This study found that approximately 12% of Canadians used some sort of CAM service in the past 12 months, and that CAM use was associated with female gender, high income and high levels of education. An inverted U-shaped relationship was noted between CAM use and age. This pattern has also been observed in other studies [8–10], indicating that CAM use may either have generational effects or be what Millar refers to in his paper as a "mid-life phenomenon" . This study also shows that those with a chronic disease are not uniformly high users of CAM services. Those with epilepsy had slightly lower level of CAM use in the past year as the general population, but this did not reach statistical significance, while those with diabetes were significantly less likely to have used any CAM service in the past year. Additionally, those with different chronic conditions are consulting different CAM practitioners.
That individuals with asthma, diabetes and migraine remain statistically more (in the case of asthma and migraine) or less (in the case of diabetes) likely to utilize CAM services after adjustment for demographic factors such as age, sex and income suggests that these differences cannot be explained by predisposing characteristics alone, and in fact, represent true differences between groups. This difference may be due in part to the relatively constant nature of diabetes, once adequate blood sugar control has been achieved, as opposed to the more sporadic and acute nature of asthma and migraine attacks. A study using data from Statistics Canada's National Population Health Survey (1994-1999) found that individuals with arthritis/rheumatism, asthma, back problems, bronchitis/emphysema, Crohn's disease, and migraine were more likely to use CAM services than the general population . However, once adjustments were made for chronic pain only those with asthma and back problems had significantly higher use than the general population . Another study found that approximately two-thirds of survey respondents reported using CAM because they felt that conventional treatments were not effective for treating their health problem . This may support the hypothesis that once adequate control of a chronic condition is achieved, individuals do not feel the need to seek out alternative treatments. Furthermore, current conventional care paradigms for diabetes tend to be holistic in nature and require patients to be actively involved in preventing further symptoms, while treatment for both migraine and asthma tends to be more reactionary when symptoms occur and focuses on pharmaceutical management.
The finding of differential use of CAM services by type of chronic disease is important as it is commonly stated in the literature that many CAM users do not disclose or discuss their CAM use with their primary care physician, and due to polypharmacy, those with chronic disease are at an increased risk of complex drug interactions . A study examining herbal use in children presenting to a Canadian emergency room found that approximately 16% of children were taking medications and natural health products that could potentially interact . Additionally, a survey of patients receiving care from the Canadian College of Naturopathic Medicine found that only 58.5% of respondents discussed CAM use with their primary care physician, but 90.9% discussed their prescription medication use with their naturopathic physician . As this study and others show that individuals with certain chronic conditions are more likely to use CAM services, and these services are often used alongside standard medical care, this indicates that the onus has now been placed on care providers to specifically inquire about the use of CAM services. While approximately 70% of physicians do not ask their patients about the use of CAM services, physician inquiry has been shown to increase patient disclosure of CAM use by a factor of 19 (OR = 18.77, 95% CI: 5.06-69.62) . Research also shows that physicians are uncomfortable discussing CAM services with their patients as generally they have little formal knowledge or personal experience with these services .
Ultimately, patients often seek out alternative treatments when they feel they are missing something from Canada's conventional health care system. A Canadian study examining why patients chose to use CAM services found that while the most commonly reported reasons that patients used CAM services were that these services allowed them to take a more active role in their health and they identified with the holistic approach . Additionally, 40.1% of respondents reporting using CAM services because they had problems communicating with their medical doctor, and approximately two-thirds of respondents reported that conventional medicine was not effective for their particular health issue, that they were desperate, and were at a point where they were willing to try anything .
There are strengths and limitations to our study. The main strengths of the study include its population-based ascertainment and the very large sample size. Limitations of this study include its reliance on self-report data, and a lack of data on the type of health complaints that were addressed by CAM practitioners and rationales for seeking alternative treatments. Statistical correction for multiple testing was not undertaken, hence it is possible that a spurious association was found by chance alone. However, this is a descriptive study that is not aiming assess a specific hypothesis. Additionally, while information was collected on visits to herbalists, specific detailed information on the use of natural health products that were prescribed by a CAM practitioner or self-prescribed, which may have a greater probability of negatively interacting with standard medications, was not collected.