Attitudes of healthcare professionals toward patient counseling on drug-nutrient interactions

Knowledge, attitudes and practices of healthcare professionals regarding drug-food interactions: a scoping review

OBJECTIVES

Drug-food interactions (DFIs) are a problem in clinical practice as they can alter the bioavailability of drugs and nutrients and may lead to various adverse effects. Healthcare professionals (HCPs) play a significant role in counselling patients and preventing these interactions. Knowledge, attitudes and practices (KAPs) regarding DFIs are, therefore, vital to ensure that they carry out their role efficiently. This review maps evidence on KAPs of HCPs regarding DFIs and highlights gaps for further research.

METHODS

A systematic literature search for the period from 1990 to 2018 was done using Google Scholar, PubMed and ScienceDirect. Keywords such as 'knowledge, attitudes, practices, healthcare professionals, drug-food interactions' in combination with the Boolean operator (AND) were used. Articles published only in English that described KAPs of HCPs relating to DFIs were included.

KEY FINDINGS

Twelve studies were included in this review. Inadequate knowledge was observed among the HCPs as they were unable to identify important DFIs. The HCPs had a positive attitude towards acquiring knowledge, reporting and counselling patients on DFIs. Most of the medical residents felt that they were inadequately trained on DFIs and over half believed that DFIs were only slightly important in clinical practice.

CONCLUSION

Deficits exist in the KAPs of HCPs regarding DFIs. An educational intervention targeting HCPs is recommended. Further research assessing the KAPs of the HCPs is required as the small number of studies conducted was a limitation.

Medications and Micronutrients: Identifying Clinically Relevant Interactions and Addressing Nutritional Needs

Objective: Prescription drug use is on the rise, and the use of dietary supplementation remains common. In the United States, more than half of all adults take a dietary supplement in any given month. As a result, drug-nutrient interactions are becoming an important consideration when pharmacists counsel patients about their drug regimens. We reviewed the literature to identify common and/or clinically relevant drug-nutrient interactions that pharmacists may encounter in practice. Data Sources: A MEDLINE search for English-language publications from 1970 through March 2017 was performed using search terms (and variations) related to drugs, medications, micronutrients, and interactions. Study Selection and Data Extraction: Relevant studies, case reports, and reviews describing drug-nutrient interactions were selected for inclusion. Data Synthesis: Some drug-nutrient interactions may result in micronutrient insufficiencies or even frank deficiencies, thereby necessitating augmentation with multivitamin/minerals or individual vitamin/mineral dietary supplements. This most often occurs with long-term therapy for chronic conditions, such as treatment with proton-pump inhibitors and histamine-2 receptor antagonists. In addition, some chronic diseases themselves, such as diabetes, may predispose patients to micronutrient insufficiencies, and dietary supplementation may be advisable. Conclusions: Drug-nutrient interactions can often be resolved through specific dosing strategies to ensure that the full effect of the medication or the dietary supplement is not compromised by the other. In rare cases, the dietary supplement may need to be discontinued or monitored during treatment. Pharmacists are in a key position to identify and discuss these drug-nutrient interactions with patients and the health care team.

ACE inhibitors and potassium foods – nurses' knowledge

Purpose

– According to Joint Commission standards, patients should be educated about drug-nutrient interactions. Because nurses are well-suited to educating patients, this paper aims to assess their knowledge of ACE inhibitor drugs, nutrient interactions and high- and low-potassium foods.

Design/methodology/approach

– Licensed nurses from a teaching hospital in the US south eastern Atlantic region completed a self-administered questionnaire (n=83). Means, standard deviations and 95 percent confidence intervals were calculated for continuous data and frequency and percentage distribution for discrete data. Student's t-test was used to evaluate responses by ACE inhibitor patient load and nursing education.

Findings

– Mean nurse knowledge of ACE inhibitors and potassium was 62±16 percent and identifying high- and low-potassium foods was 32±23 percent. Most identified five from 12 high-potassium foods and did not know the designation of six, one from 14 low-potassium foods and did not know the designation of 11. Knowledge scores and identifying high- and low-potassium foods were similar regardless of ACE inhibitor patient load and nursing education.

Practical implications

– ACE inhibitors are the fourth most commonly used drug class in the USA. Nurses are well positioned to recognize potential drug-nutrient interactions owing to changing or adding a drug, dose delivery method, dietary change or a patient's physical or clinical status that may indicate nutrient deficiency. The findings suggest that the nurses surveyed were proficient in identifying ACE inhibitors pharmacology, but that most were unable to identify foods that increase drug-nutrient interaction risk, and thus this is an area in which additional training might be beneficial.

Originality/value

– Case menus were used to portray real-life scenarios in which healthcare practitioners can provide patient education about ACE inhibitor drug and dietary potassium interactions.

HEALTH SERVICES RESEARCH METHODS IN PHARMACY: Survey research: (1) Design, samples and response

Social survey methodology is the most widely used approach by pharmacy practice researchers, accounting for a higher proportion of published papers than any other. Survey techniques have been used to address a range of research objectives in a variety of populations and settings.

Extensive hand searches of published survey research have enabled a review of the issues and problems that social survey research presents when applied in pharmacy settings, and an exploration of how they have been addressed. This review is in two parts. This first part focuses on the research questions that have been addressed by survey methods, design of the studies, sampling frames and procedures, response rates and management of non-response. A second paper will discuss the development of survey instruments, and the issues of validity, reliability and generalisability.

HEALTH SERVICES RESEARCH METHODS IN PHARMACY: Survey research: (2) Survey instruments, reliability and validity

Social surveys are an important tool in health services research. They have been used in a high proportion of pharmacy practice research studies and in a wide range of settings. Extensive hand searches of published studies has enabled a review of the issues and problems that survey methods present when applied in pharmacy practice and an exploration of how they have been addressed by researchers. It is hoped that the review will enable pharmacy practice researchers to benefit from the experience of their colleagues when conducting their own research. This is the second part of a two-part review of surveys in pharmacy practice research. The first part (IJPP, 1997;5:152) focused on research questions, study design, sampling frames and procedures, response and non-response. This second part discusses the development of survey instruments and the issues of validity, reliability and generalisability.

An Approach to Evaluating Drug-Nutrient Interactions

Although the significance of interactions between drugs is widely appreciated, little attention has been given to interactions between drugs and nutrients. Pharmacists are challenged to remember documented interactions involving available drugs, and they face the possibility that each newly approved therapeutic agent may be involved not only in unrecognized drug-drug interactions but in drug-nutrient interactions as well. A more consistent approach to evaluating drug-nutrient interactions is needed. The approach must be systematic in order to assess the influence of nutritional status, food, or specific nutrients on a drug's pharmacokinetics and pharmacodynamics, as well as the influence of a drug on overall nutritional status or on the status of a specific nutrient. We provide such a process, using several recently approved drugs as working examples. Risk factors and clinical relevance are described, with distinctions made between documented and potential interactions. Application of this process by the pharmacist to any drug will help increase their expertise. Furthermore, full consideration by pharmacists of all possible interactions of the drug regimens used in practice can allow for improved patient care.

Interação fármaco-nutriente: uma revisão

A dieta influencia todos os estágios do ciclo da vida, fornecendo nutrientes necessários ao sustento do corpo humano. Alterações de ordem funcional e/ou estrutural, provocadas por doenças e infecções agudas ou crônicas, levam à utilização de medicamentos, cujo objetivo é restaurar a saúde. A via preferencial escolhida para a sua administração é a oral, entre outras razões, por sua comodidade e segurança. O fenômeno de interação fármaco-nutriente pode surgir antes ou durante a absorção gastrintestinal, durante a distribuição e armazenamento nos tecidos, no processo de biotransformação ou mesmo durante a excreção. Assim, é de importância fundamental conhecer os fármacos cuja velocidade de absorção e/ou quantidade absorvida podem ser afetadas na presença de alimentos, bem como aqueles que não são afetados. Por outro lado, muitos deles, incluindo antibióticos, antiácidos e laxativos podem causar má absorção de nutrientes. Portanto, o objetivo do presente artigo é apresentar uma revisão dos diversos aspectos envolvidos na interação fármaco-nutriente.

Attitude of physicians toward patient package inserts for medication information in Belgium

In Belgium, the distribution of medications to outpatients in community pharmacies is almost exclusively by branded unit-of-use packages, with a package insert inside every package. At the time of the study (spring 1990), the implementation of legislation that mandated a shift from highly technical documents to patient package inserts (PPIs), understandable by the lay person, had begun. This study explores the attitude of practising physicians toward written medication information for patients. A mail questionnaire was sent to 1500 (8% random sample) Belgian general practitioners and to 500 (22% random sample) internal medicine specialists. A total of 543 usable questionnaires were returned (27.5% return rate). Ninety-two percent of the physicians stated that their patients seldom or never requested additional information on drug efficacy or side effects, during routine consultation; 30% estimated that more than half of their patients read the PPI; 75% expect that a patient would experience side effects after reading about them in the PPI; 59% agreed that the PPI could help the patient react more adequately in unforeseen situations. It was possible to cluster the respondents in a stable segmentation of three clusters: moderately positive physicians (20%), ambiguous to neutral physicians (44%), physicians overtly negative to written drug information (36%). The low response rate to this extensive postal questionnaire limits the conclusions to a qualitative description of relevant clusters of respondents. In contrast with the opinion of physicians about patient readership, results from other studies indicate that the vast majority of patients read the package inserts.

Interdisciplinary patient and family education

The education of patients and their families can support positive patient healthcare outcomes. Patient and family education is an essential component of the healthcare delivery process, but it often is fragmented, with individual disciplines providing information without coordination. At the Carl T. Hayden VA Medical Center in Phoenix, AZ, a team reviewed the facility's process for providing patient education. As a result of this review, interdisciplinary process and documentation forms that improved both the quality of education provided and the documentation of that education in the medical record were developed.