Use of alternative therapies by patients with rheumatic disease in Guadalajara, Mexico: Prevalence, beliefs, and expectations

Abstract

Objective. To assess the prevalence, practices, beliefs, and expectations of patients with rheumatic diseases in relation to the use of alternative therapies. Methods. We conducted a cross-sectional survey of 300 consecutive patients with rheumatic diseases at 3 outpatient rheumatic disease clinics in Guadalajara, Mexico to evaluate the use of alternative therapies. A face-to-face structured interview was administered by a trained assistant to evaluate the prevalence of use and patient beliefs, perceptions, and expectations in relation to alternative therapies. Results. Two hundred fifty patients (83%) had used a total of 1386 alternative therapies (range 1-19); 203 (68%) patients had used alternative therapy in the previous 12 months. Sixty-one percent received at least one alternative treatment before the first rheumatology consultation, but an additional 18% initiated these therapies after their initial contact with a rheumatologist at our clinics. Only 66 (26%) of the patients using alternative therapy notified their rheumatologist about their use. Thirty-six patients (14%) discontinued formal treatment at least on one occasion in order to receive alternative therapies, and only 8 (22%) notified their rheumatologist. Alternative therapy practitioners recommended discontinuation of conventional therapy on 57% of the occasions when formal treatments were discontinued. Mean expenditures per patient for fees to alternative therapy providers were equivalent to 28 days of the official minimum daily wage, and per patient costs for the remedies themselves were equivalent to 13 days of the official minimum daily wage. Patients who used alternative therapy in the past 12 months had lower education (7 versus 10 years, P < 0.001) and were slightly more disabled (1.7 versus 1.5, modified Health Assessment Questionnaire, P < 0.01). Conclusions. In this survey most patients used alternative therapies for the treatment of their rheumatic disease. Alternative therapies were costly and appeared to decrease adherence to conventional therapy. Health care providers should openly discuss the use of alternative therapy in patients with rheumatic diseases.