Taylor David McD, Walsham Nicola, Taylor Simone E, Wong Lufee
Department of Emergency Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
Pharmacotherapy. 2006 May;26(5):634-40. doi: 10.1592/phco.26.5.634.
To determine the nature and prevalence of potential interactions between prescription drugs and complementary and alternative medicines (CAMs) and the reasons some patients do not advise their physicians of CAM use.
Cross-sectional survey.
The emergency department of the Royal Melbourne Hospital, a tertiary referral center.
Four hundred four adult patients (>or= 18 yrs) who visited the emergency department between February 1, 2002, and March 31, 2003. Intervention. A specifically designed, self-administered questionnaire, available in seven languages.
Main outcome measures were the prevalence of potential prescription drug-CAM interactions and the reasons some patients do not advise their physicians of CAM use. Mean +/- SD patient age was 50.6 +/- 20.0 years; 220 patients were men (54.5%, 95% confidence interval [CI] 49.5-59.4%). When asked about use during the previous year, 275 patients (68.1%, 95% CI 63.2-72.5%) reported having taken a CAM; of these, 138 were also taking a prescription drug. We identified 15 documented potential drug-CAM interactions in nine patients (3.3% of CAM users, 95% CI 1.6-6.3%) and 97 theoretical potential drug-CAM interactions in 51 patients (18.6% of CAM users, 95% CI 14.2-23.8%). Aspirin and warfarin were the most commonly involved drugs. Of CAM users, 197 (71.6%, 95% CI 65.9-76.8%) never informed their physician about CAM use, most frequently because they were not asked.
The prevalence of potential drug-CAM interactions among patients in the emergency department is considerable, and some of these interactions could be clinically significant. Practitioners should increase their awareness of potential drug-CAM interactions, and education initiatives aimed at encouraging patient-physician discussion of CAM use are recommended, such as a CAM history in their patient evaluation. Further research is required to better determine the clinical significance of drug-CAM interactions.
确定处方药与补充和替代医学（CAMs）之间潜在相互作用的性质和发生率，以及一些患者未向医生告知使用CAMs的原因。
横断面调查。
皇家墨尔本医院急诊科，一家三级转诊中心。
2002年2月1日至2003年3月31日期间到急诊科就诊的404名成年患者（≥18岁）。干预措施：一份专门设计的、可自行填写的问卷，有七种语言版本。
主要结局指标为潜在的处方药与CAM相互作用的发生率，以及一些患者未向医生告知使用CAMs的原因。患者的平均年龄为50.6±20.0岁；220名患者为男性（54.5%，95%置信区间[CI]49.5 - 59.4%）。当被问及上一年的使用情况时，275名患者（68.1%，95%CI 63.2 - 72.5%）报告使用过CAMs；其中，138名患者同时也在服用处方药。我们在9名患者中发现了15例已记录的潜在药物与CAM相互作用（占CAM使用者的3.3%，95%CI 1.6 - 6.3%），在51名患者中发现了97例理论上的潜在药物与CAM相互作用（占CAM使用者的18.6%，95%CI 14.2 - 23.8%）。阿司匹林和华法林是最常涉及的药物。在使用CAMs的患者中，197名（71.6%，95%CI 65.9 - 76.8%）从未告知医生其使用CAMs的情况，最常见的原因是医生未询问。
急诊科患者中潜在的药物与CAM相互作用的发生率相当高，其中一些相互作用可能具有临床意义。从业者应提高对潜在药物与CAM相互作用的认识，建议开展旨在鼓励患者与医生讨论使用CAMs的教育活动，例如在患者评估中询问CAM使用史。需要进一步研究以更好地确定药物与CAM相互作用的临床意义。
