Periodic Survey of Fellows
American Academy of Pediatrics
Division of Health Policy Research
Executive Summary
This survey was initiated by the Task Force on Complementary
and Alternative Medicine to assess the knowledge, attitudes and behaviors
of AAP members regarding use of complementary and alternative (CAM)
therapies in their practice. The survey explored pediatricians' practices
and beliefs surrounding complementary medicine and alternative therapies,
including screening on patients' use of CAM, beliefs about the effectiveness
of CAM, knowledge about and recommendations/referrals for CAM therapies,
as well as personal use of CAM. This survey will be used to assess the
degree to which pediatricians are aware of their patients' interest
in and use of CAM and the degree to which pediatricians have integrated
complementary medicine and alternative therapies into their practice.
Findings will be used to guide future efforts in developing educational
programs in this area.
Periodic Survey #49 was an eight-page self-administered
questionnaire sent to 1,607active United States members from July through
November 2001. After an original and five follow-up mailings a total
of 856 completed questionnaires were received for a response rate of
53.3%. Analyses are based on 745 pediatricians (87% of all respondents)
who provide direct patient care.
Screening for CAM Use
Eighty-seven percent of pediatricians had at least one inquiry from
patients or parents about a complementary or alternative therapy during
the three months prior to the survey; 12.9% had no such inquiries. The
most common inquiries were about herbs such as echinacea or St. Johns
wort (67% of pediatricians reported such inquiries), dietary supplements,
such as melatonin, fish oil, megavitamins (64%), chiropractic (59%)
and special diets such as vegetarian or macrobiotic (46%).
When taking a patient history or prescribing medication, nearly all
pediatricians ask their patients about use of prescription medications
and over-the-counter-medications such as acetaminophen (89.1% and 81.8%
of pediatricians, respectively, ask more than 75% of their patients
about these medications). However, few pediatricians ask their patients
about use of any form of CAM. About 1 in 5 pediatricians ask about herbal
therapies (20.2%), special diets (17.5%) or dietary supplements (17.3%),
but the majority of pediatricians do not ask their patients about any
other form of CAM.
Recommendations/Referrals for CAM Therapies: 3 Scenarios
Nearly all pediatricians (91.9%) recommend antihistamines or decongestants
for recurrent upper respiratory infection in a 3-year old and 83% say
they may also test for allergies. In addition, most also recommend environmental
strategies such as use of an air filter and/or avoidance of tobacco
smoke (93.0%) and avoiding crowed day care settings (83.6%). More than
half (58.0%) say they would usually or occasionally give nutritional
recommendations such as chicken soup or avoiding milk, and 30.8% would
recommend Eucalyptus oil in a vaporizer or a VAPO-bath. Pediatricians
less commonly recommend, even as adjunctive therapies, any other CAM
therapy.
Nearly all pediatricians follow standard guidelines for
medical management of a 15-year old with moderately severe asthma, ie,
98.0% recommend beta-agonists and 98.3% recommend daily anti-inflammatory
medications. Ninety-two percent also recommend environmental strategies
such as reducing exposure to allergens and tobacco smoke. Most pediatricians
recommend exercise such as Yoga or swimming (55.1%) to complement standard
biomedical treatment, and 18.4% also recommend hypnosis or relaxation
therapy. Fewer than 10% recommend any other CAM therapy for this condition.
Nearly all pediatricians (97.2%) follow standard guidelines
for management of attention deficit hyperactivity disorder, ie, recommend
medications such as Ritalin, Cylert, etc. In addition, most recommend
environmental strategies such as more structure and one-on-one attention
(85.6%) and an individual learning plan and tutoring (85.3%). More than
half of pediatricians (57.0% would also recommend psychotherapy. About
one-fourth would recommend, as adjunctive therapies caffeine (29.5%),
Yoga (24.5), or mind-body therapies such as hypnosis, relaxation or
distraction (21.5). Fewer than 5%of pediatricians recommend other forms
of CAM.
Attitudes Toward CAM
One-third of pediatricians (34.9%) say they or their families used some
type of CAM therapy during the 12 months prior to the survey; 66.0%
reported no use of CAM. Seven out of 10 pediatricians (70.3%) who say
they used CAM therapies during the past year reported using a massage
therapist, 21.0% say they sought care from a chiropractor, 13.5% say
they consulted a spiritual or religious healer and 13.1% saw an acupuncturist.
Most pediatricians (72.8%) agree they should provide
patients with information about all potential treatment options. More
than half (53.8%) think they should consider nontraditional therapies
when treating patients; however, 48.1% think that doing so may make
them susceptible to medical liability claims (and 31% are unsure). Nearly
40% of pediatricians say they are comfortable discussing CAM therapies
with patients and are confident in their ability to manage/coordinate
the care of patients who are also seeing nonmedical providers; however
a large proportion is unsure (26% and 28%, respectively). Pediatricians
are fairly evenly divided as to whether they would recommend a CAM therapy
considered safe but of untested efficacy for chronic life-threatening
conditions (37.1% agree, 31.6% disagree and 31.3% are unsure) or acute
self-limiting conditions (32.5% agree, 32.0% disagree and 35.6% are
unsure).
Seventy percent of pediatricians say they have patients
who use CAM therapies. Among these pediatricians, most do not think
use of CAM typically interferes with standard medical care (37.7% say
seldom/never, 44.4% occasionally), causes delay in seeking standard
medical care (21%, 51.1%), or impairs doctor-patient communication (49.4%,
36.0%). h of pediatricians think use of CAM therapies often increases
the risks of additional side effects (27.9%) and about half (46.8%)
think it occasionally increases such risks. While more than half of
pediatricians (56.9%) do not think CAM therapies reduce the side effects
of standard medications, 18.3% of pediatricians think they often or
occasionally do so and a large proportion, 24.7%, are unsure. Most pediatricians
(55.9%) think use of CAM therapies does not decrease overall health
care costs, however, 17.9% say it often or occasionally decreases such
costs and 26.2% are unsure about its effect on health care costs.
Information Needs Regarding CAM Therapies
In general, most pediatricians report they have little or no knowledge
of complementary or alternative medicine therapies. However, 3 out 10
pediatricians express at least moderate knowledge about nutritional
therapies, dietary/nutritional supplements, therapeutic exercise, and
massage therapy. About one-fifth of pediatricians say they are knowledgeable
about chiropractic, herbal remedies, spiritual healing, and mind-body
therapies such as hypnosis, relaxation or biofeedback. Fewer pediatricians
report any substantial knowledge about other forms of CAM.
Interest is high among pediatricians in receiving information
about all areas of CAM therapy. Three-fourths of pediatricians indicate
they would like more information on dietary supplements, herbal remedies
and nutritional therapies. Seventy percent expressed interest in therapeutic
exercise, about 60% are interested in information on various mind-body
therapies, acupuncture/acupressure and massage therapy. About half of
pediatricians want to know more about homeopathy, Therapeutic Touch,
environmental therapies, chiropractic and spiritual healing.