Patient needs and preferences for herb-drug-disease interaction alerts: a structured interview study

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Abstract

Background

While complementary and alternative medicine (CAM) is commonly used in the United States and elsewhere, and hazardous interactions with prescription drugs can occur, patients do not regularly communicate with physicians about their CAM use. The objective of this study was to discover patient information needs and preferences for herb-drug-disease interaction alerts.

Methods

We recruited 50 people from several locations within the University of Utah Hospital to participate in this structured interview study. They were asked to provide their preferences for the herb-drug-disease interaction alerts. Qualitative methods were used to reveal the themes that emerged from the interviews.

Results

Most participants reported they had previously used, or they were currently using, CAM therapies. The majority had made the effort to inform their healthcare provider(s) about their CAM usage, although some had not. We found that most respondents were interested in receiving alerts and information about potential interactions. Many preferred to receive the alerts in a variety of ways, both in person and electronically.

Conclusions

In addition to conventional medicine, many patients regularly use complementary and alternative therapies. And yet, communication between patients and providers about CAM use is not consistent. There is a demand for interventions in health care that provide timely, integrative communication support. Delivering the herb-drug-disease alerts through multiple channels could help meet critical patient information needs.

Electronic supplementary material

The online version of this article (doi:10.1186/s12906-017-1630-6) contains supplementary material, which is available to authorized users.

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Most cited references 12

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Complementary and alternative medicine use among adults and children: United States, 2007.

Patricia Barnes, Barbara E. Bloom, Richard Nahin (2008)

This report presents selected estimates of complementary and alternative medicine (CAM) use among U.S. adults and children, using data from the 2007 National Health Interview Survey (NHIS), conducted by the Centers for Disease Control and Prevention's (CDC) National Center for Health Statistics (NCHS). Trends in adult use were assessed by comparing data from the 2007 and 2002 NHIS. Estimates were derived from the Complementary and Alternative Medicine supplements and Core components of the 2007 and 2002 NHIS. Estimates were generated and comparisons conducted using the SUDAAN statistical package to account for the complex sample design. In 2007, almost 4 out of 10 adults had used CAM therapy in the past 12 months, with the most commonly used therapies being nonvitamin, nonmineral, natural products (17.7%) and deep breathing exercises (12.7%). American Indian or Alaska Native adults (50.3%) and white adults (43.1%) were more likely to use CAM than Asian adults (39.9%) or black adults (25.5%). Results from the 2007 NHIS found that approximately one in nine children (11.8%) used CAM therapy in the past 12 months, with the most commonly used therapies being nonvitamin, nonmineral, natural products (3.9%) and chiropractic or osteopathic manipulation (2.8%). Children whose parent used CAM were almost five times as likely (23.9%) to use CAM as children whose parent did not use CAM (5.1%). For both adults and children in 2007, when worry about cost delayed receipt of conventional care, individuals were more likely to use CAM than when the cost of conventional care was not a worry. Between 2002 and 2007 increased use was seen among adults for acupuncture, deep breathing exercises, massage therapy, meditation, naturopathy, and yoga. CAM use for head or chest colds showed a marked decrease from 2002 to 2007 (9.5% to 2.0%).

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Overriding of drug safety alerts in computerized physician order entry.

Heleen van der Sijs, Jos Aarts, Arnold Vulto … (2005)

Many computerized physician order entry (CPOE) systems have integrated drug safety alerts. The authors reviewed the literature on physician response to drug safety alerts and interpreted the results using Reason's framework of accident causation. In total, 17 papers met the inclusion criteria. Drug safety alerts are overridden by clinicians in 49% to 96% of cases. Alert overriding may often be justified and adverse drug events due to overridden alerts are not always preventable. A distinction between appropriate and useful alerts should be made. The alerting system may contain error-producing conditions like low specificity, low sensitivity, unclear information content, unnecessary workflow disruptions, and unsafe and inefficient handling. These may result in active failures of the physician, like ignoring alerts, misinterpretation, and incorrect handling. Efforts to improve patient safety by increasing correct handling of drug safety alerts should focus on the error-producing conditions in software and organization. Studies on cognitive processes playing a role in overriding drug safety alerts are lacking.

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Interactions between herbal medicines and prescribed drugs: an updated systematic review.

Edzard Ernst, Angelo Izzo (2008)

The concomitant use of herbal medicines and pharmacotherapy is wide spread. We have reviewed the literature to determine the possible interactions between seven popular herbal medicines (ginkgo, St John's wort, ginseng, garlic, echinacea, saw palmetto and kava) and conventional drugs. Literature searches were performed using MEDLINE, Cochrane Library and EMBASE and we identified 128 case reports or case series, and 80 clinical trials. Clinical trials indicate that St John's wort (Hypericum perforatum), via cytochrome P450 (CYP) and/or P-glycoprotein induction, reduces the plasma concentrations (and/or increases the clearance) of alprazolam, amitriptyline, atorvastatin, chlorzoxazone, ciclosporin, debrisoquine, digoxin, erythromycin, fexofenadine, gliclazide, imatinib, indinavir, irinotecan, ivabradine, mephenytoin, methadone, midazolam, nifedipine, omeprazole, oral contraceptives, quazepam, simvastatin, tacrolimus, talinolol, verapamil, voriconazole and warfarin. Case reports or case series suggest interactions of St John's wort with adrenergic vasopressors, anaesthetics, bupropion, buspirone, ciclosporin, eletriptan, loperamide, nefazodone, nevirapine, oral contraceptives, paroxetine, phenprocoumon, prednisone, sertraline, tacrolimus, theophylline, tibolone, tryptophan, venlafaxine and warfarin. Ginkgo (Ginkgo biloba) decreases the plasma concentrations of omeprazole, ritonavir and tolbutamide. Clinical cases indicate interactions of ginkgo with antiepileptics, aspirin (acetylsalicylic acid), diuretics, ibuprofen, risperidone, rofecoxib, trazodone and warfarin. Ginseng (Panax ginseng) may interact with phenelzine and warfarin. Kava (Piper methysticum) increases the clearance of chlorzoxazone (a CYP2E1 substrate) and may interact with alprazolam, levodopa and paroxetine. Garlic (Allium sativum) interacts with chlorpropamide, fluindione, ritonavir and warfarin; it also reduces plasma concentrations of chlorzoxazone (a CYP2E1 probe). Echinacea might affect the clearance of caffeine (a CYP1A2 probe) and midazolam (a CYP3A4 probe). No interactions have been reported for saw palmetto (Serenoa repens). Numerous interactions between herbal medicines and conventional drugs have been documented. While the significance of many interactions is uncertain, several interactions, particularly those with St John's wort, may have serious clinical consequences.

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Author and article information

Contributors

Carrie M. Christensen: +801-462-9042 , c.m.christensen@utah.edu

Rebecca S. Morris: Rebecca.Morris@hsc.utah.edu

Seraphine Chepkemoi Kapsandoy: Seraphine.Kapsandoy@imail.org

Melissa Archer: Melissa.Archer@hsc.utah.edu

Jinqiu Kuang: Jinqiu.Kuang@hsc.utah.edu

Laura Shane-McWhorter: lmcwhorter@pharm.utah.edu

Bruce E. Bray: bruce.bray@hsc.utah.edu

Qing Zeng-Treitler: q.t.zeng@utah.edu

Journal

Journal ID (nlm-ta): BMC Complement Altern Med

Journal ID (iso-abbrev): BMC Complement Altern Med

Title: BMC Complementary and Alternative Medicine

Publisher: BioMed Central (London )

ISSN (Electronic): 1472-6882

Publication date (Electronic): 19 May 2017

Publication date PMC-release: 19 May 2017

Publication date Collection: 2017

Volume: 17

Electronic Location Identifier: 272

Affiliations

[1 ]ISNI 0000 0001 2193 0096, GRID grid.223827.e, Department of Biomedical Informatics, , University of Utah School of Medicine, ; 421 Wakara Way, Suite 140, Salt Lake City, UT 84108 USA

[2 ]ISNI 0000 0001 2193 0096, GRID grid.223827.e, Drug Regimen and Review Center, , University of Utah College of Pharmacy, ; Salt Lake City, UT USA

[3 ]ISNI 0000 0001 2193 0096, GRID grid.223827.e, Department of Pharmacotherapy, , University of Utah College of Pharmacy, ; Salt Lake City, UT USA

Article

Publisher ID: 1630

DOI: 10.1186/s12906-017-1630-6

PMC ID: 5438528

PubMed ID: 28526079

SO-VID: 3b1130a4-7945-492f-ba1c-3f1f622cf5dd

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 7 August 2015

Date accepted : 8 February 2017

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100000002, National Institutes of Health (US);

Award ID: 1R01AT006548

Award Recipient : Qing Zeng-Treitler

Funded by: FundRef http://dx.doi.org/10.13039/100000002, National Institutes of Health (US);

Award ID: 5R01LM011334

Award Recipient : Qing Zeng-Treitler

Custom metadata

ScienceOpen disciplines: Complementary & Alternative medicine

Keywords: alerts,complementary and alternative medicine,structured interview study

Data availability:

ScienceOpen disciplines: Complementary & Alternative medicine

Keywords: alerts, complementary and alternative medicine, structured interview study

Patient needs and preferences for herb-drug-disease interaction alerts: a structured interview study

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Abstract

Background

Methods

Results

Conclusions

Electronic supplementary material

Related collections

The International Journal of Person Centered Medicine

Most cited references 12

Complementary and alternative medicine use among adults and children: United States, 2007.

Overriding of drug safety alerts in computerized physician order entry.

Interactions between herbal medicines and prescribed drugs: an updated systematic review.

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