CONTINUITY OF THE DOCTOR-PATIENT RELATIONSHIP MAY INFLUENCE DECISIONS TO SEE A COMPLEMENTARY AND ALTERNATIVE MEDICAL CARE PROVIDER

  Purpose: Previous studies have shown that continuity of general practitioner (GP) care is associated with less use of emergency departments, hospitalisations and outpatient specialist services. We wanted to explore possible associations between continuity of GP care and use of complementary and alternative medical (CAM) providers. 

    Method: Population-based health surveys have been conducted in Tromsø, Norway, since 1974. We used questionnaire data from the sixth Tromsø study conducted in 2007-8.  Four groups were invited to participate; every resident aged 40-42 or 60-87 years (n=12,578), a 10% random sample of individuals aged 30-39 (n=1,056), a 40% random sample of people aged 43-59 (n=5,787) and all remaining subjects who had attended a similar study in Tromsø previously (n=341). Participants were asked whether they during the last 12 months had visited an alternative practitioner (homeopath, acupuncturist, foot zone therapist, herbal medicine practitioner, laying on hands practitioner, healer, clairvoyant etc.). We used multivariate logistic regression to analyse possible associations between a long standing GP-patient relationship and the utilisation of CAM providers. Analyses were adjusted for age, gender, marital status, income, education, frequency of GP visits, self-rated health and other proxies for health care need.

    Result: Of 9,743 eligible GP users (i.e. who had visited a GP the last 12 months) 85% had seen the same GP for more than two years. The probability of visiting a CAM provider was statistically significantly lower among those with a GP relationship of more than 2 years compared to those with a shorter GP relationship (OR 0.79, 95% CI 0.67-0.94). The association remained statistically significant in regression models where self-rated health was replaced by psychological problems for which help has been sought (OR 0.81, CI 0.68-0.96), persistent or constantly recurring pain that has lasted for 3 months or more (OR 0.79, CI 0.67-0.94), persistent musculoskeletal pain for at least 3 of the last 12 months (OR 0.79, CI 0.66-0.93), or EQ-5D score (OR 0.78, CI 0.65-0.93).Other predictors of CAM use were female gender, poor health, low age and high income.

    Conclusion: Continuity of GP care was associated with lower utilisation of CAM providers.  This corroborates findings from previous studies of continuity of GP care and utilisation of other health care services.  Further studies are needed to understand the dynamics behind this apparently robust association.