Complementary and Alternative Practices and Products (CAPPS)

Nursing Practice and CAPPS 

What Is CAPPs, Demographics About CAPPS, Analysis, Contribution Of Citizens,Outcomes, Challenges For Health Practitioners, Problems In CAPPs.

What Is CAPPs

    Definitions of complementary and alternative procedures and products (CAPPs) and estimates of consumer use will continue to change as researchers complete rigorous scientific studies in this area. 

    While health con-summers today are empowered to take control of their health care outcomes, a large number of nurses and other health care professionals still lack knowledge about CAPPS, thus creating a barrier to consumers achieving their goal. 

    Rigorous clinical studies continue to be needed to provide evidence of treatment efficacy for many symptoms and conditions. 

    Research monies are available for competitive research proposals through the NCCAM and other departments within the National Institutes of Health. 

    Consumer demand and pressure will continue to drive integration of selected CAPPS into the conventional health care system as well as prompting the need for continued rigorous science in this field. 

    These factors foster optimism and increase the potential for additional evidence-based holistic care, facilitating the safe integration of selected CAPPS into health care.

Demographics About CAPPS

    A large percentage of people worldwide are using complementary and alternative practices and products (CAPPS), referred to also as "complementary and alternative medicine" (CAM), and, more recently, integrative medicine (NIH, 2003). 

    However, the term CAM is not a true descriptor in that use of these practices and products is not limited to medicine. Integrative medicine is the newest term added to the range of definitions related to the concept of "complementary and alternative" medicine. 

    The term "integrative" increasingly used by clinicians and researchers, reflecting findings in the survey literature that suggested most people use CAPPs in con junction with, rather than as an alternative to, conventional or mainstream medical services (NCCAM, 2003; Ni et al. al., 2002).

Analysis

    Despite any confusion in use of terms, surveys indicated that a significant percentage of the adult population in the United States (ranging from 30% to 45% at the beginning of the new millennium) is trying a variety of these ancient and modern CAPPS to treat a variety of symptoms and conditions (Eisenberg et al., 1993, 1998; Ni et al., 2002). 

    A parallel trend is the increasing use of CAPPS among senior citizens, specifically in the aging US population. A recent national sample study has shown that 30% of people aged 65 and older used at least one CAPP modality compared with 46% of those younger than age 65 (p < .001) (Ai & Bolling, 2002). 

    These surveys indicate, also, that the American public is spending billions of dollars for CAPPS, most of which is not reimbursed by third-party payers.

Contribution Of Citizens 

    In response to the increasing interest of the American people in the healing potential of CAPPS, the Federal Government created in 1992 the Office of Alternative Medicine (OAM) (elevated in 1999 to the National Center for Complementary and Alternative Medicine [NCCAM]). 

    The mission of the NCCAM is to assure users, through rigorous research studies, that the CAPPS widely used by the American people do what the practitioners of these modalities and the manufacturers of these products claim. 

    It is acknowledged today that anecdotes about efficacy and effectiveness of practices for which there are not plausible explanations are insufficient, thereby giving importance to well-designed and well-executed research.

    The term complementary medicine/therapies was introduced during the decade of the 1970s in the United Kingdom and refers to those practices and products that link the most appropriate therapies to meet the individual's physical, mental, emotional, and spiritual needs. 

    In some cultures the term "alternative" refers to those practices and products that are provided in place of conventional health care, many of which are outside the realm of accepted health-care theory and practices in the United States. 

    Still today, practices and products categorized as complementary and alternative reflect a broad spectrum of modalities and beliefs. 

    Consequently, what is defined as such varies based upon professional or occupational perspective. Among the early initiatives of the NCCAM was identification of broad categories of CAPPs as a beginning to the classification of the more than 200 modalities that are reported to have more than 10,000 uses. 

    These categories fall under the rubrics of alternative medical systems (eg, homeopathy, naturopathy); mind-body interventions ( eg mental imagery, music therapy); biologically based therapies (eg, dietary supplements, herbal products).

    Manipulative and body-based methods (eg, massage, chiropractic); and energy therapies (eg, qi gong, therapeutic touch, electromagnetic energy fields as in magnet therapy). 

    The NCCAM fosters research to reduce barriers that keep promising therapies from emerging. To promote research in CAPPS, OAM initially established 10 research centers across the country, one of which is directed by a nurse. 

     NCCAM has since enlarged this number to 13 research centers across the country and has reported plans to develop international research centers as well (NCCAM). 

    Interested persons seeking state-of-the-science information on selected CAPPs may access a Public Information Clearinghouse Database, and the Evaluations Section of NCCAM may be accessed at the web site (NCCAM, 2003; Taylor, 1998).

Outcomes 

    Selected complementary and alternative practices have been studied sufficiently to provide conclusive evidence of effectiveness. 

    For example, there are data to support a number of behavioral and relaxation practices used to treat pain and insomnia. 

    However, data currently available are insufficient to be definitive that one practice or procedure is more effective than another for a given condition. 

    Yet, because of psychosocial differences among persons, as well as variations in personality traits among individuals, one procedure or product may be more suited than another for a given person (NIH Technology Assessment Panel, 1996; Owens, Taylor, & DeGood , 1999) .

Challenges For Health Practitioners 

    The challenge today for health care professionals is to become and stay informed regarding indications and contraindications for use of the myriad of procedures and products that patients are using, including the potential interactions of natural products with pharmaceuticals, foods, and lifestyles. 

    Movement to offer some content about CAPPs within the curricula of schools of nursing, medicine, and pharmacy is evident. 

    However, while faculty responsible for the integration of this content sometimes desire to include it, there appears to be less agreement among faculty on the practical aspects of its integration (Gaydos, 2001; Kligler , 1996). 

    A more recent effort of the NCCAM focuses on introducing CAPPs information into allopathic, osteopathic, nursing, dental, and pharmacy schools to capture the attention of young health professionals (Taylor, Menzies, & Boyden, 2001).

Problems In CAPPs

    The main issue regarding research in CAPPS is not the adversarial position, eg "CAPPs vs mainstream," but the more scholarly position of asking whether an intervention is effective or not; is it safe or not? (NCCAM, 2001).

    Rigorous programs of research involving any of these practices and products may begin with basic questions: What's going on with a particular therapy in the investigator's target population? 

    How do individual differences, as assessed by a given measurement tool, influence what happens or does not happen in the use of a particular therapy for management of a specified symptom? 

    From general questions such as these, coupled with extensive literature reviews and consultation with experts, more specific questions about the use of these therapies in patient care evolve to guide the investigator's research .

    Because nursing takes the position that patients' perceptions, thoughts, and feelings are an important part of their reality, these influence the nature of inquiry and the choice of outcome measures. 

    Focusing on individual differences among patients when assessing use, efficacy, and effectiveness of CAPPs allows the investigator to analyze disparate patient care findings and synthesize these into questions that will add to the body of knowledge about these therapies (Owens et al, 1999). 

    Findings resulting from research studies testing the efficacy of CAPPS may lead to knowledge that can be useful in making reliable predictions and linking appropriate therapies to a person for promotion of health or symptom management (Taylor, 1998).