Patricia Uber, PharmD; Kelly Summers, PharmD; Mandeep R. Mehra, MBBS
Note: Drs. Uber, Summers, and Mehra participated equally in the design of the study, analysis of the findings, and writing of the manuscript. Dr. Summers served as the observing pharmacist in all patient encounters.
Disclaimer: The views and conclusions expressed in this publication do not necessarily represent the views of the U.S. Food and Drug Administration or the U.S. government.
Potential Conflicts of Interest: None disclosed.
Uber P., Summers K., Mehra M.; Clinicians and Nutraceutical Use in Cardiology Patients: Ignorance and Neglect. Ann Intern Med. 2010;153:65-66. doi: 10.7326/0003-4819-153-1-201007060-00029
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Published: Ann Intern Med. 2010;153(1):65-66.
Background: Half of all patients worldwide, and especially those with chronic illnesses, use nutraceuticals and nonprescription over-the-counter (OTC) drugs (1, 2). Persons with cardiovascular disease rank foremost in this respect (3). Many patients do not discuss their use of these agents with clinicians (1, 2).
Objective: To evaluate the accuracy of cardiovascular clinicians' efforts in determining patient use of these agents and to measure clinicians' attitudes about assessing use of these agents.
Methods: We conducted an institutional review board–approved, prospective, single-blind, observational study of attending cardiology specialists and cardiologists-in-training. 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 nutraceutical and OTC drug use. At the end of the day, the pharmacist asked providers, “What percentage of time do you ask patients about nutraceutical use and OTC use?” by using a structured 6-item questionnaire that included distracter questions. We classified OTC drugs as agents that were designated and regulated by authorities as a general-sale medication, were available off the shelf, and required no pharmacy handling. We classified nutraceuticals as other agents that were neither food nor drugs, including herbal and nutritional supplements.
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