Complementary medicines in hospitals: a focus on surgical patients and safety

Braun, L 2006, Complementary medicines in hospitals: a focus on surgical patients and safety, Doctor of Philosophy (PhD), Health Sciences, RMIT University.

Document type: Thesis
Collection: Theses

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Title Complementary medicines in hospitals: a focus on surgical patients and safety
Author(s) Braun, L
Year 2006
Abstract Aim: This study aimed to determine how CMs used by surgical patients are managed in the hospital system by doctors and pharmacists and what patient and practitioner influences affect this management.

Research design and method: Five systematic reviews were conducted to investigate the peer-reviewed literature for information about Australians use of CM; overseas and Australian doctors and CM; surgical patients use of CM and safety information about CMs in surgery as a basis to design and conduct three surveys. Surveys of hospital doctors, pharmacists and surgical patients were used to obtain measurement of people's attitudes, perceptions, behaviours and usage of CMs. For healthcare practitioners, knowledge of complementary medicines (CMs), past training, current practice and interest in future practice of complementary therapies (CTs) and education was also investigated.

Results: Approximately 50% of surgical patients reported taking CMs in the 2 weeks prior to surgery and approximately 50% of these patients intended to continue use in hospital. The most commonly used CMs were: fish oil supplements, multivitamins, vitamin C and glucosamine supplements as well as some CMs considered to potentially increase bleeding risk or induce drug interactions. It was not uncommon for CMs to be used at the same time as prescription medicines.

Most surgical patients in general self-prescribe their CMs or have them recommended by family and friends whereas medical practitioners were the main prescribers to cardiac surgery patients. Nearly 60% of patients using CMs in the 2 weeks prior to admission did not tell hospital staff about use. The main reason for non-disclosure was not being asked about use whereas fear of a negative response was rarely a concern. The most common sources of information surgery patients refer to were GPs, pharmacists and health food stores. Hospital doctors and pharmacists did not routinely refer to information sources about CMs safety.

The majority of doctors and pharmacists did not routinely ask patients about CMs, or record usage information. They had little training and knowledge of the evidence of commonly used CMs and lacked confidence in dealing with CMs-related issues. Their attitude to CMs is moderately negative and many are wary of safety, efficacy and cost-effectiveness issues. The majority of practitioners considered some CTs as potentially useful, particularly acupuncture, massage and meditation whereas the medicinal CTs and chiropractic were considered potentially harmful. Most practitioners were interested in future education about CMs and CTs and some would consider practising CTs. Personal usage of CTs was low although there was substantial interest in receiving future treatment.

Conclusion: Despite many strategically orientated initiatives developed in Australia to promote evidence based medicine (EBM) and quality use of medicines (QUM), it appears that CMs have been largely ignored and overlooked in the practice of Medicine and Pharmacy within the hospital system. Furthermore, it appears that in regards to CMs a 'don't ask, don't tell, don't know' culture exists within hospitals and that evidence based patient-centred care and concordance is not being achieved and potentially patient safety and wellbeing is being compromised.
Degree Doctor of Philosophy (PhD)
Institution RMIT University
School, Department or Centre Health Sciences
Keyword(s) Alternative medicine - Australia
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