Consumers of natural health products: natural-born pharmacovigilantes?

<p>Abstract</p> <p>Background</p> <p>Natural health products (NHPs), such as herbal medicines and vitamins, are widely available over-the-counter and are often purchased by consumers without advice from a healthcare provider. This study examined how consumers respond when they believe they have experienced NHP-related adverse drug reactions (ADRs) in order to determine how to improve current safety monitoring strategies.</p> <p>Methods</p> <p>Qualitative semi-structured interviews were conducted with twelve consumers who had experienced a self-identified NHP-related ADR. Key emergent themes were identified and coded using content analysis techniques.</p> <p>Results</p> <p>Consumers were generally not comfortable enough with their conventional health care providers to discuss their NHP-related ADRs. Consumers reported being more comfortable discussing NHP-related ADRs with personnel from health food stores, friends or family with whom they had developed trusted relationships. No one reported their suspected ADR to Health Canada and most did not know this was possible.</p> <p>Conclusion</p> <p>Consumers generally did not report their suspected NHP-related ADRs to healthcare providers or to Health Canada. Passive reporting systems for collecting information on NHP-related ADRs cannot be effective if consumers who experience NHP-related ADRs do not report their experiences. Healthcare providers, health food store personnel, manufacturers and other stakeholders also need to take responsibility for reporting ADRs in order to improve current pharmacovigilance of NHPs.</p

Parents' Experiences Discussing Pediatric Vaccination with Healthcare Providers: A Survey of Canadian Naturopathic Patients

Parents who choose to selectively vaccinate or avoid vaccination for their children may do so at risk of compromising relations with their family physician or pediatrician. Groups that are associated with reduced rates of pedicatic vaccination, such as parents who access naturopathic care, may be particularly vulnerable to this issue.In March through September 2010, we administered a 26-item cross-sectional survey to 129 adult patients, all of whom were parents with children ≤ 16 years of age, presenting for naturopathic care in Ontario, Canada. Ninety-five parents completed the survey (response rate 74%), and only 50.5% (48 of 95) reported that their children had received all recommended vaccines. Most parents (50.5%; 48 of 95) reported feeling pressure to vaccinate from their allopathic physician and, of those who discussed vaccination with their physician, 25.9% (21 of 81) were less comfortable continuing care as a result. Five percent (4 of 81) of respondents were advised by their physician that their children would be refused care if they decided against vaccination. In our adjusted generalized linear model, feeling pressure to vaccinate (odds ratio [OR] = 3.07; 95% confidence interval [CI] = 1.14 to 8.26) or endorsing a naturopathic physician as their most trusted source of information regarding vaccination (OR = 3.57; 95% CI = 1.22 to 10.44) were associated with greater odds of having a partially vaccinated or unvaccinated child. The majority (69.6%; 32 of 46) of parent's with partially vaccinated or unvaccinated children reported a willingness to re-consider this decision.Use of naturopathic care should be explored among parents in order to identify this high-risk group and engage them in discussion regarding pediatric vaccination to encourage evidence-based, shared decision making. Physicians should ensure that discussions regarding vaccination are respectful, even if parents are determined not to vaccinate their children

Reporting Adverse Drug Reactions Associated with Herbal Products: Consumer, Health Food Store Personnel and Pharmacist Perspectives

Natural health products (NHPs) are sold over-the-counter and are often perceived to be safe, despite potential risks. The current Canadian reporting system collects information on suspected adverse drug reactions (ADRs) and suffers from severe under-reporting. As retailers, pharmacists and health food store personnel may be in a position to facilitate collection of herbal ADR reports because of their accessibility to consumers. Objective: To investigate retailer and consumer responses to herbal ADRs. Methods: In-depth interviews were conducted with retailers and consumers across Toronto until theoretical saturation was achieved (n=36). Participants were purposefully selected to ensure diverse backgrounds and experiences. Interviews were transcribed and coded for key emerging themes. Results: Consumers tended to self-prescribe NHPs and were only likely to discuss their NHP use with people they trusted – usually health food store personnel, family and friends. Many consumers did not have good relationships with their conventional health providers, which inhibited discussions about NHP-related ADRs. When consumers did disclose suspected ADRs to retailers, the retailers generally did not report these NHP-related ADRs to Health Canada. Most pharmacists found workplace challenges insurmountable, although pharmacist approaches to herbal ADRs tended to vary depending on their professional disposition. Pharmacists who saw themselves as knowledge generators were more likely to report. Health food store personnel offered generous product return policies and actively returned NHPs suspected of causing an ADR to the manufacturer. However, they had no knowledge of the Canadian ADR reporting system and thus did not submit any reports. Conclusion: Consumers tended to disclose suspected NHP-related ADRs only rarely and to retailers with whom they had developed previous good relationships. This highlights the importance of improving patient-practitioner (or retailer) communication. Pharmacists generally did not report ADRs due to workplace challenges, unless they had a very strong professional disposition. These results have important implications with respect to pharmacy education. Health food store return policies resulted in suspected ADR reports to the manufacturers. Manufacturers are mandated to report ADRs to Health Canada, so this finding may have important implications within industry for the future of ADR reporting systems involving herbal products and public health.Ph

The role of natural health products (NHPs) in dietetic practice: results from a survey of Canadian dietitians

Abstract Background Registered dietitians (RDs) play a key role in disseminating information about nutrition and intervening in nutrition-related disorders in the Canadian context. Natural health products (NHPs) are increasingly associated with nutrition in patient and health professional discussions. For this study, NHPs were divided into three categories: nutritional supplements (NS); functional foods/nutraceuticals (FF/N); and herbal preparations (HP). The objective was to explore RDs’ perceptions about their professional roles and responsibilities with respect to three categories of natural health products (NHPs). Methods This research consisted of an on-line survey of registered dietitians (RDs) in Ontario. Surveys were distributed electronically to all practicing RDs in Ontario by the College of Dietitians of Ontario. There were 558 survey respondents, a response rate of 20%. Results The vast majority of RDs reported being consulted by clients about all product categories (98% for NS; 94% for FF/N; 91% for HP), with RDs receiving the most frequent questions about NS and the least frequent about HP. 74% of RDs believed that NS are included within the current scope of practice, compared to 59% for FF/N and 14% for HP. Even higher numbers believed that these products should be included: 97% for NS, 91% for FF/N and 47% for HP. RDs who report personally ingesting FF/N and HP were significantly more likely to report that these products should be in the dietetic scope of practice. In contrast, RDs who provide one-on-one counselling services or group-level counselling/workshops were significantly less likely to believe HP should be in the dietetic scope of practice. Conclusions Opinions of RDs indicated that NS and FF/N (and possibly HP) fall within, or should fall within, RDs’ scope of practice. Opportunity exists for RDs to undertake a professional role with respect to NHPs. Policy clarification regarding RD roles is needed

Discussion of Vaccination with a Family Physician or Pediatrician (n = 81).

<p>Discussion of Vaccination with a Family Physician or Pediatrician (n = 81).</p

Characteristics of Survey Respondents (n = 95).

<p>Key: SD = standard deviation.</p><p>* = respondents could endorse more than 1 option.</p>‡<p> = respondents are limited to those parents that reported having felt pressure to vaccinate their children (n = 57).</p

Variables Associated with Naturopathic Patients having a Partially Vaccinated or Unvaccinated Child.

<p>OR = Odds Ratio.</p><p>95% CI = 95% Confidence Interval.</p

Discussion of Vaccination with a Naturopathic Physician (n = 45).

<p>Discussion of Vaccination with a Naturopathic Physician (n = 45).</p