Cross-sectional surveys of staff physicians, nurse practitioners and physician assistants were conducted on-line between April 25 and July 6, 2006. An e-mail was sent by the Dean of the medical school asking clinical faculty to complete the anonymous survey on-line. The e-mail included a link to the on-line survey site. Four reminders were sent over one month to encourage completion. No incentives were offered for survey completion.
Physicians were eligible if they reported spending any time providing clinical care. Nurse practitioners and physician assistants were identified by the Human Resource Department of the medical school and hospital. Subjects were excluded if they spent 100% of their time in research and teaching (i.e., no clinical care), or if they were not employed by the medical school or hospital (e.g., community clinical faculty).
In addition to demographic questions, the survey included questions about two types of services: a) therapies themselves (e.g., dietary supplements such as herbs, fish oil or vitamins; therapeutic diets; therapeutic exercise; massage therapy; etc) and b) comprehensive services (e.g., multidisciplinary pain management; heart healthy lifestyle program; cancer patient support program). Some therapies and services currently exist within the institution (e.g., massage services and Cancer Patient Support Program), and some are potential future services and programs. Asking about existing services provided a benchmark against which to compare responses to potential services. The terms "CAM" and "alternative" medicine were avoided to minimize confusion and to facilitate comparison of diverse therapies within the familiar framework of comprehensive care. For each of the complementary therapies listed in the survey that may have been unfamiliar or confusing, we included links to the NIH NCCAM internet site defining those therapies (NIH NCCAM[44]), e.g., Reiki, yoga, Tai Chi, hypnosis, biofeedback, etc.
For individual services, we asked clinicians if they had provided it themselves or referred the patient to a provider within the medical center or the community, and how often would they anticipate referring a patient over the next 12 months. For example, under Therapies, Question 1 read: "Vitamins, minerals, other dietary supplements such as herbs, fish oil, glucosamine or melatonin:"
"In the past year, how often have you recommended or referred for this therapy?" "If you have referred/recommended a patient for this therapy at least once in the past year, where was the service provided (Wake Forest University Baptist Medical Center, WFUBMC, in the community or both)?" "In the next 12 months, how many times are you likely to use or refer patients to this therapy if provided at WFUBMC?" (Response categories ranged from 0 to 9 or more times.) For analysis purposes, we noted the number of respondents who anticipated making any referrals and the number making frequent (nine or more) referrals.
Similarly for the comprehensive service programs, some were already available at the Medical Center at the time of the survey. However, due to the size and complexity of the medical center, it is possible that physicians in some specialties are unaware of programs more pertinent to other specialties. We anticipated that fewer than 100% of respondents would refer patients to any of these programs given the diverse nature of respondents. For example, we thought it unlikely that pediatricians would refer patients to a "Comprehensive Back Pain" program. Questions about comprehensive services followed questions about specific therapies to help respondents understand that comprehensive services include diverse therapies in addition to medications and surgery. For example, "In the next 12 months, how many times are you likely to use or refer patients to each of the following: a. Multidisciplinary pain management."
Answers for questions were scored as the percentage of respondents who reported any referrals (greater than 0) and the percentage who would refer 9 or more times. Open text fields were also available for each question for respondents to write comments.
The survey was written by a programmer who was blinded to study questions using the Empliant survey writing software. The Empliant software was able to anonymously tabulate the results. Altogether the instrument contained 62 questions and could be completed on-line in less than 20 minutes.
Analysis included descriptive statistics only. There were no a priori hypotheses. The study was conducted to generate information for service development and strategic planning rather than hypothesis testing.
Answers to all your Biology Questions
