title: Exposure to Alternative Healthcare Providers and Adherence to Guidelines among Patients with Diabetes.
abstract: OBJECTIVE
  Diabetes is increasing in prevalence across Canada. In the continuously evolving primary care landscape, practitioners from varied training paths are claiming rights to care for patients, including those with diabetes. Little is known about patient exposure to complementary and alternative medicine (CAM) providers, or about such providers' use of guideline-based monitoring and treatment recommendations. The purpose of this study was to examine compliance with 4 recommendations (influenza vaccination, eye examination, glycated hemoglobin measurement and foot exam) by patients with diabetes who use CAM providers compared to those who exclusively use primary care physicians.
  
  
  METHODS
  We analyzed data on 7209 patients with diabetes using the Canadian Community Health Survey. Patients with exposure to CAM providers were compared with individuals who were exposed to a family physician only. Multivariate logistic regression was conducted adjusted for age, sex, duration of diabetes, insulin/oral antihyperglycemic agent use and education.
  
  
  RESULTS
  Approximately 4% of persons had been exposed to CAM providers in the preceding year. The odds ratio for receiving influenza vaccination among those exposed to a CAM provider was 0.94 (95% CI 0.74-1.17). The odds ratios for eye examinations in the preceding 24 months, and for foot examinations and glycated hemoglobin tests in the preceding 12 months were 1.02 (95% CI 0.69-1.48), 1.18 (0.83-1.67) and 1.09 (95% CI 0.71-1.66), respectively.
  
  
  CONCLUSIONS
  Our results did not show statistical significance in any of the 4 outcomes analyzed. This study supports others suggesting that persons using CAM providers do so to complement traditional medical care, rather than as an alternative to such care.
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: mowiens@interchange.ubc.ca.
authors.forename: Matthew O
authors.initials: MO
authors.lastname: Wiens
authors.affiliation: Department of Emergency Medicine, St. Paul's Hospital, Vancouver, British Columbia, Canada; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Brian E
authors.initials: BE
authors.lastname: Grunau
keywords: adherence; alternative medicine; complementary medicine; diabetes; diabète; fidélité; guidelines; lignes directrices; médecine complémentaire; médecine parallèle