U.S. and Canadian pharmacists' attitudes, knowledge, and professional practice behaviors toward dietary supplements: a systematic review

BACKGROUND: Although dietary supplements (DS) are widely sold in pharmacies, the legal, ethical, and practice responsibilities of pharmacists with respect to these products have not been well defined. This systematic review of pharmacists' attitudes, knowledge, and professional practice behaviours toward DS is intended to inform pharmacy regulators' and educators' decision making around this topic. METHODS: Eligible studies were identified through a systematic database search for all available years through to March 2006. Articles were analyzed for this review if they included survey data on U.S. or Canadian pharmacists' attitudes, knowledge, or professional practice behaviors toward DS published in 1990 or later. RESULTS: Due to the heterogeneity of the data, it was not possible to draw a conclusion with respect to pharmacists' general attitudes toward DS. Approximately equal numbers of pharmacists report positive as well as negative attitudes about the safety and efficacy of DS. There is strong agreement among pharmacists for the need to have additional training on DS, increased regulation of DS, and quality information on DS. In addition, survey data indicate that pharmacists do not perceive their knowledge of DS to be adequate and that pharmacists do not routinely document, monitor, or inquire about patients' use of DS. Despite this, a large proportion of pharmacists reported receiving questions about DS from patients and other health care practitioners. CONCLUSION: Further research is needed to explore the factors that influence pharmacists' beliefs and attitudes about DS, to accurately evaluate pharmacists' knowledge of DS, and to uncover the reasons why pharmacists do not routinely document, monitor, or inquire about patients' use of DS

Popular Healing and Primary Health Care: A Socio-Cultural Study in Rural North-Eastern Ethiopia

Introduction: Studies have shown that popular healing practices at home could play a major role in solving the problem of overcrowding in primary care services. This study explored the indigenous popular healing practices used by communities in North Eastern Ethiopia.Methodology: A qualitative ethnographic method was used for this study. Using Kleinman’s Cultural Systems Model, we conducted participatory observation (5 months during the span of one year) supplemented by ten focus group discussions (n=96) and 20 key informant interviews with purposefully selected knowledgeable community members. The focus group and key informant interviews included questions about the popular healing as a health care option and popular modes of healing practices. The process of analysis and interpretation was informed by thematically and the analysis of narratives strategies.Findings: The study found that home remedies are applied for both prevention and remedial purposes. Common ailments that are managed at home include Nedad (malaria) and Mich (acute febrile illness). Home remedies are prepared in the household by the patient, his/her parent or a family member. However, in cases where home remedies and/or home-based treatment did not cure a patient, other alternatives are looked for such as visiting a bio-medical care facility following a similar model developed by Kleinman in early 1980’s.Conclusion: Since people in the study communities believe that popular healing is a health care option among multiple health-care resources, successful rural primary health care strategy would give due attention to such local resources. This will help to ensure the optimal utilization of Ethiopia’s limited resources. ]Key Words: Popular healing, home remedies, ailments, primary health care, Ethiopi

Parental views on pediatric vaccination: the impact of competing advocacy coalitions

The debate on pediatric vaccination policy has been characterized by the presence of two distinct coalitions: those in favor of current vaccination policies and those expressing concern about these policies. The target of these coalitions is the vaccination decision of parents. To determine their influence, we conducted four focus groups in Toronto, Canada examining parental decision-making concerning pediatric vaccination. Our focus groups consisted of both fathers and mothers and parents who fully vaccinated and those who did not. Using the Advocacy Coalition Framework as an analytic guide, we identified several themes that provided insights into how effective the two coalitions have been in conveying their viewpoints. In general, we identified a variety of levels of belief systems existing amongst parents concerned about vaccination, some more amenable to change than others. We found that the choice to not vaccinate was largely a result of concerns about safety and, to a lesser extent, about lack of effectiveness. These parental views reflected the ability of the coalition concerned about vaccination to challenge parents' trust in traditional public health sources of information. In contrast, the parental decision to vaccinate was due to recognizing the importance of preventing disease and also a consequence of not questioning recommendations from public health and physicians and feeling pressured to because of school policies. Importantly, parents who fully vaccinate appear to have weaker belief systems that are potentially susceptible to change. While current policies appear to be effective in encouraging vaccination, if trust in public health falters, many who currently support vaccination may reevaluate their position. More research needs to be conducted to identify approaches to communicate the risks and benefits of vaccination to parents

Understanding the role of scientific evidence in consumer evaluation of natural health products for osteoarthritis an application of the means end chain approach

BACKGROUND: Over 30% of individuals use natural health products (NHPs) for osteoarthritis-related pain. The Deficit Model for the Public Understanding of Science suggests that if individuals are given more information (especially about scientific evidence) they will make better health-related decisions. In contrast, the Contextual Model argues that scientific evidence is one of many factors that explain how consumers make health-related decisions. The primary objective was to investigate how the level of scientific evidence supporting the efficacy of NHPs impacts consumer decision-making in the self-selection of NHPs by individuals with osteoarthritis. METHODS: The means-end chain approach to product evaluation was used to compare laddering interviews with two groups of community-dwelling Canadian seniors who had used NHPs to treat their osteoarthritis. Group 1 (n=13) had used only NHPs (glucosamine and/or chondroitin) with “high” scientific evidence of efficacy. Group 2 (n=12) had used NHPs (methylsulfonylmethane (MSM) and/or bromelain) with little or no scientific evidence supporting efficacy. Content analysis and generation of hierarchical value maps facilitated the identification of similarities and differences between the two groups. RESULTS: The dominant decision-making chains for participants in the two scientific evidence categories were similar. Scientific evidence was an important decision-making factor but not as important as the advice from health care providers, friends and family. Most participants learned about scientific evidence via indirect sources from health care providers and the media. CONCLUSIONS: The Contextual Model of the public understanding of science helps to explain why our participants believed scientific evidence is not the most important factor in their decision to use NHPs to help manage their osteoarthritis

Use of medicinal plants among Ethiopian patients with diabetes: A qualitative exploration

Background: Most studies on the use of medicinal plants reported from Africa (including Ethiopia) have focused on the clinical actions of medicinal plants with little attention given to patient experiences in using these plants and factors impacting patients’ decisions about using them.Objectives: The main objective of this study is to explore the experiences of patients with diabetes attending treatment in the biomedical setting regarding their use of medicinal plants.Methods: Qualitative interviews were held with 39 purposively selected participants attending their treatment in 3 public hospitals in urban centers of central Ethiopia. Interviews continued until key themes were saturated.Results: Medicinal plants were used alongside prescribed medicines with a range of factors impacting study participants decisions to trying out and continuing to use medicinal plants and also in recommending against their use or discontinuing them. Some of the main factors that encouraged use of medicinal plants include perceptions that bitter things were thought to be good for diabetes, their claimed and experienced benefits as well as the influence of others and the media while those that discouraged the use of medicinal plants primarily include safety concerns in relation to using the plants.Conclusions: The findings highlight the use of medicinal plants by patients with diabetes in the context of limited information. This is suggestive of the need for the healthcare practitioners in the conventional healthcare system to give more attention to patients’ interest in medicinal plants and for providing more evidence-based information about the plants used by these patients so as to improve health outcomes. Key words: medicinal plants, type 2 diabetes, Ethiopia, qualitative researc

The Canadian Natural Health Products (NHP) Regulations: Industry Compliance Motivations

This qualitative study explores corporations' motivations to comply with new natural health products (NHP) Regulations in Canada. Interviews were conducted with representatives from 20 Canadian NHP companies. Findings show that the rationale for compliance differs for large compared to small and medium-sized enterprises (SMEs). Large firms are motivated to comply with the regulations because of the deterrent fear of negative media coverage, social motivations, ability to comply and maintaining a competitive market advantage. In contrast, SMEs are motivated to comply due to the deterrent fear of legal prosecution and a sense of duty

Complementary and alternative medicine in psychotic disorders

The use of complementary and alternative medicine (CAM), including alternative therapies (ALT) and natural health products (NHP) such as vitamin and herbal supplements, is increasingly accepted in both the general population as well as in patients with mood and anxiety disorders. The level of acceptance and use of CAM, however, is unknown among patients being treated for psychotic disorders. Psychotic patients were surveyed about their use of and attitudes toward CAM. Questions included basic demographic and socio-economic items as well as the lifetime and 12-month use of CAM. Data were collected from June to October 2005. A sample of 172 participants representing 8.4% of the total eligible population of the outpatient clinics within the Schizophrenia Program at the Centre for Addiction and Mental Health in Toronto Canada completed the survey. Considering all forms of CAM, the lifetime and 12-month prevalence rate were 88% and 68%, respectively. The use and perceived safety of CAM by this population is similar to that reported by the general population. Clinical and public health implications of these findings are discussed.peer-reviewe

Trial of Essiac to Ascertain Its Effect in Women with Breast Cancer (TEA-BC)

Background: Breast cancer is a major cause of morbidity, mortality, and medical expenditures among women in Canada. Essiac (Resperin™ Canada Limited, Waterloo, Ontario, Canada), a blend of at least four herbs (burdock root [Arctium lappa], Indian rhubarb [Rheum palmatum], sheep sorrel [Rumex acetosella], and the inner bark of slippery elm [Ulmus fulva or U. rubra]), has become one of the more popular herbal remedies for breast-cancer treatment, secondary prevention, improving quality of life, and controlling negative side-effects of conventional breast-cancer treatment. Objectives: Our primary objective was to determine the difference in health-related quality of life (HR-QOL), as assessed by the Functional Assessment of Cancer Therapy Breast Cancer Version, between women who are new Essiac users (since breast cancer diagnosis) and those who have never used Essiac. Secondary endpoints included differences in depression, anxiety, fatigue, rate of adverse events, and prevalence of complications or benefits associated with Essiac during standard breast-cancer treatment. Additionally, we described the pattern of use of Essiac in this cohort of women. Methods: We performed a retrospective cohort study in 510 women, randomly chosen from the Ontario Cancer Tumour Registry, with a diagnosis of primary breast cancer in 2003. Results: With the exception changes in a Physical well-being subscale and a relationship with doctor subscale, Essiac did not have a significant effect on HR-QOL or mood states. Even for Physical well-being and relationship with doctor, Essiac seemed to have a negative effect, with Essiac users doing worse than the non-Essiac users. This might be attributed to the fact that the group of users comprised younger women with more advanced stages of breast cancer, and both of these subgroups of patients have been shown to be at a significantly increased risk for negative mood states and/or a decreased sense of well-being. The women were taking low doses (total daily dose 43.6 ± 30.8 mL) of Essiac that corresponded to the label directions found on most Essiac products. Friends were the most common source of information, and most women were taking Essiac to boost their immune systems or increase their chances of survival. Only 2 women reported minor adverse events, whereas numerous women reported beneficial effects of Essiac. Conclusions: Essiac does not appear to improve HR-QOL or mood states. Future studies are needed to determine whether other clinical outcomes, such as cancer reoccurrence, are affected by Essiac.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63199/1/acm.2006.12.971.pd

Practitioners' validation of framework of team-oriented practice models in integrative health care: a mixed methods study

<p>Abstract</p> <p>Background</p> <p>Biomedical and Complementary and Alternative Medicine (CAM) academic and clinical communities have yet to arrive at a common understanding of what Integrative healthcare (IHC) is and how it is practiced. The Models of Team Health Care Practice (MTHP) framework is a conceptual representation of seven possible practice models of health care within which teams of practitioners could elect to practice IHC, from an organizational perspective. The models range from parallel practice at one end to integrative practice at the other end. Models differ theoretically, based on a series of hypotheses. To date, this framework has not been empirically validated. This paper aims to test nine hypotheses in an attempt to validate the MTHP framework.</p> <p>Methods</p> <p>Secondary analysis of two studies carried out by the same research team was conducted, using a mixed methods approach. Data were collected from both biomedical and CAM practitioners working in Canadian IHC clinics. The secondary analysis is based on 21 participants in the qualitative study and 87 in the quantitative study.</p> <p>Results</p> <p>We identified three groups among the initial seven models in the MTHP framework. Differences between practitioners working in different practice models were found chiefly between those who thought that their clinics represented an integrative model, versus those who perceived their clinics to represent a parallel or consultative model. Of the scales used in the analysis, only the process of information sharing varied significantly across all three groups of models.</p> <p>Conclusions</p> <p>The MTHP framework should be used with caution to guide the evaluation of the impact of team-oriented practice models on both subjective and objective outcomes of IHC. Groups of models may be more useful, because clinics may not "fit" under a single model when more than one model of collaboration occurs at a single site. The addition of a hypothesis regarding power relationships between practitioners should be considered. Further validation is required so that integrative practice models are well described with appropriate terminology, thus facilitating the work of health care practitioners, managers, policy makers and researchers.</p