Reasons Physicians Recommend or Don’t Recommend Common Complementary Health Approaches to Patients

A new analysis suggests that physicians use a combination of personal experience and scientific evidence when deciding whether to recommend complementary health approaches. The findings also suggest that physicians who recommend these approaches may have some degree of trust in the opinions of both their peers and patients regarding these approaches. Recently published in Journal of Integrative and Complementary Medicine, the analysis was led by researchers at the National Center for Complementary and Integrative Health (NCCIH) and National Center for Health Statistics and partly funded by NCCIH.

Understanding the reasons behind physician recommendations might lead to finding ways to help physicians make appropriate decisions for their patients. For this analysis, the investigators looked at what factors influence whether a physician recommends four common complementary health approaches to patients in an office-based setting. The approaches were herbs and other nonvitamin supplements, chiropractic/osteopathic manipulation, acupuncture, and mind-body therapies (including meditation, guided imagery, and progressive relaxation).

Using the Anderson Behavioral Model of Health Services Utilization as a framework, the researchers analyzed data from the 2012 National Ambulatory Medical Care Survey (NAMCS) Physician Induction Interview. NAMCS provides a national representation of nonfederal, office-based U.S. physicians. A total of 5,622 physicians participated in the Physician Induction Interview.

Findings showed that physicians who recommended the four complementary health approaches often based their recommendations on their own personal use of the approaches, evidence in peer-reviewed literature, and on recommendations from colleagues. Below are additional findings from the analysis.

• About 70 to 75 percent of physicians who recommended the four approaches acknowledged the importance of patient reports (patients telling physicians about their use of the approaches). Patient reports ranked slightly higher as an influencing factor than evidence from peer-reviewed literature.
• For chiropractic/osteopathic manipulation, acupuncture, and mind-body therapies, the most common influencing factor for making recommendations was patient reports.
• For each of the four approaches, more than half of the physicians who made recommendations said they were influenced by scientific evidence in peer-reviewed journals.
• A higher percentage of physicians used scientific evidence as a reason for recommending herbs and other nonvitamin supplements and mind-body therapies than for recommending chiropractic/osteopathic manipulation and acupuncture.
• A higher percentage of female physicians than male physicians reported evidence in peer-reviewed journals or colleague recommendations as the reason for recommending herbs and other nonvitamin supplements or chiropractic/osteopathic manipulation. 
• Over 60 percent of physicians recommended each of the four complementary health approaches because the patient asked for the approach.
• For all four approaches, a lack of perceived benefit was the most frequently reported reason by both male and female physicians for not making a recommendation. Physicians appeared to be more influenced by perceived benefit than by health care access barriers such as limited health insurance coverage or lack of affordability.

This examination increases understanding of the intersection of the professional and personal worlds of mainstream health care providers when they are making recommendations for complementary health approaches to patients. It also helps identify potential barriers to the acceptance of evidence-based complementary approaches by office-based physicians. According to the investigators, future research could explore why physicians may use scientific evidence differently across individual approaches when making recommendations.