among non-Latino Whites relative to minorities (44% vs. 30-37%). Controlling for confounding factors, having a regular doctor [adjusted odds ratio (AOR) = 1.90] and quality patient-provider relationship (AOR = 1.37) mitigated racial/ethnic differences in CAM disclosure. Conclusion: Disclosure of CAM use can be improved through consistent provider relationships, better patient-physician communication, and quality of healthcare across racial/ethnic groups. Increased disclosure of CAM practices to conventional providers should be encouraged, particularly for self-care practices which are the most commonly used forms of CAM.