This study investigates the clinical problem-solving among Western-trained and traditionally trained acupuncturists. Fifty-six subjects with varying clinical experience were divided into four groups: physicians without acupuncture training (control), physician-acupuncturists, non-licensed physician-acupuncturists, and traditionally trained acupuncturists. Three clinical cases (two routine and one non-routine), were given to the subjects to provide diagnostic and treatment plans. The data were quantitatively and qualitatively analyzed. Subjects' diagnostic and treatment plans were evaluated against reference models for Western medicine and traditional Chinese medicine (TCM). / The results indicate that acupuncturists were influenced by their initial medical training. Physician-acupuncturists and non-licensed physician-acupuncturists' practices were greatly influenced by the training in Western medicine, regardless of their exposure to traditional Chinese medicine. The traditionally trained practitioners outperformed the other groups of subjects in the non-routine case. Accuracy in diagnoses and treatments for the non-routine case was also positively related to the length of clinical experience. The findings support theories of expertise that experts use forward reasoning when coping with familiar cases, and backward reasoning when encountering difficult cases.

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BACKGROUND: Complementary and alternative medicine (CAM) use has steadily increased globally over the past two decades and is increasingly playing a role in the healthcare system in the United States. CAM practice-based effectiveness research requires an understanding of the settings in which CAM practitioners provide services. This paper describes and quantifies practice environment characteristics for a cross-sectional sample of doctors of chiropractic (DCs), licensed acupuncturists (LAcs), and licensed massage therapists (LMTs) in the United States. METHODS: Using a cross-sectional telephone survey of DCs (n = 32), LAcs (n = 70), and LMTs (n = 184) in the Tucson, AZ metropolitan area, we collected data about each location where practitioners work, as well as measures on practitioner and practice characteristics including: patient volume, number of locations where practitioners worked, CAM practitioner types working at each location, and business models of practice. RESULTS: The majority of practitioners reported having one practice location (93.8% of DCs, 80% of LAcs and 59.8% of LMTs) where they treat patients. Patient volume/week was related to practitioner type; DCs saw 83.13 (SD = 49.29) patients/week, LAcs saw 22.29 (SD = 16.88) patients/week, and LMTs saw 14.21 (SD =10.25) patients per week. Practitioners completed surveys for N = 388 practice locations. Many CAM practices were found to be multidisciplinary and/or have more than one practitioner: 9/35 (25.7%) chiropractic practices, 24/87 (27.6%) acupuncture practices, and 141/266 (53.0%) massage practices. Practice business models across CAM practitioner types were heterogeneous, e.g. sole proprietor, employee, partner, and independent contractor. CONCLUSIONS: CAM practices vary across and within disciplines in ways that can significantly impact design and implementation of practice-based research. CAM research and intervention programs need to be mindful of the heterogeneity of CAM practices in order to create appropriate interventions, study designs, and implementation plans.

This study showed that state laws and policies constrain the locational preferences of alternative health care providers to varying degrees, depending on the particular profession and level of legal status. Three separate surveys were conducted, focusing on acupuncturists, chiropractors and homeopaths in Maryland, Virginia, North Carolina, and the District of Columbia. The acupuncture findings revealed intraprofessional divisions that lead to a strong influence of legal constraints on the locational behavior of non-MD acupuncturists. Results from the chiropractic survey reflected an established profession with a less pronounced, but moderate, influence of state laws and policies on location and mobility. The homeopathy findings, while based on a much smaller sample, did not reveal a strong relationship between legal constraints and spatial characteristics, except in the extreme case of North Carolina's recent prohibition. This study also postulated a model to explain the progression of alternative health care professions toward legitimation. The variables of public acceptance and legal constraints on location were plotted on the model to identify particular levels of progression. The importance of this research is highlighted by impending health care reforms, the need for access to professional health services, skyrocketing biomedical costs, and the documented utilization of alternative health care in this country. / Master of Science