Communication StudyPhysician–patient communication about dietary supplements
Introduction
Over half of all Americans take dietary supplements [1], [2], but such supplements may pose significant risks, including potential supplement–drug interactions [3], [4], [5], [6], side effects, and other adverse effects [7], [8], [9], [10], [11], and may incur unnecessary costs. More than 15 million adults are at risk for interactions between prescription medications and herbal supplements or high-dose vitamins [12]. Furthermore, patients may replace or decrease conventional medication use in favor of a dietary supplement [7], [8], [13]. Because of these concerns, organizations such as the United States Food and Drug Administration and National Institutes of Health recommend that patients consult a health professional before starting a dietary supplement [14], [15].
Recommendations suggest that physicians engage patients about dietary supplements by inquiring about supplement use, evaluating supplements, discussing available safety and efficacy data, and monitoring for adverse events and therapeutic responses [16], [17]. However, these suggestions do not account for potential inadequate physician knowledge about supplements [18], and little is known about what actually transpires during office visits. Some studies have analyzed discussions about complementary and alternative therapies with oncology patients [19] and older patients [20]. But these studies did not focus on dietary supplements, for which there are special safety considerations. In addition, these analyses did not address the actual content of the information exchanged during physician–patient conversations.
We analyzed three datasets, collected in three different studies during different time periods between 1998 and 2010, to describe the content and frequency of discussions about dietary supplements, and to investigate variations in communication based on supplement type (vitamins/minerals versus non-vitamin non-mineral (NVNM) dietary supplements; the latter may have more potential for medication–supplement interactions).
Section snippets
Methods
This study combines data from three separate studies, collected during three different time periods across different geographical areas in the United States. Data also were aggregated to increase the potential number of encounters containing dietary supplement discussions, and to ensure a more complete characterization of dietary supplement conversations. Investigators from each of the three studies first recruited primary care physicians for study participation, and then recruited patients of
Patient, physician, and dietary supplement characteristics
Table 1 describes the characteristics of physicians and patients who did and did not have conversations about dietary supplements. Of 1479 patients, 357 (24.2%) had visits with discussions about dietary supplements. Compared to patients who did not discuss dietary supplements, those who had conversations with their physicians were comprised of more females (67.5% versus 60.6%) and had higher educational achievement. The 2009–2010 study had more black and Asian patients than the other two
Discussion
This study combines data from three different time periods, collected in diverse geographical settings in the United States, to provide a description of primary care physician–patient information exchange about dietary supplements. Prior studies did not specifically examine conversations specific to dietary supplements because they grouped supplement discussions with other complementary and alternative medicine treatments [19], [20]. This study demonstrates that discussions about meaningful
Acknowledgements
The authors would like to thank Brian K. Manning, MPH from the American Academy of Family Physicians National Research Network for his assistance with the data. Some of the data used in this study were collected with support from the Robert Wood Johnson Foundation (Grant #034384), a UCLA Mentored Clinical Scientist Development Award (5K12AG001004) and by the UCLA Older Americans Independence Center (NIH/NIA Grant P30-AG028748). This publication was made possible by Grant Number R01AT005883 from
References (31)
- et al.
Advising patients who use dietary supplements
Am J Med
(2008) - et al.
Effectively discussing complementary and alternative medicine in a conventional oncology setting: communication recommendations for clinicians
Patient Educ Couns
(2010) - et al.
Negotiating complementary and alternative medicine use in primary care visits with older patients
Patient Educ Couns
(2012) - et al.
Dietary supplement use among U.S. adults has increased since. NHANES III (1988–1994)
NCHS Data Brief
(2011) - et al.
Use of prescription and over-the-counter medications and dietary supplements among older adults in the United States
J Am Med Assoc
(2008) Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions
Arch Intern Med
(1998)Herbal remedies: adverse effects and drug interactions
Am Fam Physician
(1999)- et al.
Adverse effects of herbal treatment of cardiovascular disease: what the physician must know
Heart Dis
(2001) - et al.
Incidence and severity of potential drug-dietary supplement interactions in primary care patients: an exploratory study of 2 outpatient practices
Arch Intern Med
(2004) Herbal remedies
N Engl J Med
(2002)
Health risks of herbal remedies: an update
Clin Pharmacol Ther
Safety issues with herbal products
Ann Pharmacother
Revisiting the behavioral model and access to medical care: does it matter?
J Health Soc Behav
Emerging role of integrative medicine in cardiovascular disease
Cardiol Rev
Trends in alternative medicine use in the United States, 1990–1997: results of a follow-up national survey
J Am Med Assoc
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