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1 First Choice Community Healthcare, Albuquerque, New Mexico
2 Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico
3 Department of Pharmacy Practice, Massachusetts College of Pharmacy & Health Sciences, Boston, Massachusetts
4 Joslin Diabetes Center, Boston, Massachusetts
5 Department of Family Medicine, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, New Jersey
CORRESPONDING AUTHOR: Brian M. Shelley, MD, First Choice Community Healthcare South Valley Family Health Commons 2001 N Centro Familiar, SW, Albuquerque, NM 87105 bshelley{at}salud.unm.edu
PURPOSE Although high rates of traditional medicine and complementary and alternative medicine (TM/CAM) use have been well documented, there has been less attention to the factors influencing communication between patients and their primary care clinicians about TM/CAM. Such communication can be important in anticipating possible drug-herb interactions and in assuring agreement about therapeutic plans.
METHODS We used sequential, multistage, qualitative methods, including focus groups, in-depth interviews, and a video vignette, to explore communication about TM/CAM between patients and their primary care clinicians. The study was conducted in RIOS Net (Research Involved in Outpatient Settings Network), a Southwestern US practice-based research network, situated largely in Hispanic and American Indian communities where TM/CAM is an important part of self-care.
RESULTS One hundred fourteen patients, 41 clinic staff members, and 19 primary care clinicians in 8 clinic sites participated. The degree and nature of TM/ CAM communication is based on certain conditions in the clinical encounter. We categorized these findings into 3 themes: acceptance/nonjudgment, initiation of communication, and safety/efficacy. Perceived clinician receptivity to and initiation of discussion about TM/CAM strongly influenced patients’ decisions to communicate; perceived clinician expertise in TM/CAM was less important. Clinicians’ comfort with patients’ self-care approaches and their level of concern about lack of scientific evidence of effectiveness and safety of TM/CAM influenced their communication about TM/CAM with patients.
CONCLUSIONS Specific communication barriers limit patient-clinician communication about TM/CAM. Clinicians who wish to communicate more effectively with their patients about these topics and better integrate the types of care their patients use can change the communication dynamic with simple strategies designed to overcome these barriers.
Key Words: Patient-physician relations • communication • complementary therapies • practice-based research • primary health care • traditional medicine
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  H. Tapp and M. Dulin The science of primary health-care improvement: potential and use of community-based participatory research by practice-based research networks for translation of research into practice Exp Biol Med, March 1, 2010; 235(3): 290 - 299. [Abstract] [Full Text] [PDF]
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 R. L. Williams, B. M. Shelley, A. L. Sussman, and on behalf of RIOS Net clinicians The Marriage of Community-based Participatory Research and Practice-based Research Networks: Can It Work? -A Research Involving Outpatient Settings Network (RIOS Net) Study J Am Board Fam Med, July 1, 2009; 22(4): 428 - 435. [Abstract] [Full Text] [PDF]
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 W. R. Phillips In This Issue: Practice, Research, and Reflection Ann. Fam. Med, March 1, 2009; 7(2): 98 - 99. [Full Text] [PDF]
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