Chung Hsuen Wu

Patient disclosure about herb and supplement use among adults in the US

Analyses of 2002 National Health Interview supplement on complementary and alternative medicine (NHI%AM) indicate that approximately 38 million adults in the US (18.9% of the population) used natural herbs or supplements in the preceding 12 months, but only one-third told their physician about this use. The objectives of this study are: (i) to determine subpopulation rates of patient–physician communication about herbal product and natural supplement use and (ii) to identify the relative influence of patient factors and interaction factors associated with patient-physician communication about herb and supplement use. Logistic secondary analysis was done by using the complementary and alternative medicine supplement of the 2002 National Health Interview Survey. Subjects were a random stratified sample of US adults who used herbs in the past 12 months (n = 5 196) and self-reported rates of disclosure to physicians about herb and supplement use. Results show that disclosure rates were significantly lower for males, younger adults, racial and ethnic minorities and less intensive users of medical care. Across subpopulations, disclosure was the exception rather than the norm. Given the potential risks of delayed or inappropriate treatment and adverse drug reactions and interactions, physicians should be aware of herb and supplement use and counsel patients on the potential risks and benefits of these treatments.

Trend and Pattern of Herb and Supplement Use in the United States: Results from the 2002, 2007, and 2012 National Health Interview Surveys

Background. In 1990s, complementary and alternative medicine (CAM), including use of herbs and supplements, gained popularity in the United States. However, more recent surveys suggest that demand for herbs and supplements has stabilized. Objective. This study examined the prevalence, patterns, and changes in herb and supplement use among the US adults, using the 2002, 2007, and 2012 National Health Interview Surveys (NHIS). Methods. Weighted population estimates were derived from three complementary and alternative medicine supplements to the NHIS. Prevalence rates for herb and supplement use were compared, using Wald chi-square tests to measure changes between years. Results. An estimated 40.6 million US adults reported herb and supplement use in 2012. However, the rate of herb and supplement use dropped from 18.9% in 2002 to 17.9% in 2007 and 2012 (P < 0.05). This decline in use was more pronounced among women, racial or ethnic minorities, and adults with low incomes. Conclusion. Herb and supplements use remains common in the USA, but adult use rates are on the decline. It is still important for health care providers to ask patients about herb and supplement use.

The prevalence of herb and dietary supplement use among children and adolescents in the United States: Results from the 2007 National Health Interview Survey.

OBJECTIVE The purpose of this study is to examine the national prevalence of herb and dietary supplement usage among children and adolescents age 4-17 in the United States, and to identify population factors associated with usage. METHODS Weighted population estimates are derived from the 2007 National Health Interview Child Complementary and Alternative Medicine Supplement (sample n=9417). Wald chi-square tests are used to compare factors associated with herb and dietary supplement use. RESULTS An estimated 2.9 million children and adolescents used herbs or dietary supplements in 2007. Pediatric herb and supplement use was more common among adolescents and non-Hispanic whites, and positively associated with parental education and household income. Children with activity limitations due to chronic health conditions, long-term prescription use, or relatively heavy use of physician services were also more likely to use herbal supplements. Echinacea and fish oil were most commonly used herbs and supplements. CONCLUSIONS Children in the US appear to use herbs or dietary supplements at a much lower rate than adults. This analysis shows a pattern of moderate and appropriate herb and supplement use in the pediatric population.

National trends of psychotropic medication use among patients diagnosed with anxiety disorders: Results from Medical Expenditure Panel Survey 2004–2009

Data from the 2004 to 2009 Medical Expenditure Panel Survey (MEPS) were used to: (1) characterize changes in utilization and (2) identify factors associated with the use of psychotropic medication among patients with anxiety disorders. We calculated the prevalence, compared the use patterns for each year and drug class, and used logistic regression to identify the factors associated with psychotropic medication use. Patients ever using a psychotropic medication for anxiety grew from 57.4% in 2004 to 63.8% in 2009 (p<0.01). From 2004 to 2009, use of benzodiazepines (22.7-30.5%, p<0.01) and atypical antipsychotics (2.3-3.9%, p<0.01) increased. A high prevalence in the use of benzodiazepines (41.8% in 2004 to 48.8% in 2009) was observed among older adults. Older age, having insurance coverage, and poor health status were significantly associated with self-reported psychotropic medication use. An increase of psychotropic medication use from 2004 to 2009 was observed. A high prevalence and increasing trend in the use of benzodiazepines may warrant further attention given safety concerns in older adults.

Patient characteristics associated with the use of antidepressants among people diagnosed with DSM-IV mood disorders: results from the National Comorbidity Survey Replication.

ABSTRACT Background: Depression is one of the most common mental illnesses in the United States. However, research on antidepressant usage patterns in a large nationally representative sample is limited. Objectives: The aims of this study were (1) to examine factors associated with the use of antidepressants in patients with DSM-IV mood disorders, and (2) to determine reasons for inadequate and non-persistent medication taking behaviors. Research design and methods: A cross-sectional study was conducted using the National Comorbidity Survey Replication (NCS-R) dataset in the U.S. People within the dataset with DSM-IV mood disorders were qualified as the sample population (n = 1798). Selected factors based on the Andersens Behavioral Model of Health Services Use were assessed among antidepressant users (n = 473) and nonusers (n = 1322). The logistic regression analysis was used to examine the association between the dependent variable, the use of antidepressants, and the independent variables, predisposing, enabling and need factors. Descriptive statistics were used to determine reasons of inadequate and non-persistent medication taking behaviors. Results: Antidepressant use was more prevalent in patients who were middle age (30–59) (p < 0.01), non-Hispanic white (p < 0.001), unemployed (p < 0.001), living in the South (p < 0.01), having a regular source of care (p < 0.001), and having high severity of emotional distress (p < 0.001). About 41% of patients reported that they forgot to take or took less medication in the study period. Reasons for stopping medication included: “The medication was not helping” (30.8%), followed by “Side effects” (13.8%) and “Couldn’t afford to pay for the medicine” (13.0%). Limitations: A small sample size in racial/ethnic minority groups; a small sample size in the reasons of stopping taking medications due to the missing values in consecutive questions. Conclusions: The factors associated with use of antidepressants and reasons of inadequate and non-persistent medication taking behaviors in patients with mood disorders are many and varied. Health care providers need to understand these factors as they work with their patients to improve the likelihood of patients’ successfully to complete their course of treatment.

THE ASSOCIATION BETWEEN ANTIDEPRESSANT DOSAGE TITRATION AND MEDICATION ADHERENCE AMONG PATIENTS WITH DEPRESSION

To evaluate the association between upward dose titration of antidepressants and medication adherence during the first 6 months of a newly initiated antidepressant treatment for patients with major depressive disorder (MDD).

The association between regular use of aspirin and the prevalence of prostate cancer: Results from the National Health Interview Survey.

AbstractProstate cancer is prevalent with significant morbidity in the United States. Aspirin previously has been found to be associated with reduced carcinogenesis of prostate cells. However, it remains unclear whether regularly taking aspirin could lower the risk of prostate cancer. Therefore, our aim was to examine the association between self-reported regular use of aspirin and the prevalence of prostate cancer in a national sample of the US adult population.The National Health Interview Survey is an annual survey conducted by the National Center for Health Statistics to investigate health and healthcare use of the US population. The current study is a population-based cross-sectional study using the 2010 National Health Interview Survey data. Adult male respondents who self-reported regularly taking aspirin at least 3 times per week were grouped as regular users. The prostate cancer prevalence was measured by respondents’ self-report of prostate cancer. Multivariable logistic regression models were used to evaluate the association between these 2 factors by adjusting for covariates selected based on Andersen Behavioral Model of Health Services Use.An estimated 23 million (23.7%) males in the United States reported that they took aspirin regularly. Of them, 5.0% had prostate cancer. Regular aspirin use was significantly associated with a lower self-reported prevalence of prostate cancer after adjusting for predisposing, enabling, and need factors (odds ratio 0.60, 95% confidence interval 0.38–0.94).Regular aspirin use was found to be significantly associated with a lower self-reported prevalence of prostate cancer in the United States in 2010. Further clinical trials and longitudinal studies are needed to confirm the causality between regular aspirin use and prostate cancer.

Patterns of Pharmacological Treatment for Osteoporosis Among Patients Qualified for Pharmacotherapy According to the National Osteoporosis Foundation Guidelines

Background: Whereas the National Osteoporosis Foundation (NOF) guidelines suggest pharmacological treatment for patients at high risk of fractures, little is known about the prevalence of osteoporosis treatment among those who met the NOF criteria for pharmacotherapy. Objective: To evaluate the prevalence of osteoporosis treatment among patients who met the NOF criteria and to assess factors associated with pharmacological treatment. Methods: The 2005-2010 National Health and Nutrition Examination Survey served as the data source. Using the Fracture Risk Assessment Tool, the study included postmenopausal women and men 50 years or older who met the NOF treatment criteria. Andersen’s Behavioral Model was used to select predisposing, enabling, and need factors that might predict osteoporosis treatment. A logistic regression was used to assess factors associated with osteoporosis treatment. Results: An estimated 16 million individuals qualified for osteoporosis treatment according to the NOF guidelines. Only 24% of them received pharmacological treatment, and 89% of the patients receiving treatment were women. Only 6% to 12% of men who were at high risk of osteoporosis or fracture received pharmacotherapy. Older age, long-term corticosteroid use, history of fractures, and T-score ≤−2.5 were associated with increased odds of osteoporosis treatment, whereas male gender and lack of a usual source of health care were associated with decreased odds of osteoporosis treatment. Conclusions: Less than one-fourth of the population who should be considered for pharmacotherapy received osteoporosis treatment. Clinicians should be more aware of the unmet need for medication treatment for osteoporosis.

The Association Between Long-Term Bisphosphonate Use and the Risk of Fracture Among Women Aged 50 or Older with Osteoporosis

BACKGROUND Osteoporosis is a prevalent disease, and bisphosphonates can effectively reduce the risk of osteoporotic fractures. However, the association between the length of the medication treatment and the risk of fractures remains unclear. The purpose of this study was to evaluate the association between long-term bisphosphonate use (treatment duration ≥5 years) and the risk of fractures among women with osteoporosis aged 50 or older. MATERIALS AND METHODS We conducted a retrospective cohort study by using the 2001-2011 National Health Insurance Research Database in Taiwan. We included women who were 50 years or older, who had a diagnosis of osteoporosis, and who were newly initiating oral bisphosphonates between January 1, 2002 and December 31, 2003. The index date was the date of the first dispensing of oral bisphosphonate during the enrollment period. Women were considered to be using bisphosphonates until they had a gap in supply of more than 3 months. We classified bisphosphonate use as long term (≥5 years) and regular (<5 years) based on its length of use. The dependent variable was the time to the first observed clinical fracture. Cox-proportional hazard regression models were used to evaluate the association between long-term bisphosphonate use and the risk of fractures. RESULTS The study included 1342 women with a mean age of 71 years. Of them, 83 (6.2%) were long-term bisphosphonate users. A total of 185 (13.8%) had a fracture. After adjustments, long-term bisphosphonate use was not associated with a lower risk of fractures than was regular bisphosphonate use (adjusted hazard ratio: 1.49, 95% CI: 0.91-2.45). CONCLUSION This study found no evidence of a lower risk of fractures to be associated with long-term bisphosphonate use among women aged 50 or older with osteoporosis in Taiwan. Orthopedists as well as other healthcare providers should be aware of the limited benefits of long-term bisphosphonate use.