JAMA studies suggest need for increase monitoring of medications, supplements

CHICAGO — More older adults used multiple medications and dietary supplements, and taking them together put more people at increased risk for a major drug interaction, according to a new study published online Monday by JAMA Internal Medicine. Additional commentary included in the journal noted that consumers and physicians are not discussing their use of vitamins and supplements as often as they might and another writer supported formalizing one role pharmacy has assumed - monitoring medication use. 

 

Between 2006 and 2011, concurrent use of at least five prescription medications increased from 30.6% to 35.8% over the study period, reported Dima Qato of the University of Illinois at Chicago. And concurrent use of five or more medications or supplements of any type increased from 53.4% to 67.1%.

 

About 15.1% of older adults in 2010-2011 were at risk for a major drug interaction compared with an estimated 8.4% in 2005-2006. 

 

"These findings suggest that the unsafe use of multiple medications among older adults is a growing public health problem," Qato noted. "Therefore, health care professionals should carefully consider the adverse effects of commonly used prescription and nonprescription medication combinations when treating older adults and counsel patients about these risks." 

 

In that period, use of over-the-counter medications declined from 44.4% to 37.9% and use of dietary supplement use increased from 51.8% to 63.7%. Multivitamin or mineral supplements and calcium were the most commonly used supplements during the study period.

 

However, even as use of dietary supplements was on the rise, primary care physicians often don't initiate conversations with patients about their use of complementary and alternative medicine use and patients have had concerns about discussing CAM with their physicians for fear of disapproval. These communication barriers may prevent CAM from being integrated into patient treatment and self-care routines, Judy Juo and Pamela Jo Johnson, both of the University of Minnesota, explained in an accompanying commentary. They based that analysis on survey data for 7,493 adults. Of the adults, 3,094 (42.3%) did not disclose their most used form of CAM, according to the results reported in the research letter.

 

Nondisclosure was most common among adults who did yoga, tai chi or qi gong and among those who practiced meditation or mindfulness. Adults who used herbs or supplements and who had acupuncture disclosed the most, results show.

 

When adults did not disclose CAM to their physicians, it was most often due to physicians not asking about it or patients believing their physicians didn't need to know about their CAM use, according to the results.

 

"Contrary to earlier findings, our results attribute most nondisclosure to physicians not asking about CAM use or to concerns about physician knowledge regarding CAM rather than to physician discouragement or negativity about the use of CAM," Juo and Johnson noted. "Consequently, physicians should consider more actively inquiring about patients' use of CAM, especially for modalities likely to be medically relevant." 

 

“We urge consumers to speak with their doctors and other healthcare practitioners about everything they consume, including dietary supplements," advised Andrea Wong, VP scientific and regulatory affairs for the Council for Responsible Nutrition. "Our annual consumer survey on dietary supplements has repeatedly found the vast majority of supplement users agree that they let their physicians know about the supplements they are taking.  In our most recent survey, 91% of supplement users 55 years of age and older indicated they do so. The new research letter  from JAMA Internal Medicine indicates that, of the patients who use complementary and alternative medicine, 75% reported use of herbals or supplements to their doctor, the highest percentage of disclosure." 

 

"It is time to take the next leap forward. We need to create systems that support an ongoing process of monitoring medications," wrote Michael Steinman of the University of California, San Francisco, in a related commentary. "Such systems would help us periodically assess the benefits, harms and ongoing need for each of a patient's medications, as well as the reasonableness of the medication regimen as a whole. These systems could also help physicians with deprescribing, for example by supporting gradual down-titration of a medication and monitoring patients for adverse drug withdrawal reactions after a drug is stopped."