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3/4/2004

Undisclosed Use of Medications High Among Rural Women

Kate Traynor

Women frequently take prescription drugs, nonprescription medications, and herbal supplements but may not reveal the full extent of their medication use to their health care providers, according to a report in the Feb. 24 issue of the American Journal of Obstetrics and Gynecology.

In a study examining the medication habits of women in rural West Virginia, researchers—aided by pharmacy students on a clerkship rotation—that 92 percent of the women had used at least one prescription drug, and 97 percent reported taking a nonprescription medication during the past year. Fifty-nine percent of the 776 patient encounters involved women who had taken at least one herbal remedy in the preceding year.

Timothy S. Tracy, a professor at the University of Minnesota College of Pharmacy's Department of Experimental and Clinical Pharmacology and one of the report's authors, said that some of the substances taken by patients had the potential to interact, although looking for adverse events was not the focus of the study.

"We were mainly trying to find out what in the world our patients were taking," Tracy said.

Tracy was affiliated with the Robert C. Byrd Health Sciences Center of West Virginia University in Morgantown when the study took place.

According to the report, 2.3 percent of the study participants who used an oral contraceptive said they were also taking St. John's wort, an herbal remedy for depression that can decrease the contraceptive's effectiveness. In all, 7.6 percent of the study participants reported using St. John's wort, including four women who reported concurrent use of a prescription antidepressant and eight who took the herbal product along with a prescription central-nervous-system depressant.

All of the women involved in the study were nonpregnant patients of a single gynecologist. Study data were collected by pharmacy students who worked in the physician's clinics during one-month research clerkships. Students interviewed the patients in private after they had seen the physician, a process that Tracy said took about 20 minutes per patient.

Tracy said the students used a three-step process to obtain medication histories from the study participants. During the first step, he said, a student asked the patient to state which prescription, nonprescription, and herbal remedies she used.

Next, Tracy said, patients were to name medications they had taken to treat specific ailments, such as a headache or heartburn. Finally, the women were presented with a list of herbal products and asked if they had used any of them.

"At each step," Tracy said, "we got progressively more information" from the women.

The study also revealed that patients were reluctant to divulge the full extent of their medication and dietary supplement use to health care providers but were willing to open up to the students—particularly about self-treating with nonprescription and herbal products. In fact, Tracy said, patients often prefaced their disclosures with a request that the student not reveal the information to the physician.

"The student was not seen as an authority figure" but the physician was, Tracy explained. He added that the physician saw the study data in aggregate, not linked to individual patients.

Tracy speculated that, in addition to worries about the physician's reaction to self-treatment, patients may not regard nonprescription and herbal products as true medications or see the importance of mentioning use of these products to a physician.

Another factor that might affect disclosure, Tracy said, is that patients may "associate a medication with a physician."

"If this is my gynecologist, then I don't need to tell him about my blood-pressure medication" is the reasoning, he said.

Tracy said that recruiting pharmacy students to collect the medication data was both critical for the study's success and beneficial for the students.

"It's a great experience for the students," he said. "What they tell me was that there's always this apprehension about talking to patients. Rotations don't always have as much of that as you like."

By the time the month-long clerkship ends, Tracy said, a student will have completed "comprehensive interviews with probably 200 to 300 patients."

"Once you've done that, you have no trouble talking to patients, because you've been alone in a room [with them] for periods of time. And [students] find it to be invaluable in terms of communication. They say, you know, I've learned how to get more information-that I wasn't asking the question just right, and I figured out a way that got me better information" from the patient, he said.

About 42 pharmacy students participated in the clerkships, which Tracy described as "very popular" with the students. "There were more wanting to do it than we could handle," he said.