Patterns of Complementary and Alternative Medicine Use in ED Patients and Its Association With Health Care Utilization J.Z. LI, BA, J.V. QUINN, MD, MS, C.E. MCCULLOCH, PHD, B.P. JACOBS, MD, MPH, AND P.V. CHAN, BS This study characterizes the use of complementary and alternative med- icines (CAM) among ED patients and demonstrates patterns of health- care utilization among users and nonusers of CAM therapies. A cross- sectional observational study was performed by administering questionnaires to ED patients at a university teaching hospital. Of the 356 patients surveyed, more than half (55%) had tried at least one com- plementary and alternative therapy within the past 12 months and 17% had tried CAM for their presenting medical problem. The use of CAM interventions varied significantly among different demographic groups. The number of ED visits over the past year did not differ between the users and nonusers of CAM, but those using alternative therapies did have more visits to outpatient physicians over the past 12 months (7.8 vs. 5.2; 95% confidence interval [CI], 7-4.6; P <.01). After controlling for age, ethnicity, education level, religion, income, and self-report of overall health status, users of CAM had more frequent visits to outpatient phy- sicians (odds ratio [OR], 1.06; 95% CI, 1.02-1.1; P <.01), had no difference in their rates of hospitalization, but trended toward spending fewer days in the hospital when they were admitted (OR, .96; 95% CI, .92-1.0; P  .06). Complementary and alternative medicines are being used by a majority of ED patients with a significant number having used CAM for their presenting complaint before visiting the ED. CAM users do not differ in their utilization of the ED when compared with nonusers, but do have a significantly increased frequency of outpatient physician visits. (Am J Emerg Med 2004;22:187-191. © 2004 Elsevier Inc. All rights re- served.) Complementary and alternative medicines (CAM) are generally defined as those therapies not normally taught in U.S. medical schools and not usually available in U.S. hospitals. It has become an important part of the U.S. healthcare system with 42% of the U.S. population access- ing these therapies in 1997 and with total out-of-pocket expenditures estimated at $27 billion, which is comparable to the estimated out-of-pocket costs for all U.S. physician services that year. 1 There have been only a few studies on the use of CAM in an ED setting. In a 1999 survey of ED patients, 56% were found to have tried alternative therapies sometime in the past with the most popular therapies being massage, chiropractic, and herbs. In addition, most patients who had used CAM had not informed their physicians of such use, 2 which should be of particular importance to EPs because of the potential for side effects and for herb– drug interactions. 3-9 Despite the increasing awareness of the popularity of CAM and the monies spent on these treatments by patients, there have been few reports studying the use of CAM in ED patients and the association between CAM use and the use of traditional healthcare resources. The main objectives of this study were to determine the frequency and types of CAM therapies being used by ED patients, the socioeco- nomic factors correlated with the use of CAM, and whether the users of CAM differed in their utilization of the health- care system compared with nonusers. METHODS Study Design and Population This study was performed at the ED of the University of California, San Francisco (UCSF) Medical Center. This ED serves a diverse city of 730,000 and has an annual volume of 34,000 patients. The survey was administered to a con- venience sample of patients presenting to the ED between May 2001 and June 2002. We excluded patients who were unable to participate as a result of extreme illness or trauma; those with altered mental status resulting from a psychiatric illness, drugs, or alcohol intoxication; those who were in- carcerated; and those with a language barrier. The question- naire, informed consent forms (translated into both Spanish and Chinese), and survey methods were approved by the UCSF Institutional Review Board. Survey Content and Administration Along with the demographic information, patients were asked questions regarding the following areas: their present- ing complaint, the number of primary care and nonprimary care outpatient physician visits, the number and length of hospitalizations in the past year, current medical concerns, medications, type and frequency of CAM used for their presenting complaint as well as for any other reasons in the past 12 months, and the number of times the patients visited a CAM practitioner (defined as someone who was paid to perform or give advice about the CAM). Patients were able to choose from a list of 17 CAM interventions that were compiled after a review of the literature. 1,2,10,11 The subjects From the Divisions of Emergency Medicine and Biostatistics and the Osher Center for Integrative Medicine, University of California, San Francisco, San Francisco, California. Manuscript received March 24, 2003; accepted April 24, 2003. Funded by a grant from the Emergency Medicine Foundation and the Society for Academic Emergency Medicine. Address reprint requests to J. V. Quinn, MD, MS, Box 0208, University of California, San Francisco, San Francisco, CA 94143- 0208. Email: quinnj@medicine.ucsf.edu Key Words: Complimentary alternative medicine, CAM, health care utilization. © 2004 Elsevier Inc. All rights reserved. 0735-6757/04/2203-0009$30.00/0 doi:10.1016/j.ajem.2004.02.006 187