Health Care Choices: Chronic Illness
As older people live longer with chronic illnesses that require ongoing management of both the disease processes and the attendant symptoms, the choices they make about treatments become more important. A recent study of the use of complementary/alternative therapies amongst older rural dwellers in Montana and North Dakota raised a number of questions about the use of these therapies by individuals with chronic health problems. The study built on this previous work in which the team examined the extent of use of complementary therapies amongst rural elders. Complementary therapy can be effective alone or in combination with traditional care or even contraindicated in other situations. Its use could be a contributing factor to either the increase or decrease in the span of healthy life for an individual. Because increasing the quality and years of healthy life for all Americans is one of the major goals of Healthy People 2010, the role of complementary therapy in the attainment of this goal needs to be explored, especially in the health care of older rural dwellers with chronic health conditions.
The specific aims of this phase of the Health Care Choices Project were to: (a) understand better the extent of use of complementary therapies for chronic conditions, (b) understand better what specific complementary therapies are used for what chronic conditions, (c) ascertain perception of the efficacy of the selected complementary therapy for chronic conditions, and (d) explore awareness of the availability of complementary therapy providers.
A qualitative study design was used to obtain in-depth descriptive data from older people living in the rural areas of Montana and North Dakota. Ten women and men, who participated in the earlier study conducted by this team of researchers, were selected using theoretical sampling techniques. Tape-recorded telephone interviews were conducted by a seasoned interviewer. Data was analyzed for themes, properties and dimensions. The analysis yielded a set of questions and hypotheses about the use of complementary therapies by older adults with chronic health conditions that will further the research in this area.
A no-cost extension of the Center for Research on Chronic Health Conditions in Rural Dwellers funding allowed for two addition small scale projects. The purpose of the first sub-study was to determine the availability of complementary and alternative medicine (CAM) resources to individuals in twenty rural communities in two western states. Data were collected through internet phone directories searches and an on-line survey of Montana naturopaths. Seventy-three CAM providers were identified in the target communities.
The first sub-study to examine the availability of CAM providers in rural communities was just one piece of the puzzle of rural health care accessibility. The research team wondered whether CAM providers traveled to other more remote rural communities to deliver services as some mainstream providers do, to what extent CAM providers were seen as primary care providers, how people learned about local CAM providers, and what the referral relationships were between mainstream and complementary providers. To begin to explore these questions in the second sub-study an internet-based survey of the naturopathic physicians in Montana was conducted. This group was selected as they are licensed in several states, they present themselves as primary care providers, there were comparative data from other states, and the research team was able to access these providers through the state professional organization. The computer-based survey of the practice characteristics of naturopathic physicians was sent to all twenty-five licensed naturopaths in Montana. Eleven naturopathic physicians completed the survey for a 44% response rate.
The two sub-studies, while modest in nature, began to clarify how and why rural residents use CAM and the relationship between CAM use and mainstream medicine. Understanding the role that CAM plays in overall health promotion and illness management among rural residents is important in rural health care practice and a great deal more research is needed in this area.