A cross-sectional study of provider and patient characteristics associated with outpatient disclosures of dietary supplement use

Tarn, Derjung M.; Karlamangla, Arun S.; Coulter, Ian D.; Paterniti, Debora A.; Knox, Lyndee; Khang, Peter; Hui, Ka Kit; Wenger, Neil S.

doi:10.1016/j.pec.2015.03.020

Cited by 36 publications

(39 citation statements)

References 26 publications

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“…Nearly half of CAM users fail to report the use of these medications to their health-care provider and often fail to disclose all CAM even when they do so (30,31). Physicians should have a high suspicion for CAM in otherwise healthy patients with unexplained liver enzyme abnormalities.…”

Section: Discussionmentioning

confidence: 99%

Clinical Features and Outcomes of Complementary and Alternative Medicine Induced Acute Liver Failure and Injury

Hillman

Gottfried

Whitsett

et al. 2016

American Journal of Gastroenterology

102

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OBJECTIVES The increasing use of complementary and alternative medicines (CAMs) has been associated with a rising incidence of CAM-induced drug-induced liver injury (DILI). The aim of this study was to examine the clinical features and outcomes among patients with acute liver failure (ALF) and acute liver injury (ALI) enrolled in the Acute Liver Failure Study Group database, comparing CAM-induced with prescription medicine (PM)-induced DILI. METHODS A total of 2,626 hospitalized patients with ALF/ALI of any etiology were prospectively enrolled between 1998 and 2015 from 32 academic transplant centers. Only those with CAM or PM-induced ALI/ALF were selected for analysis. RESULTS A total of 253 (9.6%) subjects were found to have idiosyncratic DILI, of which 41 (16.3%) were from CAM and 210 (83.7%) were due to PM. The fraction of DILI-ALF/ALI cases due to CAM increased from 1998–2007 to 2007–2015 (12.4 vs. 21.1%, P=0.047). There was no difference in the type of liver injury—hepatocellular, cholestatic, or mixed—between groups as determined by R score (P=0.26). PM-induced DILI showed higher serum alkaline phosphatase levels compared with the CAM group (median IU/L, 171 vs. 125, P=0.003). The CAM population had fewer comorbid conditions (1.0 vs. 2.0, P<0.005), higher transplantation rates (56 vs. 32%, P<0.005), and a lower ALF-specific 21-day transplant-free survival (17 vs. 34%, P=0.044). CONCLUSIONS CAM-induced DILI is at least as severe in presentation as that observed due to PM with higher rates of transplantation and lower transplant-free survival in those who progress to ALF. This study highlights the increasing incidence of CAM-induced liver injury and emphasizes the importance of early referral and evaluation for liver transplantation when CAM-induced liver injury is suspected.

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Section: Discussionmentioning

confidence: 99%

Clinical Features and Outcomes of Complementary and Alternative Medicine Induced Acute Liver Failure and Injury

Hillman

Gottfried

Whitsett

et al. 2016

American Journal of Gastroenterology

102

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“…25 Herbals/supplements such as black cohosh and St. John's wort have the potential to affect the cytochrome p450 enzyme systems, altering hepatic metabolism as well as increased or decreased bioavailability of other medications. 20 It is the responsibility of OHCPs and pharmacists to educate patients regarding the impact these medications can have on optimal oral health and interactions with prescription medications used in a dental practice. This effect may be greater when combined with other antiplatelet medications.…”

Section: Discussionmentioning

confidence: 99%

“…To provide safe and efficacious dental care, the oral health care provider (OHCP) must first obtain an accurate and complete list of medications the patient is taking and carefully evaluate any potential interactions that may impact the delivery of dental care. 20 However, these medications still carry the risk of drug-drug and dental treatment interactions along with questions of safety and efficacy. 18 The medication history is further complicated by OTC products and herbals/supplements.…”

mentioning

confidence: 99%

A Survey of Dental Patient Attitudes on the Likelihood and Perceived Importance of Disclosing Daily Medications

Johnson

Franco

Harris-Vieyra

2018

Journal of Dental Education

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An accurate medication history allows the oral health care provider (OHCP) to evaluate a patient's overall health and disease status, as well as assess the effect medications may have on dental treatment and oral health. It has been previously documented that dental patients do not always report an accurate medication list. The aims of this study were to determine dental patients' perceptions regarding the importance and likelihood of accurately disclosing prescription, over-the-counter (OTC), and herbal/supplement medications to their OHCP. A voluntary patient survey was administered from October 2015 through March 2016 to new dental patients at the Creighton University School of Dentistry student-operated clinic. Of 300 surveys distributed, 217 were found to be complete for inclusion in the evaluation (response rate 72.3%). Of the responding patients, 75.6%, 69.1%, and 63.6% reported believing it was very important to inform their dentists of their prescribed, OTC, and herbal/supplement medications, respectively. Additionally, 80.7%, 71.4%, and 62.7% reported that they always informed their dentists of all their prescribed, OTC, and herbal/supplement medications, respectively. Although the majority of these patients agreed on the importance of reporting medication information to their OHCP and reported doing so, this survey found room for improvement, especially regarding OTC and herbal/supplement medications. It is imperative that both the pharmacist and OHCP educate dental and pharmacy students to inform patients of the importance of providing an accurate and complete medication history to ensure the safest possible delivery of their dental treatment.

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“…Study procedure details are described elsewhere. 16 Patients were queried about their demographics, and provider-patient office visits were audio-recorded. Medical records were abstracted for documentation of osteoporosis or osteopenia in the 12 months prior to the day of the audio-recorded office visit.…”

Section: Study Design Setting and Participantsmentioning

confidence: 99%

Provider Recommendations in the Face of Scientific Uncertainty: An Analysis of Audio-Recorded Discussions about Vitamin D

2016

Self Cite

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BACKGROUND:Little is known about how providers communicate recommendations when scientific uncertainty exists. OBJECTIVES: To compare provider recommendations to those in the scientific literature, with a focus on whether uncertainty was communicated. DESIGN: Qualitative (inductive systematic content analysis) and quantitative analysis of previously collected audio-recorded provider-patient office visits. PARTICIPANTS: Sixty-one providers and a socioeconomically diverse convenience sample of 603 of their patients from outpatient community-and academicbased primary care, integrative medicine, and complementary and alternative medicine provider offices in Southern California. MAIN MEASURES:Comparison of provider informationgiving about vitamin D to professional guidelines and scientific information for which conflicting recommendations or insufficient scientific evidence exists; certainty with which information was conveyed. RESULTS: Ninety-two (15.3 %) of 603 visit discussions touched upon issues related to vitamin D testing, management and benefits. Vitamin D deficiency screening was discussed with 23 (25 %) patients, the definition of vitamin D deficiency with 21 (22.8 %), the optimal range for vitamin D levels with 26 (28.3 %), vitamin D supplementation dosing with 50 (54.3 %), and benefits of supplementation with 46 (50 %). For each of the professional guidelines/scientific information examined, providers conveyed information that deviated from professional guidelines and the existing scientific evidence. Of 166 statements made about vitamin D in this study, providers conveyed 160 (96.4 %) with certainty, without mention of any equivocal or contradictory evidence in the scientific literature. No uncertainty was mentioned when vitamin D dosing was discussed, even when recommended dosing was higher than guideline recommendations. CONCLUSIONS AND RELEVANCE: Providers convey the vast majority of information and recommendations about vitamin D with certainty, even though the scientific literature contains inconsistent recommendations and declarations of inadequate evidence. Not communicating uncertainty blurs the contrast between evidence-based recommendations and those without evidence. Providers should explore best practices for involving patients in decision-making by acknowledging the uncertainty behind their recommendations. INTRODUCTIONMedical care is full of uncertainty. Uncertainty is inherent in most diagnostic and treatment decisions.1,2 Decision-making is complicated by equivocal, insufficient or nonexistent scientific evidence, and by differences in provider or patient interpretations of the evidence. Medical communication guidelines suggest disclosing uncertainty to patients.3,4 Yet providers typically fail to convey uncertainty, 5 and the scientific literature contains little information about provider recommendations in the context of uncertainty.Vitamin D supplementation is a good topic for investigating provider-patient communication around scientific uncertainty, because 26-56 % of Americans tak...

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A cross-sectional study of provider and patient characteristics associated with outpatient disclosures of dietary supplement use

Cited by 36 publications

References 26 publications

Clinical Features and Outcomes of Complementary and Alternative Medicine Induced Acute Liver Failure and Injury

Clinical Features and Outcomes of Complementary and Alternative Medicine Induced Acute Liver Failure and Injury

A Survey of Dental Patient Attitudes on the Likelihood and Perceived Importance of Disclosing Daily Medications

Provider Recommendations in the Face of Scientific Uncertainty: An Analysis of Audio-Recorded Discussions about Vitamin D

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