Tarn Derjung M, Guzmán Jennifer R, Good Jeffrey S, Wenger Neil S, Coulter Ian D, Paterniti Debora A
Department of Family Medicine, David Geffen School of Medicine at UCLA, University of California-Los Angeles, Los Angeles, CA, USA,
J Gen Intern Med. 2014 Sep;29(9):1242-9. doi: 10.1007/s11606-014-2899-5. Epub 2014 May 30.
Dietary supplement use in the United States is common. Patients can procure supplements without a prescription, and often do not disclose supplement use to their healthcare providers. Providers and patients may be uncertain about what would be appropriate or helpful in discussions of supplements during routine office visits.
To explore provider and patient expectations for discussions of dietary supplements.
Semi-structured interviews were conducted with a purposeful sample of healthcare providers from three specialties and their patients who reported taking supplements.
Thirty-five outpatient providers (14 primary care, six integrative medicine, and 15 complementary and alternative medicine (CAM) providers) and 107 of their patients.
Qualitative analysis of transcripts using grounded theory and iterative review.
Both providers and patients raised twelve common topics about dietary supplements that they felt were important to discuss during office visits, such as: supplements taken; supplement risks (interactions, safety/harm, side effects/adverse events); treatment benefits; efficacy; alternative treatments; and patient expectations/preferences for treatment. Some topics were mentioned more frequently by providers than patients, such as how to take, reason for taking, and evidence for use. Providers raised several topics that were mentioned infrequently by patients. Supplement costs and regulations were not brought up by any patients, even though consideration of these topics could influence patient decisions to take supplements. Complementary healthcare providers brought up topics not mentioned by primary care providers, such as the importance of supplement brands and supplement mega-dosing.
Patients and providers have concordant views about the need to discuss patient supplement use and ensure patient safety. Patients may undervalue, be unaware of, or discount information about cost or regulations that could affect their decision-making about supplement use. Future studies could examine the value, acceptability, and influence of a more comprehensive approach to discussions to help patients appropriately evaluate supplements.
在美国，膳食补充剂的使用很普遍。患者无需处方即可购买补充剂，而且往往不会向他们的医疗服务提供者透露使用补充剂的情况。在常规门诊就诊时，医疗服务提供者和患者对于在讨论补充剂时什么是合适的或有帮助的可能并不确定。
探讨医疗服务提供者和患者对膳食补充剂讨论的期望。
对来自三个专业的医疗服务提供者及其报告使用补充剂的患者进行了有目的抽样的半结构化访谈。
35名门诊医疗服务提供者（14名初级保健提供者、6名综合医学提供者和15名补充与替代医学（CAM）提供者）及其107名患者。
使用扎根理论和迭代审查对访谈记录进行定性分析。
医疗服务提供者和患者都提出了十二个关于膳食补充剂的常见话题，他们认为在门诊就诊时讨论这些话题很重要，例如：服用的补充剂；补充剂风险（相互作用、安全/危害、副作用/不良事件）；治疗益处；疗效；替代治疗；以及患者对治疗的期望/偏好。一些话题医疗服务提供者提及的频率高于患者，例如如何服用、服用原因和使用证据。医疗服务提供者提出了一些患者很少提及的话题。没有患者提及补充剂成本和法规，尽管考虑这些话题可能会影响患者服用补充剂的决定。补充与替代医学提供者提出了初级保健提供者未提及的话题，例如补充剂品牌的重要性和补充剂超大剂量服用。
患者和医疗服务提供者对于讨论患者补充剂使用情况并确保患者安全的必要性有一致的看法。患者可能会低估、不知道或忽视有关成本或法规的信息，而这些信息可能会影响他们对补充剂使用的决策。未来的研究可以考察更全面的讨论方法的价值、可接受性和影响，以帮助患者适当地评估补充剂。
