Communication Study
Physician–patient communication about dietary supplements

https://doi.org/10.1016/j.pec.2013.01.021Get rights and content

Abstract

Objective

Describe the content and frequency of provider–patient dietary supplement discussions during primary care office visits.

Methods

Inductive content analysis of 1477 transcribed audio-recorded office visits to 102 primary care providers was combined with patient and provider surveys. Encounters were collected in Los Angeles, CA (2009–2010), geographically diverse practice settings across the United States (2004–2005), and Sacramento, CA (1998–1999).

Results

Providers discussed 738 dietary supplements during encounters with 357 patients (24.2% of all encounters in the data). They mentioned: (1) reason for taking the supplement for 46.5% of dietary supplements; (2) how to take the supplement for 28.2%; (3) potential risks for 17.3%; (4) supplement effectiveness for 16.7%; and (5) supplement cost or affordability for 4.2%. Of these five topics, a mean of 1.13 (SD = 1.2) topics were discussed for each supplement. More topics were reviewed for non-vitamin non-mineral supplements (mean 1.47 (SD = 1.2)) than for vitamin/mineral supplements (mean 0.99 (SD = 1.1); p < 0.001).

Conclusion

While discussions about supplements are occurring, it is clear that more discussion might be needed to inform patient decisions about supplement use.

Practice implications

Physicians could more frequently address topics that may influence patient dietary supplement use, such as the risks, effectiveness, and costs of supplements.

Introduction

Over half of all Americans take dietary supplements [1], [2], but such supplements may pose significant risks, including potential supplement–drug interactions [3], [4], [5], [6], side effects, and other adverse effects [7], [8], [9], [10], [11], and may incur unnecessary costs. More than 15 million adults are at risk for interactions between prescription medications and herbal supplements or high-dose vitamins [12]. Furthermore, patients may replace or decrease conventional medication use in favor of a dietary supplement [7], [8], [13]. Because of these concerns, organizations such as the United States Food and Drug Administration and National Institutes of Health recommend that patients consult a health professional before starting a dietary supplement [14], [15].

Recommendations suggest that physicians engage patients about dietary supplements by inquiring about supplement use, evaluating supplements, discussing available safety and efficacy data, and monitoring for adverse events and therapeutic responses [16], [17]. However, these suggestions do not account for potential inadequate physician knowledge about supplements [18], and little is known about what actually transpires during office visits. Some studies have analyzed discussions about complementary and alternative therapies with oncology patients [19] and older patients [20]. But these studies did not focus on dietary supplements, for which there are special safety considerations. In addition, these analyses did not address the actual content of the information exchanged during physician–patient conversations.

We analyzed three datasets, collected in three different studies during different time periods between 1998 and 2010, to describe the content and frequency of discussions about dietary supplements, and to investigate variations in communication based on supplement type (vitamins/minerals versus non-vitamin non-mineral (NVNM) dietary supplements; the latter may have more potential for medication–supplement interactions).

Section snippets

Methods

This study combines data from three separate studies, collected during three different time periods across different geographical areas in the United States. Data also were aggregated to increase the potential number of encounters containing dietary supplement discussions, and to ensure a more complete characterization of dietary supplement conversations. Investigators from each of the three studies first recruited primary care physicians for study participation, and then recruited patients of

Patient, physician, and dietary supplement characteristics

Table 1 describes the characteristics of physicians and patients who did and did not have conversations about dietary supplements. Of 1479 patients, 357 (24.2%) had visits with discussions about dietary supplements. Compared to patients who did not discuss dietary supplements, those who had conversations with their physicians were comprised of more females (67.5% versus 60.6%) and had higher educational achievement. The 2009–2010 study had more black and Asian patients than the other two

Discussion

This study combines data from three different time periods, collected in diverse geographical settings in the United States, to provide a description of primary care physician–patient information exchange about dietary supplements. Prior studies did not specifically examine conversations specific to dietary supplements because they grouped supplement discussions with other complementary and alternative medicine treatments [19], [20]. This study demonstrates that discussions about meaningful

Acknowledgements

The authors would like to thank Brian K. Manning, MPH from the American Academy of Family Physicians National Research Network for his assistance with the data. Some of the data used in this study were collected with support from the Robert Wood Johnson Foundation (Grant #034384), a UCLA Mentored Clinical Scientist Development Award (5K12AG001004) and by the UCLA Older Americans Independence Center (NIH/NIA Grant P30-AG028748). This publication was made possible by Grant Number R01AT005883 from

References (31)

  • P.A. De Smet

    Health risks of herbal remedies: an update

    Clin Pharmacol Ther

    (2004)
  • C.M. Marrone

    Safety issues with herbal products

    Ann Pharmacother

    (1999)
  • R.M. Andersen

    Revisiting the behavioral model and access to medical care: does it matter?

    J Health Soc Behav

    (1995)
  • M. Oz

    Emerging role of integrative medicine in cardiovascular disease

    Cardiol Rev

    (2004)
  • D.M. Eisenberg et al.

    Trends in alternative medicine use in the United States, 1990–1997: results of a follow-up national survey

    J Am Med Assoc

    (1998)
  • Cited by (31)

    • In-depth multidisciplinary review of the usage, manufacturing, regulations &amp; market of dietary supplements

      2022, Journal of Drug Delivery Science and Technology
      Citation Excerpt :

      When dietary supplements are not printed in the history of the patient's medication use, the physician cannot track any of his patients' supplements intake, which can decrease the quality of medical care. For example, the medicine and supplement intervention in terms of pharmacology can be one of the unexpected adverse effects of supplementary dietary lack on the patients' history [115]. More interestingly, if the same supplement alone results in any adverse effect, these reports are not publicly observable.

    • Working toward evidence-based guidelines for cost-of-care conversations between patients and physicians: A systematic review of the literature

      2020, Social Science and Medicine
      Citation Excerpt :

      Although this limits our ability to generalize beyond U.S. borders, the problem of exorbitant costs in the healthcare systems of developed nations appears to be primarily an American one, so the focus seems warranted. Finally, the actual topic of cost conversations was not central to a handful of these studies (e.g., Lin et al.’s (2018) study of empathic statements in the emergency department; Mirivel’s (2010) study of cosmetic surgery; Tarn et al.’s (2013) study of dietary supplements), so the information gleaned from them was limited; however, the studies did meet inclusion criteria and provided insight into the nature of cost conversations in more diverse settings. Currently, the literature on cost conversations is still in its infancy in terms of being able to offer actionable evidence to guide quality conversations about reducing cost of care.

    • The practice of prescribing: Discovering differences in what we tell patients about prescription medications

      2014, Patient Education and Counseling
      Citation Excerpt :

      This may well reflect a general sense on the part of both clinicians and patients that for medications to be available over the counter, there is an intrinsic degree of safety that allows a more relaxed or minimized approach in discussing risks and side effects. This result is similar to research findings that discussions about dietary supplements are suboptimal regarding risk [39]. This investigation focused on the immediate patient perspective after receiving a new medication prescription.

    View all citing articles on Scopus
    View full text