Access barriers & CAM 12/22/2006

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Presentation transcript:

Access barriers & CAM 12/22/2006 APHA 2007 Medical Care Section Student Paper Award Session Perceived access barriers to conventional medicine and the utilization of complementary and alternative medicine (CAM): A population-based study Amanda Tzy-Chyi Yu, MHA Division of Health Policy and Management University of Minnesota – Twin cities November 6, 2007 Yu

Learning Objectives Identify types of practitioner-provided and self-directed CAM therapies. Describe the relationship between perceived access barriers (PAB) to conventional medicine (CM) and CAM usage. Understand modeling techniques to deal with endogenous regressors. 11/06/2007 PAB & CAM - Yu

Access barriers & CAM Background 12/22/2006 CAM – complementary and alternative medicine, unconventional medicine, unconventional therapies CM – conventional medicine, conventional health care, conventional therapy, orthodox medicine, modern medicine 11/06/2007 PAB & CAM - Yu Yu

Access barriers & CAM Background (cont.) 12/22/2006 Figure 1. Total visits to CAM practitioners by the adult population (Eisenberg et al., 1998) 427 million in 1990, exceeded the total projected visits to all primary care physicians by 40 million. 629 million in 1997, exceeded the total projected visits to all primary care physicians by 243 million. (629-427)/427 almost 50% (243-40) about 500% 11/06/2007 PAB & CAM - Yu Yu

Access barriers & CAM Research Question 12/22/2006 Are perceived access barriers to CM associated with the use of CAM? 11/06/2007 PAB & CAM - Yu Yu

Theory Figure 2. Effects of shifting budget constraints on the utilization of conventional medicine and complementary and alternative medicine CAM CM O IDC1 A B1 cm1 cam1 Budget constraint when no perceived access barriers to CM and CAM CAM: complementary and alternative medicine CM: conventional medicine B2 IDC2 C cm2 cam2 Budget constraint when perceived access barriers to CM, but not to CAM IDC3 D cm3 cam3 B3 Budget constraint when perceived access barriers to CM and CAM 11/06/2007 PAB & CAM - Yu

Review of the Literature Access barriers & CAM Review of the Literature 12/22/2006 CAM Not homogenous Access Penchansky and Thomas (1981) the five access dimensions (availability, accessibility, accommodation, affordability, and acceptability) are distinct but interrelated. 11/06/2007 PAB & CAM - Yu Yu

Methodology Cross-sectional quantitative study Data Measures of CAM Access barriers & CAM Methodology 12/22/2006 Cross-sectional quantitative study Data Measures of CAM Measures of PAB to CM Analysis plans I am aware that a cross-sectional study cannot prove causation. 11/06/2007 PAB & CAM - Yu Yu

Access barriers & CAM Data 12/22/2006 Target population: noninstitutionalized U.S. citizens aged 18 to 64 National Health Interview Survey (NHIS) 2002 (N=30,801) Demographic missing data were imputed using hotdeck in Stata 11/06/2007 PAB & CAM - Yu Yu

Measures of CAM CAM as a whole Practitioner-provided Self-directed Access barriers & CAM Measures of CAM 12/22/2006 Category 2002 CAM as a whole Every approach in the categories that follow Practitioner-provided Naturopathy Ayurveda Acupuncture Folk medicine Hypnosis Chelation therapy Chiropractic care Massage Energy healing therapy/reiki Biofeedback Self-directed Homeopathic treatment Relaxation techniques Prayer and spiritual healing Yoga/tai chi/qigong Natural herbs Special diets High-dose or megavitamin therapy 11/06/2007 PAB & CAM - Yu Yu

Measures of Perceived Access Barriers Access barriers & CAM Measures of Perceived Access Barriers 12/22/2006 Dimensions Definitions Questions (9 items) Accommodation The relationship between the manner in which the supply resources are organized to accept clients < ...You couldn't get through on the telephone.> < ...You couldn't get an appointment soon enough.> < ...Once you get there, you have to wait too long to see the doctor.> < ...The (clinic/doctor's office) wasn't open when you could get there.> Accessibility The relationship between the location of supply and the location of clients < ...You didn't have transportation. > Affordability The relationship of prices of services and providers’ insurance or deposit requirements to the clients’ ability to pay < ...Prescription medicines > < ...Mental health care or counseling > < ...Dental care (including check-ups) > < ...Eyeglasses > 11/06/2007 PAB & CAM - Yu Yu

Analysis Plans A simple probit model Access barriers & CAM Analysis Plans 12/22/2006 A simple probit model A recursive bivariate probit model Variables of interest Any PAB Affordability PAB Accommodation PAB Accessibility PAB Outcome variables Any CAM Practitioner-provided CAM Self-directed CAM There are two parts of analysis plans. 11/06/2007 PAB & CAM - Yu Yu

Simple Probit vs. Recursive BV Probit Z e2 ρ CAM PAB X e1 βPAB Note: BV - bivariate 11/06/2007 PAB & CAM - Yu

Result I 11/06/2007 PAB & CAM - Yu

Result II 11/06/2007 PAB & CAM - Yu

Result III 11/06/2007 PAB & CAM - Yu

Result IV 11/06/2007 PAB & CAM - Yu

Conclusions Overall, any PAB to CM will increase the probability of using any CAM by 16% on average. The associations between PAB to CM and practitioner-provided CAM and self-directed CAM are different. Affordability PAB are not associated with self-directed CAM, but positively associated with practitioner-provided CAM. Accommodation PAB are positively associated with both types of CAM. Accessibility PAB are positively associated with self-directed CAM, but not associated with practitioner-provided CAM. A probit model will have biased estimates if the variable of interest is endogenous. If the outcome and the variable of interest are both dichotomous, a bivariate probit model can handle endogenous independent variable by modeling error terms in both equations together. 11/06/2007 PAB & CAM - Yu

Strengths National representative sample Access barriers & CAM Strengths 12/22/2006 National representative sample Multidimensional measures of access barriers – affordability, accommodation, and accessibility Heterogeneous CAM – practitioner-provided and self-directed Take into account endogeneity of PAB to CM 11/06/2007 PAB & CAM - Yu Yu

Access barriers & CAM Limitations 12/22/2006 No detailed availability and acceptability access barriers data Cannot test the possible impact of threshold of PAB to CM on the use of CAM 11/06/2007 PAB & CAM - Yu Yu

Questions and Comments Access barriers & CAM Questions and Comments 12/22/2006 11/06/2007 PAB & CAM - Yu Yu

Access barriers & CAM 12/22/2006 Thank You! Contact information: Amanda Tzy-Chyi Yu yuxx0147@tc.umn.edu 11/06/2007 PAB & CAM - Yu Yu