Questions about complementary and alternative medicine to the Regional Medicines Information and Pharmacovigilance Centres in Norway (RELIS): a descriptive pilot study

Abstract

BackgroundProvision of clinically relevant information about complementary and alternative medicine (CAM) to health care professionals is not well described. The aim of the study was to assess questions about CAM to the Regional Medicines Information and Pharmacovigilance Centres in Norway (RELIS).MethodsAll question-answers pairs (QAPs) in the RELIS database indexed with alternative medicine from 2005-2010 constituted the study material. A randomly selected sample of 100 QAPs was characterized with regard to type of question (category, patient-specific or general), occupation and workplace of enquirer, the type of information search performed (simple or advanced), and if the answers contained information to provide factual or consultative replies (facts about or advice on clinical use of CAM, respectively). Proportions were compared with Fisher’s exact test with significance at the 0.05 level.ResultsOne thousand and thirty-eight (7.7%) out of 13 482 questions involved CAM. Eighty-two out of 100 questions concerned products containing one or more herbs, vitamins and minerals as well as other substances. Thirty-eight out of 100 questions concerned the category documentation (substance identification and/or literature reports about clinical effects), 36 interactions, 16 adverse effects, 9 pregnancy and lactation, and 1 question concerned contraindications. Sixty-three questions were patient-specific and 37 general. Fifty-four questions came from physicians, 33 from pharmacists and 13 from others (including nurses, midwives, students, CAM practitioners, and the public). Pharmacists asked more frequently about interactions while physicians asked more frequently about adverse effects (p < 0.05). Seventy-six of the questions came from outside hospital, mainly general practice and community pharmacies. Fifty-nine answers were based on a simple and 41 on an advanced information search. Thirty-three factual and 38 consultative answers were provided. In 29 answers, search provided no information. Lack of information to provide an answer was not significantly different between patient-specific (31.7%) and general questions (24.3%).ConclusionsGeneral practice and community pharmacies are the main sources for questions about CAM to RELIS. Physicians are concerned about adverse effects while pharmacists are concerned about interactions. Lack of information to provide answers to patient-specific and general questions about CAM represents a problem.

Integrative leadership plan for an integrative healing centre

“…When a profession was described as alienated, a strong term for segregated from others, then it is time for a change in practices (Gandz, 2009). Research often demonstrated a high level of non-disclosure between patients and professions due to poor communication and lack of trust in the relationship (Kretchy et al, 2014;Schjott & Erdal, 2014;Skovgaard et al, 2014;Strouss et al, 2014). This has led to complications, side effects and mortality, when traditional or CAM treatments were mixed with conventional therapy due to lack of disclosure or dissatisfaction and unhappiness with conventional medicine (Gorski & Novella, 2014;Kretchy et al, 2014;McGregor et al, 2014;Schjott & Erdal, 2014;Skovgaard et al, 2014;Strouss et al, 2014).…”

“…The researched demonstrated how current leadership and healthcare practices are failing the patients, employees, organizations, and communities (Avolio, 2007;Carey et al, 2011;Crosby, 2008;Gandz, 2009;Kretchy et al, 2014;;McGregor et al, 2014;Minke et al, 2006;Schjott & Erdal, 2014;Scott, 2010;Skovgaard et al, 2014;Strandberg et al, 2007;Strouss et al, 20 14;). Avolio (2007) reported that "the researchers need to stop underestimating the many potential elements" with regards to creating more integrative strategies in the area of leadership.…”

“…With empirical knowledge and professional experiences, some of the researchers used the term skeptical (Scott,201 0) that entails mistrust amongst people, practices, and research. This presented many challenges (Avolio, 2007;Carey et al, 2011;Clavelle & Branwell, 2013 ;Gandz, 2009;Hsiu & Shannon, 2005;McGregor et al , 2014;Scott, 2010;Schjott & Erdal, 2014;Sherman et al , 2014;Shi et al , 2014;Skovgaard et al , 2014) with regards to events, finances, leadership, organizational structures, professional groups, lack of research, communication, relationships, vision delivery, and policy and procedure development. These concerns have made leadership and healthcare cumbersome to navigate for the professionals and patients (McGregor et al, 2014) and also to delivery services.…”

“…The most utilized word was lack, meaning to not have enough, in the literature (Carey et al , 2011 ;Gandz, 2009;Hsiu & Shannon, 2005;Kretchy et al , 2014;Scott, 2010;Schjott & Erdal, 2014;Skovgaard et al , 2014). With empirical knowledge and professional experiences, some of the researchers used the term skeptical (Scott,201 0) that entails mistrust amongst people, practices, and research.…”

“…The ability to capture patients' or participants' connotations or experiences occurred when the professional interpreted what was important when he or she asked questions, created questionnaires or assessments, or formulated reports (Sherman et al, 2014;Shi et al, 2014). This came in a variety of documentation styles as this was how professionals ensured they were legally communicating between each other (Schjott & Erdal, 2014). Listening was an important component of communication as Strandberg et al (2007) described it as "what the patient is actually saying ... the patient experiences and what is the medical problem" (p.12) as often professionals only hear the words and not the content.…”