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Conway K, Ferstl C, Kumar M. Dietary supplement adulteration - knowledge, attitudes, and practices of California health care professionals: A cross-sectional survey study. PATIENT EDUCATION AND COUNSELING 2023; 114:107824. [PMID: 37290282 DOI: 10.1016/j.pec.2023.107824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/08/2023] [Accepted: 05/24/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To assess knowledge, attitudes, and practices surrounding dietary supplements (DS) among California health care professionals (HCPs) and assess factors contributing to the frequency with which HCPs discuss DS with patients. METHODS In this cross-sectional study, an online questionnaire was distributed to HCPs in California from December 2021-April 2022 via professional membership email listservs. RESULTS Among 514 HCPs, overall knowledge of DS did not vary significantly by professional group, and 90% had received little to no DS education. Pharmacists (OR = 0.328, p = 0.0001) and those with less reported DS education (OR = 0.58, p = 0.0045; OR = 0.075, p = 0.0097) had a decreased likelihood of initiating conversations about DS more frequently. Females (OR = 2.5, p < 0.0001) and those with a higher knowledge score (OR = 1.2, p = 0.0297) had an increased likelihood of initiating conversations about DS more frequently. CONCLUSIONS HCPs acknowledge the clinical significance of DS adulteration and would benefit from additional informational resources to reduce the adverse effects associated with adulterated supplements. PRACTICE IMPLICATIONS HCPs initiate more conversations about DS use when they are more informed and will gain from staying up to date on DS-related information to encourage more patient communication.
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Affiliation(s)
- Kimberly Conway
- California Department of Public Health, Sacramento, USA; California Epidemiologic Investigation Service (Cal-EIS) Fellowship, Sacramento, USA.
| | - Carrie Ferstl
- California Department of Public Health, Sacramento, USA.
| | - Madhur Kumar
- California Department of Public Health, Sacramento, USA.
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Huynh TM, Molas-Torreblanca K, Chand S, Ahuja N, Schrager SM, Zipkin R, Gold JI, Maniscalco J. Yes, we CAM: Increasing physician communication about complementary and alternative medicine through electronic medical record prompts in a pediatric hospital. Complement Ther Clin Pract 2021; 45:101449. [PMID: 34311214 DOI: 10.1016/j.ctcp.2021.101449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 06/05/2021] [Accepted: 07/20/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND PURPOSE Over half of patients utilize complementary and alternative medicine (CAM), yet fewer than 10 % of physicians inquire about use. This prospective cohort study sought to increase patient-provider communication about CAM through electronic medical record (EMR) prompts and education, as well as study concordance rates of physician and nursing CAM-related documentation. MATERIALS AND METHODS Recordings in history and physical (H&P) documents authored by first-year pediatric residents were used as a proxy for communication. Rates of documentation were assessed at baseline, after the introduction of an EMR prompt, and after an educational intervention. Nursing documentation was compared with resident documents to assess rates of concordance regarding CAM-related documentation. RESULTS Baseline CAM-related documentation rate was 24 % and increased to 50 % after introducing an EMR CAM prompt (p < 0.001). No significant change occurred after education: 38 % had CAM-related documentation (p = 0.09). Physician and nursing documentation concordance rates were 58 % at baseline, 48 % after introduction of prompts, and 35 % after introducing education. CONCLUSION Visual cues alone may be effective in increasing patient-provider communication about CAM, though low concordance between physician and nursing documentation may suggest variability in how CAM is defined and inquired about.
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Affiliation(s)
- Thanh M Huynh
- Department of Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA, 90027, USA; Department of Pediatrics, Keck School of Medicine of USC, 1975 Zonal Avenue, Los Angeles, CA, 90033, USA.
| | - Kira Molas-Torreblanca
- Department of Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA, 90027, USA; Department of Pediatrics, Keck School of Medicine of USC, 1975 Zonal Avenue, Los Angeles, CA, 90033, USA
| | - Sanjay Chand
- Department of Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA, 90027, USA
| | - Namrata Ahuja
- Department of Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA, 90027, USA; Department of Pediatrics, Keck School of Medicine of USC, 1975 Zonal Avenue, Los Angeles, CA, 90033, USA
| | - Sheree M Schrager
- Department of Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA, 90027, USA; Office of Research and Sponsored Programs, California State University Northridge University Hall 275, 18111 Nordhoff Street, Northridge, CA, 91330, USA
| | - Ronen Zipkin
- Department of Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA, 90027, USA; Department of Pediatrics, Keck School of Medicine of USC, 1975 Zonal Avenue, Los Angeles, CA, 90033, USA
| | - Jeffrey I Gold
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA, 90027, USA; Departments of Anesthesiology, Pediatrics, and Psychiatry & Behavioral Sciences, Keck School of Medicine of USC, 2250 Alcazar Street, #2200, Los Angeles, CA, 90033, USA
| | - Jennifer Maniscalco
- Department of Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA, 90027, USA; Department of Pediatrics, Keck School of Medicine of USC, 1975 Zonal Avenue, Los Angeles, CA, 90033, USA; Department of Pediatrics, Johns Hopkins University, Johns Hopkins All Children's Hospital, Office of Medical Education, 601 5th Avenue S, St. Petersburg, FL, 33701, USA
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Jyung H, Bhandiwad A, Handel MJ, Walter E, Teets R. Integrative medicine smart phrase pilot study: Evaluating an EHR tool to improve providers' attitudes, knowledge and use of herbal and dietary supplements. Explore (NY) 2020; 17:458-462. [PMID: 32624416 DOI: 10.1016/j.explore.2020.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 10/24/2022]
Abstract
CONTEXT While many patients use herbal and dietary supplements (H/DS) for wellness, disease prevention and treatment, providers still cite a lack of resources and formal training as barriers to responding to patients' inquiries about H/DS. Although the federal government, academic institutions and the private sector now offer more opportunities for education and research on H/DS, greater support in real time is needed to facilitate providers during the clinical encounter. OBJECTIVE This small, pilot study evaluates the effects of implementation of smart phrases in the electronic health record (EHR) and an educational intervention on providers' knowledge, attitude and use of H/DS in the clinical encounter. DESIGN, SETTING AND PARTICIPANTS The study was conducted at The Institute for Family Health (IFH), a Federally Qualified Health Center and academic health center which operates the Department of Family Medicine and Community Health in affiliation with the Icahn School of Medicine at Mount Sinai. Baseline and post-intervention surveys were conducted to explore providers' attitudes, knowledge and use of integrative medicine (IM) smart phrases on H/DS. MAIN OUTCOME MEASURES Providers' awareness of smart phrases of H/DS, knowledge of the content, confidence in using smart phrases to discuss H/DS, self-reported use of smart phrases were measured. RESULTS A total of 32 subjects participated in the intervention and completed the baseline survey. Only half of the participants were familiar with the IM smart phrases in our system and 12.5% felt they were aware of the information covered in these smart phrases. Eighteen of 32 participants completed the post-intervention assessment. The intervention was successful in statistically increasing participants' self-reported awareness of the information covered in the IM smart phrases (p<0.01). Increased confidence in using IM smart phrases to initiate patients on a new supplement showed statistical significance (p=0.03). There were no clear patterns in reported behavior changes following the training with the exception of a significant increase in the self-reported frequency of past month use of IM smart phrases during a patient visit (p=0.01). Lastly, there were no changes in the frequency of smart phrase use in the EHR. CONCLUSION The implementation and adoption of evidence-based use of H/DS in the clinical encounter requires a sustained educational component to make the availability of smart phrases via technology (EHR) an effective strategy.
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Affiliation(s)
- Hyowoun Jyung
- The Institute for Family Health, 230 W 17(th) Street 8(th) floor, New York, NY, United States; Icahn School of Medicine at Mount Sinai Department of Family Medicine & Community Health, 1425 Madison Avenue, Suite L5-40, New York, NY 10029 United States.
| | - Anup Bhandiwad
- The Institute for Family Health, 230 W 17(th) Street 8(th) floor, New York, NY, United States; Icahn School of Medicine at Mount Sinai Department of Family Medicine & Community Health, 1425 Madison Avenue, Suite L5-40, New York, NY 10029 United States
| | - Marsha J Handel
- Icahn School of Medicine at Mount Sinai Department of Family Medicine & Community Health, 1425 Madison Avenue, Suite L5-40, New York, NY 10029 United States
| | - Eve Walter
- The Institute for Family Health, 230 W 17(th) Street 8(th) floor, New York, NY, United States; Icahn School of Medicine at Mount Sinai Department of Family Medicine & Community Health, 1425 Madison Avenue, Suite L5-40, New York, NY 10029 United States
| | - Raymond Teets
- The Institute for Family Health, 230 W 17(th) Street 8(th) floor, New York, NY, United States; Icahn School of Medicine at Mount Sinai Department of Family Medicine & Community Health, 1425 Madison Avenue, Suite L5-40, New York, NY 10029 United States
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Thai TTN, Nguyen KT, Pham TT, Nguyen PM, Derese A. Can combined online and face-to-face continuing medical education improve the clinical knowledge and skills of family doctors in Vietnam? A cluster randomised controlled trial. Trop Med Int Health 2020; 25:388-396. [PMID: 31955480 DOI: 10.1111/tmi.13372] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess the effectiveness of a combined online and face-to-face continuing medical education (CME) programme, for improvement in clinical knowledge and skills of family doctors, in comparison with a control group; and to explore the self-reported satisfaction, competencies and confidence of those in the intervention group. METHODS We used a cluster randomised controlled trial, with pre- and post-testing, and a feedback survey at the end of the 18-month CME programme. The measurements consisted of a multiple-choice test, an objective structured clinical examination test and an anonymously self-administered questionnaire. RESULTS There were 58 family doctors from four provinces in the intervention group and 32 doctors from three provinces in control group, both in the Mekong Delta region in Vietnam. The mean age of participants was 47.8 years, and the female/male ratio was 1/2.9. After training, the intervention group had significantly higher scores on overall knowledge (mean difference = 1.4, 95% CI 1.0-1.86, P < 0.001; Cohen's d 1.36, Pearson's r 0.53), in four of the five education modules: peptic disorders, diabetes, hypertension and bone-muscle-joint diseases (Pearson's r 0.56, 0.56, 0.34 and 0.4, respectively), and in problem-solving skills (Pearson's r 0.27). Self-reports showed a positive learning attitude, strong interest and improved confidence and competency among doctors in the intervention group. CONCLUSIONS A combined online and face-to-face CME programme proved applicable and effective for improving the clinical knowledge and problem-solving skills of family doctors in Vietnam.
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Affiliation(s)
- Thuy T N Thai
- Department of Family Medicine, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Kien T Nguyen
- Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Tam T Pham
- Faculty of Public Health, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Phuong M Nguyen
- Faculty of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam.,Skillslab Unit, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Anselme Derese
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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Differences among health care students' attitudes, knowledge and use of dietary supplements: a cross-sectional study. Complement Ther Med 2018; 41:35-40. [PMID: 30477862 DOI: 10.1016/j.ctim.2018.09.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 09/05/2018] [Accepted: 09/06/2018] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The objectives of this study were to evaluate the difference among pharmacy, dental and medical students' attitudes, knowledge and use of dietary supplements. Furthermore, factors likely to influence their personal use and willingness to recommend supplement to patient were investigated. DESIGN A cross-sectional survey study. SETTING The study was carried out at a single university. MAIN OUTCOME MEASURES Survey gathered socio-demographic data and questioned students' attitudes, knowledge and use of dietary supplements. RESULTS A total of 506 students were included in the study. Pharmacy students showed more positive attitudes about dietary supplements, and achieved higher knowledge scores when compared to dental or medical students (p < 0.001). Medical students were more likely to use evidence based sources of information about dietary supplements. There was no difference in supplements use across study programs (p = 0.177). As many as 59.7% of students that participated in the study reported using dietary supplements. Data analysis showed that the previous personal use supplements was a significant independent predictor whether students would recommend supplements to their patients (OR 27.03, 95% CI 14.08-50, p < 0.001). CONCLUSIONS Students' education did not influence their personal use of dietary supplements. However, their personal experience seems to influence their willingness to recommend supplements to patients. Pharmacy students showed greater knowledge about supplements than their dental or medical colleagues. In future practice, health care students could benefit from collaboration with pharmacists when they provide care to patients seeking advice about the use of dietary supplements.
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