According to data from the 2012 National Health Interview Survey, approximately 18% of American adults take dietary supplements, amounting to more than 40 million people. The CDC recently reported that the most commonly used dietary supplements are vitamins and minerals. Other supplements that are frequently used by patients include herbs, amino acids, or other substances.
“Many people use dietary supplements, but they often do not disclose that they use these products to their healthcare providers,” says Paula M. Gardiner, MD, MPH. Research suggests that some patients may not disclose this information because they are unaware that physicians need to know about it. Other studies have revealed that patients may be reluctant to tell their healthcare providers for fear of being judged.
A Significant Issue
According to the Joint Commission, dietary supplements should be viewed by clinicians in the same context as they view prescription medications. “Just like prescription drugs, dietary supplements can have an impact on patient’s health outcomes and hence influence how clinicians manage their patients,” Dr. Gardiner says. These supplements can affect physiological processes in the body and may have an impact on medical procedures, such as surgery, chemotherapy, blood work, and other treatments or procedures.
Dr. Gardiner notes that many over-the-counter products contain dietary supplements and have many active chemical properties that can be addictive or counteract the effects of the prescription drugs. “If clinicians don’t know all of the therapies that their patients are taking, they can’t do their job properly,” says Dr. Gardiner.
Exploring the Issue
A study published in Patient Education and Counseling by Dr. Gardiner and colleagues explored inpatient reconciliation of dietary supplement use and sought to determine characteristics that were linked to documentation of patients using these supplements. The research team analyzed 558 inpatients recruited from the Reengineered Discharge Clinical Trial. “Ultimately, we wanted to see if patients self-reported using dietary supplements,” says Dr. Gardiner, who is from Boston Medical Center, which is where the Reengineered Discharge Clinical Trial also took place. “We also wanted to determine if their supplement use was documented when they were admitted to the hospital.”
According to the results, 60% of inpatients involved in the study reported using dietary supplements. Among patients who used these supplements, only 36% had documentation of this use in their medical records. The investigation also found that just 18% of dietary supplement users reported that they disclosed using these agents to their healthcare provider. In addition, 48% of dietary supplement users reported they would continue to use the supplements.
“Ideally, patients should be asked at admission about dietary supplement use, instructed to disclose their use of specific products, and have their supplement use documented in medical records,” says Dr. Gardiner. “Overall, just 6% of participants in our study accomplished all three of these tasks. These findings demonstrate that there is lack of consistent medical reconciliation regarding use of these supplements in the inpatient setting.”
Several demographic factors appeared to have an effect on whether or not dietary supplement use was documented (Table). Documentation of dietary supplement use on medical charts was lower among older individuals and non-white patients.
Important Practice Implications
The study by Dr. Gardiner and colleagues adds to the current literature on medical reconciliation. “It’s important to empower physicians with this information so that they become aware of the problem,” Dr. Gardiner says. “Healthcare providers need to learn more about the effects of specific dietary supplements during their medical education and from continuing medical education activities. Medical schools and professional associations have an opportunity to educate new physicians about the importance of dietary supplement dialogue with patients of all ages and cultural backgrounds.” Education on the safety and efficacy of these agents is paramount to ensuring good patient outcomes.
According to Dr. Gardiner, clinicians need to communicate more with patients when they are admitted to the hospital about dietary supplement use and document these discussions each step of the way. She adds that the consequences of being unaware of possible drug-dietary supplement reactions can lead to a domino effect. Clinicians may unknowingly provide treatment plans or prescribe medications that cause adverse reactions or interactions.
Although it can be overwhelming to take the time to discuss dietary supplement use with patients, Dr. Gardiner says these efforts are worthwhile. “Research has shown that medically complicated patients are likely to use more supplements, but all patients can be at risk for adverse effects from using these agents,” she says. “To help prevent reactions from dietary supplement-prescription medication interactions, clinicians should establish a formalized approach to documentation. We can’t make assumptions that only specific patient groups should be asked about dietary supplement use. Involving nurses and pharmacists may help ensure that dietary supplement use is asked about and documented.”
Readings & Resources (click to view)
Gardiner P, Sadikova E, Filippelli AC, White LF, Jack BW. Medical reconciliation of dietary supplements: don’t ask, don’t tell. Patient Educ Couns. 2015;98:512-517. Available at: http://www.pec-journal.com/article/S0738-3991(15)00002-6/abstract.
Gardiner P, Filippelli AC, Sadikova E, White LF, Jack BW. Medication and dietary supplement interactions among a low-income, hospitalized patient population who take cardiac medications. Evid Based Complement Alternat Med. 2015;2015:429826.
Grimes TC, Duggan CA, Delaney TP, et al. Medication details documented on hospital discharge: cross-sectional observational study of factors associated with medication non-reconciliation. Br J Clin Pharmacol. 2011;71:449-457.
Mehta DH, Gardiner PM, Phillips RS, McCarthy EP. Herbal and dietary supplement disclosure to health care providers by individuals with chronic conditions. J Altern Complement Med. 2008;14:1263-1269.