Interview with NCCAM Director, Dr. Briggs
Dr. Josephine P. Briggs speaks to NIH Radio about NCCAM's new Health Care Provider Portal.
Balintfy: From the National Institute of Health, this is NIH Research Radio. Welcome to episode 133 of NIH Research Radio with news about the ongoing medical research at the National Institutes of Health—the nation's medical research agency. I'm your host Joe Balintfy, and coming up in this episode—detailed information on CAM resources.
Balintfy: We’re talking more now with Dr. Josephine Briggs about complementary and alternative medicine. Dr. Briggs, how many people in the United States are using CAM?
Briggs: Well, we do a survey called the National Health Interview Survey that's simply implemented together with the CDC. And the data from that survey done in 2007 showed that about 40% of Americans, 12% of children are turning to some form of complementary medical or health practice either to promote their own health and wellness or to deal with a particular health condition.
People are spending a lot of money on these interventions. Our estimate is $34 billion in out-of-pocket costs. This is about a little over 1% of total healthcare expenditures and a very sizable part of the actual out-of-pocket cost. So, people are spending money on this. It's very important, therefore, that healthcare providers be able to give them accurate information about which of these modalities are safe and which may be helpful and which ones to be concerned about.
Balintfy: In the beginning of this program, we heard about a different, more recent survey. Dr. Briggs, what was most revealing about that one?
Briggs: Right. We did a recent survey together with AARP and that showed that often people are in fact not telling their healthcare providers about their use of complementary and alternative medicine. I'm particularly concerned about dietary supplement use and the fact that some dietary supplements can interact with drugs. It's also a problem, some drugs interact with other drugs, but healthcare providers, particularly those writing prescriptions for drugs, really need to know all the pills people are taking because there can be interactions that diminish the efficacy and there can also be interactions that result in greater side effects.
Balintfy: Dr. Briggs, are there specific statistics on the use of CAM from this survey?
Briggs: Well, the data was in the AARP survey, which was focusing on the Americans over the age of 50 that 2/3 had not discussed CAM with a healthcare provider. And we know that in this age group, many people are on prescription drugs. So this is one reason that this demographic group, older Americans, are particularly concerned in this area.
Balintfy: In general, what are some important reasons for health care providers to talk about CAM practices and products with their patients?
Briggs: So, the interactions between dietary supplements and herbals and conventional drugs is certainly one important reason. CAM practices are used by many Americans to promote health and it's also a valuable entry for the healthcare provider to talk about health behaviors. The advice that we need to be more active and eat a healthy diet is one that patients need to take charge of themselves and talking about their health practices, the whole range of health practices, is a very good way as a physician, and I know this from my own care patients, to begin that dialogue. So there are these two important reasons.
Some alternative practices can be risky and certainly one concern is people using an alternative practice and avoiding or failing to get an accurate diagnosis. But the other two reasons of promotion of healthy behaviors and drug interactions are two additional reasons.
Balintfy: So to help primarily health care providers, NCCAM has a new web-based resource. What is that Dr. Briggs?
Briggs: Yeah, we're very proud of it. It is called our healthcare provider portal. We feel that it's going to meet important needs of healthcare providers to provide resources both for their own continuing education, learning about the evidence based and the clinical practice guidelines, actually getting CME credits, and providing access to a wide range of information resources they can use in conversations with their patients.
Balintfy: How does this web-based resource help health care providers duscuss CAM practices and products with their patients?
Briggs: So one important aspect of this site is access to all the clinical practice guidelines that have been developed in this area, and these include guidelines developed by the American Pain Society, the American College of Physicians, and other mainstream health organizations who have evaluated systematically the evidence for safety and efficacy of these approaches. Another very valuable resource that we link to on our website is the Cochrane Collaborative, which has performed many systematic reviews. So, this access in one place to the evidence plus and minus for health impact of these interventions is one important resource.
We also have CME credits available through the website. There's a CME process for physicians and other healthcare providers to evaluate their knowledge of these. And then finally, we have a lot of resources, information and fact sheets, that we think will be helpful to docs and nurses and other healthcare providers to answer specific questions of patients about say herbs and other interventions. So we think it's got a lot of valuable information for healthcare providers.
Balintfy: How was this information developed?
Briggs: Well, we have a team who has worked on this and they use evidence base – our key thing here is evidence base. And so they hunt through the libraries of evidence-based information including PubMed, others and do very careful searches for the information that will be helpful. We have increasingly a body of evidence-based systematic reviews that carefully, using established standards, collate all the trials that have been done and use rigorous statistical methods to draw conclusions. That's the process of evidence-based medicine and that's the process, which is the basis of our website.
Balintfy: Are there some other features you want to highlight?
Briggs: We've talked about the main ones. I just briefly mentioned the availability of literature searches. There are strategies for literature searching. So for some docs, searching PubMed in these areas is unfamiliar territory and so we have developed some resources and approaches to do those kind of literature searches. We have summaries of research studies that we've recently funded and safety and effectiveness information.
We have a toolkit there on encouraging the dialogue between patients and providers. That's called our Time to Talk toolkit and that provides sheets for example wallet cards and tip sheets that docs can give patients and then ask them to come back with the information brought into one place. So we think that there are quite a range of resources on the website that should be helpful. And we're very eager for people who use this to give us feedback as to what they would like, what's missing, and what would also be helpful.
Balintfy: Why is NCCAM providing this information?
Briggs: This is very central to our mission is providing the public with the ability to make evidence-based decisions about healthcare utilization and healthcare practices. This is really a core piece of NCCAM's mission and its part of the National Institutes of Health, our broad mission is to promote the nation's health and part of that is providing this kind of information.
Balintfy: Thank you Dr. Josie Briggs. For more information on CAM, CAM surveys and the web-portal with resources for health care providers, visit the website, www.nccam.nih.gov. And that’s it for this episode of NIH Research Radio. If you have any questions or comments about this program, or have a story suggestion of your own for a future episode, please let me know. Best to reach me by email—my address is firstname.lastname@example.org. I'm your host, Joe Balintfy. Thanks for listening.
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