Herbal product use and perioperative patients

AORN Journal,  May, 2004  by Cheryl MacKichan,  Jacklyn Ruthman

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In the same study, it was determined that consumers who used alternative medications came from a variety of socioeconomic backgrounds, and no differences in sociodemographic characteristics were identified. (2) Ethnicity was one identified difference, however. (24,25) Asian/Pacific Islanders used herbs 29% more than Caucasians and African Americans. One-fifth to one-half of the people of Asian/Pacific Island sociodemographic background in this study used herbal products. (24,25) Finally, older Americans who used alternative medicines came from all sociodemographic groups. (26)

INSURANCE COVERAGE FOR HERBAL THERAPIES

Insurance companies often do not cover herbal products or therapies. Insurance policies that do cover alternative therapies generally have high deductibles and copayments. These policies usually mandate low levels of capitation on the total amount that can be allocated for these services. Increased alternative therapy use in the United States, despite the lack of insurance coverage, is noteworthy. (1) Some authors believe that the rising cost of conventional medications has led patients to seek less expensive alternatives. (1,12,14)

HERBAL MEDICINE PROVIDERS

Research literature today indicates that if consumers are going to use alternative therapies, they do so by seeing specialists in the area of interest. Herbal medicine providers often are known as herbalists. (1,14,16) Training programs vary, and, currently, there is no guarantee of a provider's competence, whether in the United States or internationally, particularly because standards and regulations have been inconsistent for some time. (16) Herbalists generally use unpurified plant extracts, which contain many constituents. Herbalists claim that herbs used together work synergistically and that toxicity is reduced when whole plants are used instead of active ingredients, a process known as buffering. This differs from conventional pharmaceuticals because conventional medications generally are not dispensed as polypharmocological preparations. (16)

Herbalists focus on treating chronic conditions and improving well-being. Like conventional health care providers, herbalists obtain extensive histories and perform comprehensive physical examinations. In addition, they typically assess everyday body processes, such as appetite, digestion, defecation, urination, and sleep. Herbalists tend to treat their patients using these body functions as indicators of underlying causes of chronic illnesses. Follow-up appointments are similar to those used in conventional medicine. Herbalists tend not to treat musculoskeletal or acute mental disorders. (16)

Many herbalists have some formal training. Currently, the American Herbalists Guild is the only peer-review organization for herbalists in the United States. This organization maintains a record of registered members who have been evaluated and recognized in the field of herbal medicine. The organization offers a course consisting of 1,200 didactic and 400 clinical hours. Credentialing and certification still are nonexistent in the United States and internationally. Typically, herbalists have solo practices or practice in complementary medicine clinics. (27)