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Risvoll H, Risør T, Halvorsen KH, Waaseth M, Stub T, Giverhaug T, Musial F. General practitioners' role in safeguarding patients with dementia in their use of dietary supplements. A qualitative study. Scand J Prim Health Care 2024; 42:16-28. [PMID: 37982720 PMCID: PMC10851825 DOI: 10.1080/02813432.2023.2283182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/08/2023] [Indexed: 11/21/2023] Open
Abstract
OBJECTIVE The use of dietary supplements (DS) may cause harm through direct and indirect effects. Patients with dementia may be particularly vulnerable. This study aims to explore general practitioners' (GPs') experiences with DS use by these patients, the GPs perceived responsibilities, obstacles in taking on this responsibility, their attitudes toward DS, and suggestions for improvements to safeguard the use of DS in this patient group. DESIGN Qualitative individual interview study conducted February - December 2019. Data were analysed using systematic text condensation. SETTING Primary healthcare clinics in Norway. SUBJECTS Fourteen Norwegian GPs. FINDINGS None of the informants were dismissive of patients using DS. They were aware of the possible direct risks and had observed them in patients. Most GPs showed little awareness of potential indirect risks to patients with dementia who use DS. They acknowledged the need for caretaking of these patients. Although there were differences in practice styles, most of the GPs wished to help their patients safeguarding DS use but found it difficult due to the lack of quality assurance of product information. Furthermore, there were no effective ways for the GPs to document DS use in the patients' records. Several suggestions for improvement were given by the GPs, such as increased attention from GPs, inclusion of DS in the prescription software, and stricter regulatory systems for DS from the authorities. CONCLUSION The GPs had initially little awareness of this safety risk, but there were differences in practice style and attitudes towards DS. The GPs did not perceive themselves as main responsible for safe use of DS in patient with dementia. The most important reason to disclaim responsibility was lack of information about the products. One suggestion for improvement was better integration of DS in patients' medical record.
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Affiliation(s)
- Hilde Risvoll
- NAFKAM, Department of Community Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
- NLSH Vesterålen, Department of Neurology, Stokmarknes, Norway
- Valnesfjord Helsesportsenter, Valnesfjord, Norway
| | - Torsten Risør
- Section for General Practice, Department of Community Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
- Section for General Practice & Research Unit for General Practice, Department of Public Health, University of Copenhagen, København K, Denmark
| | - Kjell H. Halvorsen
- IPSUM research group, Department of Pharmacy, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Marit Waaseth
- IPSUM research group, Department of Pharmacy, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Trine Stub
- NAFKAM, Department of Community Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Trude Giverhaug
- Center for Profession and Quality, University Hospital of North Norway, Tromsø, Norway
| | - Frauke Musial
- NAFKAM, Department of Community Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
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Risvoll H, Musial F, Waaseth M, Giverhaug T, Halvorsen K. Home care service employees' contribution to patient safety in clients with dementia who use dietary supplements: a Norwegian survey. Scand J Prim Health Care 2021; 39:403-412. [PMID: 34524069 PMCID: PMC8725956 DOI: 10.1080/02813432.2021.1970944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To explore home care services (HCS) employees' professional experiences with the use of dietary supplements (DSs) in their clients with dementia. We also investigated their attributed professional responsibility concerning this use and their attitudes toward DSs in general. Differences between nurses and nurse assistants were investigated. DESIGN A cross-sectional survey with self-administered questionnaires. SETTING Home care services in six Norwegian municipalities in the period August-December 2016. SUBJECTS A total of 231 (64% response rate) HCS employees; 78 nurses and 153 nurse assistants (auxiliary nurses and employees without formal education).Main outcome measures: Health care employees' experiences with patient safety in clients with dementia who use DSs. RESULTS Fifty per cent were concerned that clients with dementia might harm their health due to DS use. Thirty-one per cent reported having intervened in order to reduce the risk. Seventy-one per cent preferred to administer DSs to clients with dementia rather than leaving this responsibility to the clients. The respondents placed the responsibility for patient safety in clients with dementia using DSs mainly with the general practitioners, while they ascribed themselves and pharmacies a medium level of responsibility. There were only minor difference between nurses and nurse assistants, and no difference in attitudes towards DSs. CONCLUSION Employees in HCS were concerned about the DS use in clients with dementia. Moreover, almost one-third had intervened to improve clients' patient safety. The majority indicated that HCS should administer DSs rather than the clients with dementia themselves.KEY POINTSTo our knowledge, this is the first study investigating the role of home care services with regard to patient safety in clients with dementia who use dietary supplements (DSs).•Home care service employees worried about patient safety related to DS use in clients with dementia.•Home care service employees attributed to themselves medium responsibility to ensure the safe use of DSs in these clients.•Lack of knowledge was the most important reason why home care service employees did not recommend DSs to clients.
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Affiliation(s)
- Hilde Risvoll
- NAFKAM, Department of Community Medicine, UiT, The Arctic University of Norway, Langnes, Tromsø, Norway
- NKS Kløveråsen as, Bodø, Norway
- Valnesfjord Helsesportssenter, Valnesfjord, Norway
- CONTACT Hilde Risvoll NAFKAM, Department of Community Medicine, UiT, The Arctic University of Norway, Langnes, Tromsø, Norway
| | - Frauke Musial
- NAFKAM, Department of Community Medicine, UiT, The Arctic University of Norway, Langnes, Tromsø, Norway
| | - Marit Waaseth
- Department of Pharmacy, UiT, The Arctic University of Norway, Langnes, Tromsø, Norway
| | - Trude Giverhaug
- RELIS North Norway, University Hospital of North Norway, Tromsø, Norway
| | - Kjell Halvorsen
- Department of Pharmacy, UiT, The Arctic University of Norway, Langnes, Tromsø, Norway
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Steiner GZ, George ES, Metri NJ, MacMillan F, Dubois S, Moyle W, Hohenberg MI, Singh K, Townsend C, Chang D, Bensoussan A, McBride KA. Use of complementary medicines and lifestyle approaches by people living with dementia: Exploring experiences, motivations and attitudes. Int J Older People Nurs 2021; 16:e12378. [PMID: 34176213 DOI: 10.1111/opn.12378] [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: 06/02/2020] [Revised: 01/26/2021] [Accepted: 03/24/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Lack of effective treatments for chronic conditions is associated with high rates of complementary medicine (CM) use. However, little is known about CM use for dementia. AIMS AND OBJECTIVES The aim of this study was to explore the experiences, motivations, and attitudes towards CM use by people living with dementia in an Australian setting. DESIGN This study had a qualitative research design; quantitative demographic information was also collected. METHODS In-depth interviews were conducted with people living with dementia and their caregivers (N = 18). A thematic (inductive) analysis approach was taken to interpret data. RESULTS Three in four participants used CM for dementia, spending ~AUD$100/month (USD$70/month). Within three overarching themes, a range of sub-themes was identified: (1) CM knowledge and use: people living with dementia and caregivers understanding of CM, types of CM used, and CM usage patterns; (2) Self-determined reasons for use/non-use: maintain or improve quality of life, hope, management of dementia symptoms, level of awareness, willingness and evidence, perceptions on efficacy and safety of CM, experiences of conventional medicine, and holistic approach to wellness; (3) External determinants of use: information on CM, relationship influences on CM use, and experiences with General Practitioners (GPs) and CM. CONCLUSION Findings highlight that CM use is widespread and positively viewed by people living with dementia and their caregivers. Decisions regarding CM use were based on personal opinions. Findings have important implications for conversations with health professionals regarding CM use by people living with dementia to improve communication, health literacy, and reduce the risk of adverse effects through polypharmacy. IMPLICATIONS FOR PRACTICE This study showed that CM is a valued approach for dementia management by people living with dementia, their families, and healthcare providers. Future international research is required to evaluate the efficacy and safety of these approaches and promote accurate advice in nursing care.
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Affiliation(s)
- Genevieve Z Steiner
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia.,Translational Health Research Institute (THRI), Western Sydney University, Penrith, NSW, Australia
| | - Emma S George
- Translational Health Research Institute (THRI), Western Sydney University, Penrith, NSW, Australia.,School of Health Sciences, Western Sydney University, Penrith, NSW, Australia
| | - Najwa-Joelle Metri
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Freya MacMillan
- Translational Health Research Institute (THRI), Western Sydney University, Penrith, NSW, Australia.,School of Health Sciences, Western Sydney University, Penrith, NSW, Australia
| | - Shamieka Dubois
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Wendy Moyle
- Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia
| | - Mark I Hohenberg
- School of Medicine, Western Sydney University, Penrith, NSW, Australia
| | - Kawaljit Singh
- School of Medicine, Western Sydney University, Penrith, NSW, Australia
| | - Camilla Townsend
- School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Dennis Chang
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Alan Bensoussan
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Kate A McBride
- Translational Health Research Institute (THRI), Western Sydney University, Penrith, NSW, Australia.,School of Medicine, Western Sydney University, Penrith, NSW, Australia
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Risvoll H, Musial F, Halvorsen KH, Giverhaug T, Waaseth M. Pharmacy employees' involvement in safeguarding persons with dementia who use dietary supplements: Results from a survey of Norwegian pharmacies. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 19:179. [PMID: 31324241 PMCID: PMC6642513 DOI: 10.1186/s12906-019-2587-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 06/30/2019] [Indexed: 01/09/2023]
Abstract
Background Community-dwelling persons with dementia commonly use dietary supplements (DS), often without receiving help with the administration. Patient safety is a concern, as DS-drug interactions and adverse events are potential complications. Since many persons with dementia buy their DS in pharmacies, we investigated Norwegian pharmacy employees’ attitudes and professional practice behaviors related to DS. Methods We conducted a survey in eight Norwegian municipalities of pharmacy employees involved in the sale of DS. The questionnaire covered demographics and investigated attitudes toward DS, professional practice behaviors related to the sale of DS, experiences with customers with dementia, and perceived and attributed responsibilities with regard to patient safety. Results One hundred and five employees responded (response rate: 52%). Most employees regarded general practitioners (GPs) as primarily responsible for safeguarding the use of DS by persons with dementia and rated themselves less responsible. Thirty-seven percent of the employees reported personal use of DS (past or current use). Nine percent considered some of the DS to have symptomatic or prophylactic effects against dementia. Forty-eight percent confirmed that they informed customers about potential adverse events; 42% indicated that they did this sometimes. Sixteen percent checked regularly for DS-drug interactions, and two-thirds checked depending on the customers’ health, the type of drug or the type of DS. One-quarter regularly asked about the co-use of prescription drugs (PD) when selling DS, while only 2% asked about the co-use of DS when dispensing PD. Only 25% reported access to independent scientific information on all or most DS sold in their pharmacy. Eight percent had experienced unsafe use of DS by persons with dementia. Six percent had been taught about counselling persons with dementia. Education level influenced professional practice behavior to some extent. Conclusion Pharmacy employees do not see themselves as primarily responsible for the safe use of DS by persons with dementia. Moreover, they have limited experience with the unsafe use of DS by these persons. There is potential for improvement regarding tools and educational interventions for pharmacy employees to provide sufficient help to persons with dementia who use DS. Electronic supplementary material The online version of this article (10.1186/s12906-019-2587-4) contains supplementary material, which is available to authorized users.
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