Friday, 7 September 2018

Family medicine physicians' perception and attitudes of herbal substances use in greater Lisbon region.

Phytomedicine. 2018 Aug 1;47:1-11. doi: 10.1016/j.phymed.2018.04.040. Epub 2018 Apr 17. Pereira da Silva A1, Geraldes M2, Díaz-Lanza AM3, Kovacs I4, Costa MC5. Author information 1 Health Care Unit Alameda, Ministry of Health, Lisbon, Portugal. Electronic address: 2 CBIOS - Research Center for Biosciences & Health Technologies, Lisbon, Portugal. 3 Biomedical Sciences Department, Faculty of Pharmacy, University Alcala, Alcala de Henares, Madrid, Spain; Research Center in Economic and Organizational Sociology, Lisbon School of Economics & Management, University of Lisbon, Portugal. 4 Research Center in Economic and Organizational Sociology, Lisbon School of Economics & Management, University of Lisbon, Portugal. 5 CBIOS - Research Center for Biosciences & Health Technologies, Lisbon, Portugal; NICiTeS - Nucleus of Research in Health Sciences and Technologies, ERISA - Escola Superior de Saúde Ribeiro Sanches, Lisbon, Portugal; R&D unit, Mass Spectrometry Laboratory, Faculty of Sciences, University of Lisbon, Portugal. Abstract BACKGROUND: Previous works showed patients preference for herbal substances (HS) although they also highlighted a discrepancy with physicians' adherence to HS and its recommendation. HYPOTHESIS/PURPOSE: This study aimed to assess physician's perception and attitudes concerning the use of HS for their patients in a Family Medicine approach. STUDY DESIGN: Observational cross-sectional exploratory study. METHODS: A questionnaire survey was applied to National Health System physicians; 113 questionnaires were distributed in the Greater Lisbon region. RESULTS: 80 valid questionnaires were received. The age of participants ranges from 29 to 64 with mean age of M ± SD:51.9 ± 10.0 years, mostly women (71.4%). Of these, 61.5% were unaware of traditional herbal medicinal products' (THMP) legal recognition and 67.3% of the difference between THMP and well-established use medicines. Absence of accordance between use and knowledge of herbal medicines (HM)/herbal products (HP) (p = 0.025) can be related to lack of Phytotherapy knowledge perception based on the nonexistence of specific training reported by 94.0% of physicians. Through factor analysis, three dimensions were obtained: Factor1, ``Use''; Factor2, ``Autonomy''; Factor3 ``Effort''. The overall Cronbach's α was 0.77, and 0.82 for Factor1. The evidence of use/prescription, has a correlation with ``Use'' (p < 0.0001), willingness to prescribe (p < 0.0001) and self-medication (p < 0.0001). There is a correlation (r = 0.605, p < 0.0001) between HS recommendation and self-medication. There were differences in use, perception and attitudes among Personalized-Health-Care Units and Family-Health Units physicians in relation to Factor1: p = 0.007 and Factor2: p = 0.021, age (p = 0.001), years of Medical career (p = 0.002), HM use (p = 0.014) and information about alternatives (p = 0.03). Physicians who answered correctly to the question on silymarin had higher scores in factor1 than those who did not: 1.76 vs. 1.25 (p = 0.019). CONCLUSION: Low adherence to HS and little use of HM/HP were confirmed, highlighting the need for specific knowledge in Phytotherapy and its regulatory framework. This knowledge will enable the evaluation of herb-drug interactions and HM/HP adverse effects by the physicians thus justifying the integration of programmatic contents about HS in Medical Education. Copyright © 2018. Published by Elsevier GmbH. KEYWORDS: Family medicine; Medical education; Phytomedicine; Phytotherapy; Traditional herbal medicines PMID: 30166093 DOI: 10.1016/j.phymed.2018.04.040