Cardiologists ignore nutraceutical use, finds review
Writing in the Annals of Internal Medicine, researchers described their observational study of cardiologists’ interaction with their patients. The study aimed to evaluate patient use of nutraceuticals and over-the-counter (OTC) drugs, and to determine clinicians’ attitudes to the products.
Researchers from the University of Maryland School of Medicine and the US Food and Drug Administration found that clinical providers “largely ignore” the use of nutraceuticals and OTC drugs in their patients.
According to their findings, heart doctors estimated that they asked patients about the use of nutraceuticals – which they defined as dietary supplements and herbals – during almost half of their encounters. However, the researchers’ observations of these encounters revealed that in reality physicians only asked about nutraceuticals in 2 percent of their sessions.
“It is possible that providers neglect evaluation of these agents because they consider them innocuous; lump them with dietary measures and lifestyle interventions; or consider them to be ‘natural’ and, therefore, safe and effective,” write the researchers.
Observations
The prospective, single-blind, observational study involved observations of 21 cardiology specialists (10) or cardiologists-in-training (11) during 78 patient encounters. Of the 78 patients, 40 were men and 38 were women, with an average age of 58.
As part of the study, a clinical pharmacist observed clinical encounters without interacting with the patient or provider and recorded how the provider asked about nutraceutical and OTC drug use.
After the provider left the room, the pharmacist asked the patient about their use of these products. At the end of the day, the cardiologists were given a 6-item questionnaire (which included distracter questions) in order to ascertain what percentage of the time they thought they asked patients about their use of nutraceuticals.
From patient questionnaires, the pharmacist found that 54 of the 78 patients were using 86 nutraceuticals and 45 OTC drugs. In contrast, the cardiologists detected use of these products during only seven of their encounters with patients.
“The pharmacist observed providers asking patients about nutraceutical and OTC drug use during 2 percent of encounters (range, 0 – 20 percent) for attending physicians and 16.3 percent for trainees (range, 0 – 50 percent). Providers estimated that they asked patients about nutraceutical and OTC drug use during 47.1 percent of encounters (median, 50 percent; range, 10 – 90 percent): 57.0 percent for attending physicians and 38.2 percent for trainees,” wrote the researchers.
They concluded that “clinicians should use a structured approach for identifying patient use of nutraceuticals and OTC drugs.”
Source: Clinicians and Nutraceutical Use in Cardiology Patients: Ignorance and Neglect
Annals of Internal Medicine; Volume 153 • Number 1; pp65-66
