Spatial-temporal trends in complementary and alternative medicine (CAM) offices in Ontario,Canada

This paper assesses complementary and alternative medicine (CAM) from a spatial-temporal perspective; it would be of particular interest to those who evaluate health care resource accessibility over space. The analysis compares CAM supply (number of offices, employment, and sales) in Ontario by provincial district, metropolitan influence classification, and health care and social assistance employment quintiles using summary statistics, Kruskal-Wallis and median analyses, and local spatial autocorrelation evaluation. Metropolitan areas throughout Ontario, but especially in the southcentral part of the province, are well endowed with CAM supply and tend to be most important in terms of CAM change. CAM offices are increasing in size in the most populated parts of the province and shrinking in regions that are more peripheral. CAM supply per capita is highest in census subdivisions with moderate levels of health care and social assistance employment, a result that is not offset by significant temporal change. While CAM supply is restructuring in many of Ontario's most populated urban locations, the overall attraction of CAM resources to large and small metropolitan areas is clear. If current spatial-temporal trends continue, CAM spatial disparities will be exacerbated as accessibility to CAM in Ontario's most peripheral locations worsen.