Disclosure and adverse effects of complementary and alternative medicine used by hospitalized patients in the North East of England
Objectives: This study aimed to investigate the prevalence, disclosure and adverse effects of complementary and alternative medicine (CAM) use in hospitalised patients, and to explore the associations between patients’ perceived side-effects and relevant factors.
Methods: Patients who were admitted to a district general hospital and met the eligibility criteria were interviewed using a semi-structured questionnaire. Their medications and pertinent details were verified from the medical notes. All quantitative and qualitative data were collated and analysed. A chi-squared test was performed to test the associations of the perceived CAM side-effects with the significance level determined at α=0.05.
Results: A total of 240 in-patients completed the study. They were mostly white British (98.8%). The prevalence of CAM use within two years was 74.6% and one month 37.9%. Only 19 of 91 patients (20.9%) using CAM within one month disclosed their current CAM applications. Nearly half of patients (45.8%) who used CAM within two years experienced various CAM side-effects that tended to resolve after discontinuation. Slightly more than half (57.6%) perceived CAM side-effects and their perceptions were significantly associated with gender (P=0.048) and consideration for future CAM use (P=0.033). Potential interactions between herbal remedies/dietary supplements and prescribed drugs, such as garlic with lisinopril or aspirin, were assessed in 82 patients (45.8%).
Conclusion: Most in-patients used CAM and experienced some adverse effects. The disclosure of CAM use and its adverse outcomes should be encouraged by healthcare professionals.
2. Kayne SB. Complementary therapies for pharmacists. London: Pharmaceutical Press; 2002.
3. National Center for Complementary and Alternative Medicine. What is complementary and alternative medicine? Bethesda, MD: NCCAM; 2010. http://nccam.nih.gov/health/whatiscam (accessed on July 6, 2011).
4. Ernst E. The usage of complementary therapies by dermatological patients: a systematic review. Br J Dermatol. 2000;142(5):857-861.
5. Featherstone C, Godden D, Gault C, Emslie M, Took-Zozaya M. Prevalence study of concurrent use of complementary and alternative medicine in patients attending primary care services in Scotland. Am J Public Health. 2003;93(7):1080-1082.
6. Adusumilli PS, Ben-Porat L, Pereira M, Roesler D, Leitman IM. The prevalence and predictors of herbal medicine use in surgical patients. J Am Coll Surg. 2004;198(4):583-590.
7. Giveon SM, Liberman N, Klang S, Kahan E. Are people who use "natural drugs" aware of their potentially harmful side-effects and reporting to family physician? Patient Educ Couns. 2004;53(1):5-11.
8. Shakeel M, Bruce J, Jehan S, McAdam TK, Bruce DM. Use of complementary and alternative medicine by patients admitted to a surgical unit in Scotland. Ann R Coll Surg Engl. 2008;90(6):571-576.
9. Cosyns J, Jadoul M, Squifflet J, Wese F, van Ypersele de Strihou C. Urothelial lesions in Chinese-herb nephropathy. Am J Kidney Dis. 1999;33(6):1011-1017.
10. Mikhail A, Reidy JF, Taylor PR, Scoble JE. Renal artery embolization after back massage in a patient with aortic occlusion. Nephrol Dial Transplant. 1997;12(4):797-798.
11. Ernst E. Adulteration of Chinese herbal medicines with synthetic drugs: a systematic review. J Intern Med. 2002;252(2):107-113.
12. Gilani AH, Atta-ur-Rahman. Trends in ethnopharmacology. J Ethnopharmacol. 2005;100(1-2):43-49.
13. Williamson EM, Driver S, Baxter K. Stockley's herbal medicines interactions. London: Pharmaceutical Press; 2009.
14. Lewith GT, Broomfield J, Prescott P. Complementary cancer care in Southampton: a survey of staff and patients. Complement Ther Med. 2002;10(2):100-106.
15. Peng CC, Glassman PA, Trilli LE, Hayes-Hunter J, Good CB. Incidence and severity of potential drug-dietary supplement interactions in primary care patients: an exploratory study of 2 outpatient practices. Arch Intern Med. 2004;164(6):630-636.
16. Olisa NS, Oyelola FT. Evaluation of use of herbal medicines among ambulatory hypertensive patients attending a secondary health care facility in Nigeria. Int J Pharm Pract. 2009;17(2):101-105.
17. Shorofi SA, Arbon P. Complementary and alternative medicine (CAM) among hospitalised patients: an Australian study. Complement Ther Clin Pract. 2010;16(2):86-91.
18. Goldstein LH, Elias M, Ron-Avraham G, Biniaurishvili BZ, Madjar M, Kamargash I, Braunstein R, Berkovitch M, Golik A. Consumption of herbal remedies and dietary supplements amongst patients hospitalized in medical wards. Br J Clin Pharmacol. 2007;64(3):373-380.
19. Eng J. Sample size estimation: how many individuals should be studied? Radiol. 2003;227(2):309-313.
20. Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, Janecek E, Domecq C, Greenblatt DJ. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981;30(2):239-245.
21. The British Medical Association and the Royal Pharmaceutical Society. British national formulary no. 61. London: RPS; 2011. http://www.bnf.org (accessed on July 6, 2011).
22. World Health Organization. International classification of diseases v.10 (ICD-10). Geneva: WHO; 2011. http://www.who.int/classifications/icd/en (accessed on July 6, 2011).
23. Springhouse, editor. Medical pocket reference: drug-herb Interactions. New York: Lippincott Williams & Wilkins; 2002.
24. Izzo AA, Ernst E. Interactions between herbal medicines and prescribed drugs: a systematic review. Drugs. 2001;61(15):2163-2175.
25. Peng CC, Glassman PA, Trilli LE, Hates-Hunter J, Good CB. Incidence and severity of potential drug-dietary supplement interactions in primary care patients: an exploratory study of two outpatient practices. Arch Intern Med. 2004;164(6):630-636.
26. Taylor DM, Walsham N, Tayleo SE, Wong L. Potential interactions between prescription drugs and complementary and alternative medicines among patients in the Emergency Department. Pharmacotherapy. 2006;26(5):634-640.
27. Office for National Statistics. Statistical bulletin: population estimates by ethnic group 2002-2009. London: ONS; 2011.
28. Barraco D, Valencia G, Riba AL, Nareddy S, Draus CBSN, Schwartz SM. Complementary and alternative medicine (CAM) use patterns and disclosure to physicians in acute coronary syndromes patients. Complement Ther Med. 2005;13(1):34-40.
29. Liu C, Yang Y, Gange SJ, Weber K, Sharp GB, Wilson TE, Levine A, Robison E, Goparaju L, Gandhi M, Merenstein D. Disclosure of complementary and alternative medicine use to health care providers among HIV-Infected women. AIDS Patient Care STDS. 2009;23(11):965-971.
30. Cockayne NL, Duguid M, Shenfield GM. Health professionals rarely record history of complementary and alternative medicines. Br J Clin Pharmacol. 2005;59(2):254-258.
31. Murray J, Shepherd S. Alternative or additional medicine? An exploratory study in general practice. Soc Sci Med. 1993;37(8):983-988.
32. Barnes J. Pharmacovigilance of herbal medicines: A UK perspective. Drug Saf. 2003;26(12):829-851.
33. Davies DM, Ferner RE, de Glanville H. Davies’s textbook of adverse drug reactions. 5th ed. London: Chapman & Hall Medical; 1998.
34. Bailey DG, Malcolm J, Arnold O, David-Spence J. Grapefruit juice – drug interactions. Br J Clin Pharmacol. 1998;46(2):101-110.
35. Medicines and Healthcare products Regulatory Agency (MHRA). Yellow Card Scheme. London: MHRA; 2011. http://www.mhra.gov.uk/Safetyinformation/ Howwemonitorthesafetyofproducts/Medicines/TheYellowCardScheme/index.htm (accessed on July 6, 2011).
The authors hereby transfer, assign or otherwise convey to Pharmacy Practice (1) the right to grant permission to republish or reprint the stated material, in whole or in part, without a fee; (2) the right to print or epublish copies for free distribution or sale; and (3) the right to republish the stated material in any format (electronic or printed). In addition, the undersigned affirms that the article described above has not previously been published, in whole or part, is not subject to copyright or other rights except by the author(s), and has not been submitted for publication elsewhere, except as communicated in writing to Pharmacy Practice with this document.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC-BY-NC-ND) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Author Self-Archiving Policy
Pharmacy Practice permits and encourages authors to post and archive the final PDFs of their respective articles submitted to the journal on personal websites or institutional repositories after publication, while providing bibliographic details that credit its publication in this journal.