Delays in seeking conventional medical care and complementary and alternative medicine utilization

Although research has examined the connection between conventional medicine and complementary and alternative medicine (CAM) utilization, findings are mixed. On the one hand, a positive association for using both forms of medical treatments has been noted, such that higher conventional medicine use is associated with higher CAM use (Astin 1998; Eisenberg et al. 1998; Druss and Rosenheck 1999; Barrett et al. 2003; Mikhail, Wali, and Ziment 2004). On the other hand, researchers have observed a negative association (Barrett et al. 2003; Agdal 2005; Pagan and Pauly 2005), with individuals delaying conventional care and using more CAM (Marquis, Davies, and Ware 1983; Cassileth et al. 1984; Jensen 1990; Sutherland and Verhoef 1994; Sirois and Gick 2002). Given that utilization of CAM has remained popular and delays in seeking conventional medicine are on the rise, it is important to understand the relationship between CAM utilization and conventional medicine utilization, particularly if delays in seeking conventional medicine are associated with higher CAM utilization. The positive association between utilization of conventional medicine and CAM suggests that the heaviest conventional medicine users are also the heaviest CAM users (Eisenberg et al. 1993; Druss and Rosenheck 1999; Caban and Walker 2006), indicating that CAM users do not abandon conventional medicine, but rather use CAM in a complementary fashion (Barrett et al. 2000; Kessler et al. 2001; Fadlon 2005). This positive association supports the idea of medical pluralism: individuals adopt multiple forms of medicine or health practices even when conventional care is available (Kaptchuk and Eisenberg 2001) and do not simply make dichotomous choices in relation to health care (Kelner and Wellman 1997). While individuals “may reject specific medical treatments, such as certain medications, [they] retain a meaningful involvement with the conventional health care system” (Thorne et al. 2002, p. 675). For example, Hispanics who use prayer for healing view prayer as a supplement to receiving conventional health care and not as a replacement for such care (Mikhail, Wali, and Ziment 2004). On the other hand, the negative association between CAM and conventional medicine utilization suggests that individuals are opting for CAM prior to or instead of using conventional medicine (Agdal 2005). This negative association has been attributed to the ineffectiveness of conventional medicine for treating some health problems (Cassileth et al. 1984; Jensen 1990), the unpleasant and negative side effects of some conventional medications (Marquis, Davies, and Ware 1983), and the dissatisfaction with conventional practitioners or with the medical encounter (McGregor and Peay 1996; Siahpush 1999; Bishop, Yardley, and Lewith 2006). Conventional medicine can be viewed by some patients as too authoritative with a paternalistic, disparaging, condescending, or chauvinistic practitioner, while CAM can be viewed in a more positive light of facilitating health outcomes (Barrett et al. 2003). Due to the impersonal nature of conventional medicine, some patients report using CAM instead of conventional medicine because they are disgruntled with their physician (Furnham and Smith 1988; Siahpush 1999; Bishop, Yardley, and Lewith 2006). Although associations have been noted between CAM and conventional medicine, researchers have not typically moved beyond the individual beliefs and behaviors to understand how the structure of the conventional health care system can also push individuals toward CAM utilization. Goldstein (2002) argues that access issues, such as the structure and nature of the conventional health care system, should also be examined. As Strasen (1999) points out: Consumers have fewer choices about whom and where they can go for services and they have to get complicated authorizations, validations, and verifications before they can be seen by a health care practitioner. They need to fill out more forms, listen to more recorded messages, and wait longer to get an appointment. When they finally get an appointment, they wait longer periods of time, they see practitioners for shorter periods of time or not all, they spend more time with untrained support staff, and they get little or no personal attention. (p. 247) This organizational inaccessibility may also play a role in CAM use and is virtually absent in CAM research. The purpose of this study was to examine how delays in seeking conventional medical care because of access issues is associated with use of CAM. To refine this understanding, zero-inflated models are used to expand dichotomous measures of CAM utilization, a necessary, yet neglected, analysis in CAM research. Because previous studies have typically examined utilization of CAM with dichotomous measure (e.g., use/non-use) (i.e., Astin 1998 and Eisenberg et al. 1998), variance is hidden, and there becomes no way to distinguish the characteristics between an individual who used one CAM therapy and an individual who used five CAM therapies. This is the first study that we are aware of, to move beyond individuals' health behaviors and beliefs and focus on the factors inherent within the structure of the health care system using zero-inflated models. It is hypothesized that individuals who delay in seeking medical care due to organizational inaccessibility will be more likely to use CAM and will use more types of CAM.