Patrick T. Tyree

Potential Interactions Between Complementary/Alternative Products and Conventional Medicines in a Medicare Population

Background: Despite the high prevalence of complementary and alternative medicine (CAM) product use among the elderly, little is known about the extent of concurrent CAM-conventional medicine use and the potential for adverse reactions. Objective: To determine the prevalence of CAM product use concurrent with conventional medications, prescription and nonprescription, in a Medicare population and assess the risk for adverse interactions. Methods: Retrospective analysis was performed on Cardiovascular Health Study interview data from 1994, 1995, 1997, and 1999. The prevalence of concurrent combinations of CAM products and conventional drugs was tabulated. The adverse interaction risks were categorized as unknown, theoretical, and significant. Results: Of 5052 participants, the median age was 75, 60.2% were female, 16.6% were African American, and 83.4% were white. The percent using CAM products during the 4 time periods was 6.3%, 6.7%, 12.8%, and 15.1 %, The percent using both CAM products and conventional drugs was 6.0%. 6.2%. 11.7%, and 14.4%, Of these, 294 (5.8%) individuals took combinations considered to have a significant risk for an adverse interaction. Combinations with risk were observed on 393 separate interviews. Most (379) involved a risk of bleeding due to use of ginkgo, garlic, or ginseng together with aspirin, warfarin, ticlopidine, or pentoxifylline. An additional 786 observations of combinations were considered to have some, albeit theoretical or uncertain, risk (or an adverse interaction. Conclusions: Concurrent use of CAM products and conventional medicines in a Medicare population was found to be common. Research to define the risks of combining ginkgo and garlic supplements with aspirin should be of high priority.

The role of alternative medical providers for the outpatient treatment of insured patients with back pain.

Study Design. Analysis of health insurance claims from 2 large Washington State companies. Objective. To evaluate the prevalence and cost of complementary and alternative medicine (CAM) provider use for back pain treatment. Summary of Background Data. Washington State requires all commercial insurance to cover licensed CAM providers. Methods. Outpatient claims for the treatment of back pain were analyzed by the International Classification of Disease-9 codes and provider type. The number of visits and expenditures associated with different forms of treatments were calculated. Results. Back pain accounted for 15% of all outpatient visits, and these companies spent more than

Challenges of Using Medical Insurance Claims Data for Utilization Analysis

52 million on 652,593 claims submitted by 104,358 adults. Most people used only CAM (43%) or only conventional providers (45%) for back pain treatment, with merely 12% using both. Patients who saw only CAM providers had fewer comorbidities than the other 2 groups and made approximately twice as many visits as “conventional only” users (median 4 vs. 2). Average amount allowed per outpatient low back pain claim was lower for CAM visits (mean

Preventive Screening of Women Who Use Complementary and Alternative Medicine Providers

50, SD

Comparison of Health Care Expenditures Among Insured Users and Nonusers of Complementary and Alternative Medicine in Washington State: A Cost Minimization Analysis

28) than for conventional visits (mean

Identification of ovarian cancer symptoms in health insurance claims data.

128, SD

The use of complementary and alternative medical providers by insured cancer patients in Washington State

173). Total outpatient costs for the treatment of back pain were highest for the group using both CAM and conventional care (mean

Insurance coverage and subsequent utilization of complementary and alternative medicine providers

1079, SD

Use of complementary and alternative medicine providers by fibromyalgia patients under insurance coverage.

1185), and lowest for the group using CAM only (mean

Pediatric vaccination and vaccine-preventable disease acquisition: associations with care by complementary and alternative medicine providers.

342, SD