General practitioners’ role in safeguarding patients with dementia in their use of dietary supplements. A qualitative study

The use of dietary supplements (DS) may cause harm through direct and indirect effects. Patients with dementia may be particularly vulnerable. This study aims to explore general practitioners’ (GPs’) experiences with DS use by these patients, the GPs perceived responsibilities, obstacles in taking on this responsibility, their attitudes toward DS, and suggestions for improvements to safeguard the use of DS in this patient group. Qualitative individual interview study conducted February - December 2019. Data were analysed using systematic text condensation. Primary healthcare clinics in Norway. Fourteen Norwegian GPs. None of the informants were dismissive of patients using DS. They were aware of the possible direct risks and had observed them in patients. Most GPs showed little awareness of potential indirect risks to patients with dementia who use DS. They acknowledged the need for caretaking of these patients. Although there were differences in practice styles, most of the GPs wished to help their patients safeguarding DS use but found it difficult due to the lack of quality assurance of product information. Furthermore, there were no effective ways for the GPs to document DS use in the patients’ records. Several suggestions for improvement were given by the GPs, such as increased attention from GPs, inclusion of DS in the prescription software, and stricter regulatory systems for DS from the authorities. The GPs had initially little awareness of this safety risk, but there were differences in practice style and attitudes towards DS. The GPs did not perceive themselves as main responsible for safe use of DS in patient with dementia. The most important reason to disclaim responsibility was lack of information about the products. One suggestion for improvement was better integration of DS in patients’ medical record. Currently, little is known about general practitioners (GPs) caretaking of patients with dementia who use dietary supplements (DS). Our study showed that: The GPs in this study showed little awareness of the potential safety risk that DS use may represent for patients with dementia. Several obstacles in the treatment setting and in the regulation of DS make it difficult for the GPs to assume full responsibility for patients with dementia who use DS. Lack of evidence about DS safety and effect adds to professional uncertainty and may cause frustration or reluctance to address the issue.

膳食补充剂（dietary supplements, DS）的使用可能通过直接与间接途径引发健康损害，痴呆症患者或许尤其易受其影响。本研究旨在探索全科医生（general practitioners, GPs）针对此类患者使用膳食补充剂的相关经历、全科医生所认知的职责范畴、履行该职责时面临的障碍、其对膳食补充剂的态度，以及为保障该患者群体安全使用膳食补充剂的改进建议。本研究为2019年2月至12月开展的定性个人访谈研究，采用系统文本压缩法对采集的数据进行分析，调研地点为挪威基层医疗诊所，受访对象为14名挪威全科医生。

所有受访者均未否定患者使用膳食补充剂的行为，他们均知晓膳食补充剂可能带来的直接健康风险，并曾在患者身上观察到相关不良反应。多数全科医生对痴呆症患者使用膳食补充剂可能存在的间接健康风险认知不足。全科医生均认可需为该类患者提供膳食补充剂使用相关的照护服务。尽管诊疗风格存在个体差异，多数全科医生均希望协助患者安全使用膳食补充剂，但由于产品信息缺乏质量保障，此项工作开展困难；此外，全科医生缺乏有效的途径将患者的膳食补充剂使用情况记录至病历档案中。全科医生提出了多项改进建议，例如提升全科医生对该问题的关注度、将膳食补充剂纳入处方软件、由监管机构建立更为严格的膳食补充剂监管体系。

此前全科医生对该类安全风险认知不足，且其诊疗风格与对膳食补充剂的态度存在个体差异。全科医生并不认为自身需为痴呆症患者安全使用膳食补充剂承担主要责任，而推诿该职责的最主要原因是缺乏相关产品的信息。其中一项改进建议为将膳食补充剂相关信息更好地整合至患者病历系统中。

目前学界对全科医生为使用膳食补充剂的痴呆症患者提供照护的相关情况知之甚少。本研究结果显示：其一，本次调研的全科医生对膳食补充剂给痴呆症患者带来的潜在安全风险认知不足；其二，诊疗环境与膳食补充剂监管层面存在的多项障碍，使得全科医生难以全面承担起为使用膳食补充剂的痴呆症患者提供照护的职责；其三，膳食补充剂安全性与有效性相关循证证据的缺失，加剧了专业人员的职业不确定性，甚至可能引发其对该问题的抵触或倦怠情绪。