• Jennifer N Goldstein, Judith A Long, Doris Arevalo, Said A Ibrahim, and Jun J Mao.
• *Department of Medicine, Christiana Hospital, Newark, DE †Philadelphia VA Medical Center ‡Department of Medicine, University of Pennsylvania Philadelphia, PA §University of Illinois, Urbana-Champaign, Urbana, IL ∥Philadelphia VA Medical Center, Center for Health Equity and Promotion ¶Department of Family and Community Medicine, University of Pennsylvania, Philadelphia, PA.
• Med Care. 2014 Dec 1;52(12 Suppl 5):S65-9.

BackgroundVitamins and supplements are the most commonly used form of complementary and alternative medicine in the United States. Growing research suggests that patients substitute vitamins and supplements for their prescription medications. The reasons might include cost of prescription medications and discordant patient and doctor health belief systems.ObjectivesTo investigate the prevalence of substitution of vitamins and supplements for prescription medications among veterans who receive care in the VA health care system and whether substitution is associated with prescription rationing due to cost, treatment beliefs, or distrust of the health system.Research DesignCross-sectional observational survey.SubjectsPrimary care patients (n=275) at the Philadelphia VA Medical Center.MeasuresMedication substitution, prescription medication rationing, treatment beliefs, and health system distrust were measured with structured instruments. Multivariate logistic regression was performed with substitution as the dependent variable.ResultsA significant number of primary care patients in the VA system use vitamins and supplements 206 (75%). The prevalence of medication substitution is high 48 (18%). Medication substitution is strongly associated with prescription rationing due to cost (adjusted odds ratio 6.3, 95% confidence interval: 2.0-19.5, P=0.001). Similarly, greater belief in complementary and alternative approaches to care positively predicts medication substitution (adjusted odds ratio 1.08, 95% confidence interval: 1.01-1.15, P=0.011). There is no significant association between health system distrust and likelihood of medication substitution.ConclusionsMedication substitution is prevalent in this sample of inner city primary care patients who receive care in the VA system. Cost of prescriptions and belief in the value of complementary and alternative approaches to care appear to be associated with this patient-driven treatment decision.

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