Evaluation of knowledge base of hospital pharmacists and physicians on herbal medicines in Southwestern Nigeria
The use of herbal medicines among Nigerian patients and the tendency to combine this class of medicines with allopathic drugs while on hospital admission have been on the increase. Earlier studies show that community pharmacists from Nigeria believe that they need more training to counsel patients on their use of herbal medications.
Objective: To evaluate knowledge base, use, acceptability, attitudes and beliefs of hospital pharmacists and physicians in South-western Nigeria on herbal products / phytopharmaceuticals /dietary supplements (HP/PP/DS).
Methods: A 20-odd questionnaire including an 8-item herbal medicine question was used to assess the knowledge of the physicians and pharmacists in the area of pharmacology of HP/PP/DS. Effects of demographic information such as age, sex, year post graduation, years of experience and area of specialization on the scores obtained were evaluated using Fisher’s exact tests. Level of significance was set at p<0.05.
Results: Pharmacists (51.4%) believed that the training they had was not adequate while physicians (44.6%) believed HP/PP/DS are not safe and 18.5% believed they are not effective. Pharmacovigilance centres were not significantly used for adverse reactions reported by patients. Pharmacists (67.6%) and physicians (29.3%) believed phytopharmaceuticals interact with other drugs. Year of graduation had a significant effect on the perception of the possibilities of interaction for pharmacists. 5.6% of the physicians and 62.4% of the pharmacists scored ≥50% with the questions on use and interaction potentials of HP/PP/DS, with cadre and years of practice having significant effects.
Conclusions: There is a deficiency in the knowledge base of physicians, especially on the pharmacology and potential interaction of herbal medicines. There is an urgent need for the inclusion of pharmacology of common herbal medicines in the curriculum of Nigerian medical degree and an improvement in the pharmacy curriculum in this area.
2. Howell L, Kochhar K, Saywell R Jr, Zollinger T, Koehler J, Mandzuk C, Sutton B, Sevilla-Martir J, Allen D. Use of herbal remedies by Hispanic patients: do they inform their physician? J Am Board Fam Med. 2006;19(6):566-578.
3. Koh HL, Teo HH, Ng HL. Pharmacists’ pattern of use, knowledge and attitudes toward complementary and alternative medicine. J Altern Complement Med. 2003;9(1):51-63 . doi 10.1089/107628003321536940.
4. Jörgensen TM, Andersson KA, Mårdby AC.. Beliefs about medicines among Swedish pharmacy employees. Pharm World Sci. 2006;28(4):233-238. doi 10.1007/s11096-005-2907-2.
5. Aziz Z. Herbal medicines: predictors of recommendation by physicians. J Clin Pharm Ther 2004;29(3):241-246. doi 10.1111/j.1365-2710.2004.00562x.
6. Clement YN, Williams AF, Khan K, Bernard T, Bhola S, Fortuné M, Medupe O, Nagee K, Seaforth CE. A gap between acceptance and knowledge of herbal remedies by physicians: the need for educational intervention. BMC Complement Altern Med. 2005 Nov 18;5:20 doi 10.1186/1472-6882-5-20.
7. Karadeniz C, Pinarli FG, Oğuz A, Gürsel T, Canter B.. Complementary alternative medicine use in a paediatric oncology unit in Turkey. Pediatr Blood Cancer 2007;48(5):540-543. doi 10.1002/pbc.21012.
8. Gardiner P, Woods C, Kemper KJ.. Dietary supplement use among health care professionals enrolled in an online urriculum on herbs and dietary supplements BMC Complement Altern Med. 2006;126:21. doi 10.1186/1472-6882-6-21.
9. Fakeye TO, Abu T, Adebisi O. A survey of of the use of herbs among patients attending secondary health care facilities in Southwestern Nigeria. J Herb Pharmacother (In press)
10. Suchard JR, Suchard MA, Steinfeldt JL.. Physician knowledge of herbal toxicities and adverse herb-drug interactions. Eur J Emerg Med. 2004;11(4):193-197.
11. Kemper KJ, Gardiner P, Gobble J, Woods C.. Expertise about herbs and dietary supplements among diverse health professionals BMC Complement Altern Med. 2006;6:15. doi 10.1186/1472-6882-6-15
12. Adisa R, Fakeye TO. Assessment of the knowledge of community pharmacists regarding common phytopharmaceuticals sold in south western Nigeria. Trop J Pharm Res. 2006; 5(2):619-625.
13. Janetzky K, Morreale AP.. Probable interaction between warfarin and ginseng. Am J Health Sys Pharm. 1997;54:692-693.
14. Matthews MK Jr.. Association of Ginkgo biloba with intracerebral hemorrhage. Neurology 1998; 50:1933-1934.
15. Johne A, Brockmöller J, Bauer S, Maurer A, Langheinrich M, Roots I.. Pharmacokinetic interaction of digoxin with an herbal extract from St. John wort (Hypericum perforatum). Clin Pharmacol Ther 1999;66:338-345. doi 10.1053/cp.1999.v66.a101944.
16. Ko R. Adverse reactions to watch for in patients using herbal remedies. Western Journal of Medicine 1999;171(3):181-186.
17. Fugh-Berman A, Ernst E. Herb-drug interaction: review and assessment of report reliability. Br J Clin Pharmacol. 2001;52:587-595. doi 10.1046/j.0306-5251/2001.01469.x.
18. Izzo AA, Ernst E. Interactions between herbal medicines and prescribed drugs: a systematic review. Drugs 2001;61:.2163-2175.
19. Chang ZG, Kennedy DT, Holdford DA, Small RE. Pharmacists’ knowledge and attitude towards herbal medicine. Ann. Pharmacother. 2000;34(6):710-715. doi10.1345/aph.19263