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      Práticas Integrativas e Complementares na Atenção Primária à Saúde brasileira Translated title: Traditional and Complementary Medicine in Primary Health Care in Brazil

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          Abstract

          RESUMO Apresenta-se a situação das Práticas Integrativas e Complementares (PIC) na Atenção Primária à Saúde (APS) brasileira, seus problemas e estratégias de enfrentamento. Foram analisados bancos de dados, legislação, normas e relatórios governamentais, confrontados com pesquisas, sobretudo o primeiro inquérito nacional independente sobre PIC. Em 2017 e 2018, 29 modalidades de PIC foram institucionalizadas no Sistema Único de Sáude (SUS). Segundo dados oficiais, elas se expandiram e foram ofertadas por 20% das equipes de APS em 2016, em 56% dos municípios, mas o inquérito encontrou oferta só em 8% deles. Tal discrepância deve-se provavelmente ao registro/divulgação dos dados: um profissional, ao registrar uma vez o exercício de uma PIC, converte seu município em ofertante nas estatísticas governamentais. Quase 80% das PIC ocorrem na APS, sendo mais comuns: práticas corporais, plantas medicinais, acupuntura e homeopatia. Há pouca regulamentação nacional da formação e prática em PIC. A maioria dos praticantes é profissional convencional da APS, por iniciativa própria, desempenhando papel de destaque na (pouca) expansão. A inserção do tema no ensino é incipiente, e há pesquisas na área, porém poucas publicações. Estratégias de institucionalização das PIC na APS envolvem estímulo federal aos municípios, via profissionais competentes, matriciamento, educação permanente e ação governamental para sua inserção na formação profissional.

          Translated abstract

          ABSTRACT We present the situation of Traditional and Complementary Medicine (T&CM) in Brazilian Primary Health Care (PHC), its problems and coping strategies. Databases, legislation, regulations and government reports were analyzed, in particular, the first national survey on T&CM. In 2017-2018, 29 T&CM modalities were institutionalized in the Unified Health System (SUS). According to official data, they expanded and were offered by 20% of the PHC teams in 2016, in 56% of the municipalities, but the survey found offer in only 8% of them. Such discrepancy is probably due to the registration / disclosure of data: a professional, once having recorded the exercise of a T&CM converts his / her municipality into a bidder in government statistics. Almost 80% of T&CM occur in PHC, being more common: body practices, medicinal plants, acupuncture, and homeopathy. There is little national training and practice regulation in T&CM. Most professionals are conventional PHC practitioners, on their own initiative, playing an important role in the (small) expansion. The insertion of the theme in education is incipient and there are researches in the area, but few publications. T&CM institutionalization strategies in PHC involve federal stimulus to municipalities, through competent professionals, matrixing, permanent education in service, and governmental action for their insertion in the professional training.

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          Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up national survey.

          A prior national survey documented the high prevalence and costs of alternative medicine use in the United States in 1990. To document trends in alternative medicine use in the United States between 1990 and 1997. Nationally representative random household telephone surveys using comparable key questions were conducted in 1991 and 1997 measuring utilization in 1990 and 1997, respectively. A total of 1539 adults in 1991 and 2055 in 1997. Prevalence, estimated costs, and disclosure of alternative therapies to physicians. Use of at least 1 of 16 alternative therapies during the previous year increased from 33.8% in 1990 to 42.1% in 1997 (P < or = .001). The therapies increasing the most included herbal medicine, massage, megavitamins, self-help groups, folk remedies, energy healing, and homeopathy. The probability of users visiting an alternative medicine practitioner increased from 36.3% to 46.3% (P = .002). In both surveys alternative therapies were used most frequently for chronic conditions, including back problems, anxiety, depression, and headaches. There was no significant change in disclosure rates between the 2 survey years; 39.8% of alternative therapies were disclosed to physicians in 1990 vs 38.5% in 1997. The percentage of users paying entirely out-of-pocket for services provided by alternative medicine practitioners did not change significantly between 1990 (64.0%) and 1997 (58.3%) (P=.36). Extrapolations to the US population suggest a 47.3% increase in total visits to alternative medicine practitioners, from 427 million in 1990 to 629 million in 1997, thereby exceeding total visits to all US primary care physicians. An estimated 15 million adults in 1997 took prescription medications concurrently with herbal remedies and/or high-dose vitamins (18.4% of all prescription users). Estimated expenditures for alternative medicine professional services increased 45.2% between 1990 and 1997 and were conservatively estimated at $21.2 billion in 1997, with at least $12.2 billion paid out-of-pocket. This exceeds the 1997 out-of-pocket expenditures for all US hospitalizations. Total 1997 out-of-pocket expenditures relating to alternative therapies were conservatively estimated at $27.0 billion, which is comparable with the projected 1997 out-of-pocket expenditures for all US physician services. Alternative medicine use and expenditures increased substantially between 1990 and 1997, attributable primarily to an increase in the proportion of the population seeking alternative therapies, rather than increased visits per patient.
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            Why patients use alternative medicine: results of a national study.

            J A Astin (1998)
            Research both in the United States and abroad suggests that significant numbers of people are involved with various forms of alternative medicine. However, the reasons for such use are, at present, poorly understood. To investigate possible predictors of alternative health care use. Three primary hypotheses were tested. People seek out these alternatives because (1) they are dissatisfied in some way with conventional treatment; (2) they see alternative treatments as offering more personal autonomy and control over health care decisions; and (3) the alternatives are seen as more compatible with the patients' values, worldview, or beliefs regarding the nature and meaning of health and illness. Additional predictor variables explored included demographics and health status. A written survey examining use of alternative health care, health status, values, and attitudes toward conventional medicine. Multiple logistic regression analyses were used in an effort to identify predictors of alternative health care use. A total of 1035 individuals randomly selected from a panel who had agreed to participate in mail surveys and who live throughout the United States. Use of alternative medicine within the previous year. The response rate was 69%. The following variables emerged as predictors of alternative health care use: more education (odds ratio [OR], 1.2; 95% confidence interval [CI], 1.1-1.3); poorer health status (OR, 1.3; 95% CI, 1.1-1.5); a holistic orientation to health (OR, 1.4; 95% CI, 1.1-1.9); having had a transformational experience that changed the person's worldview (OR, 1 .8; 95% CI, 1 .3-2.5); any of the following health problems: anxiety (OR, 3.1; 95% CI, 1.6-6.0); back problems (OR, 2.3; 95% CI, 1 .7-3.2); chronic pain (OR, 2.0; 95% CI, 1.1 -3.5); urinarytract problems (OR, 2.2; 95% CI, 1.3-3.5); and classification in a cultural group identifiable by their commitment to environmentalism, commitment to feminism, and interest in spirituality and personal growth psychology (OR, 2.0; 95% CI, 1.4-2.7). Dissatisfaction with conventional medicine did not predict use of alternative medicine. Only 4.4% of those surveyed reported relying primarily on alternative therapies. Along with being more educated and reporting poorer health status, the majority of alternative medicine users appear to be doing so not so much as a result of being dissatisfied with conventional medicine but largely because they find these health care alternatives to be more congruent with their own values, beliefs, and philosophical orientations toward health and life.
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              Beyond medicalisation.

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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                sdeb
                Saúde em Debate
                Saúde debate
                Centro Brasileiro de Estudos de Saúde (Rio de Janeiro, RJ, Brazil )
                0103-1104
                2358-2898
                September 2018
                : 42
                : spe1
                : 174-188
                Affiliations
                [1] Florianópolis Santa Catarina orgnameUniversidade Federal de Santa Catarina orgdiv1Departamento de Saúde Pública Brazil charles.tesser@ 123456ufsc.br
                [3] Niterói Rio de Janeiro orgnameUniversidade Federal Fluminense orgdiv1Instituto de Saúde Coletiva Brazil mnascimento3@ 123456gmail.com
                [2] Recife orgnameFundação Oswaldo Cruz orgdiv1Instituto de Pesquisas Aggeu Magalhães Brazil islandia@ 123456cpqam.fiocruz.br
                Article
                S0103-11042018000400174
                10.1590/0103-11042018s112
                c32314ee-d399-4902-85de-2fefe3ce7ba7

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 30 May 2017
                : 15 August 2018
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 59, Pages: 15
                Product

                SciELO Public Health

                Categories
                Artigo Original

                Complementary therapies,Primary Health Care,Staff development,Terapias complementares,Atenção Primária à Saúde,Desenvolvimento de pessoal

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