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Complementary and integrative health has been divided into 5 subcategories, including alternative whole medical systems and mind-body interventions.
Complementary and alternative medicine, also referred to as complementary and integrative health (CIH), is used widely around the world as well in the United States. CIH has been defined as “a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine” by the National Institutes of Health. The National Center for Complementary and Integrative Health (NCCIH) goes on to divide CIH into 5 subcategories: alternative whole medical systems, mind-body interventions, biologically based therapies, manipulative and body-based methods, and energy therapies.1
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Results from a survey conducted by the NCCIH identified natural products as the most frequently consumed subgroup of CIH in 2012, with 17.7% of adults and 4.9% of children using these therapies, highlighting the use of CIH across diverse age groups.2 According to data from the National Health and Nutrition Examination Survey, approximately 57.6% of individuals 20 years or older reported the use of at least 1 dietary supplement or complementary and alternative medication in the past 30 days. Although many young people and children use CIH treatments and products, a substantial 74.3% of adults older than 60 years report the use of 1 or more dietary supplements.3 Notably, there has been a discernible shift in the trends of complementary and alternative medications and supplement use over time, with the most recent data from 2017 to 2018 revealing an uptick compared with statistics from 2007 to 2008, emphasizing the growing popularity of alternative medicines and the multifaceted nature of approaches adopted by individuals to enhance their well-being.3
The COVID-19 pandemic caused cataclysmic shifts in the delivery of health care and presented numerous challenges to conventional medicine across all aspects. As health systems became exhausted and patient’s access to health care was limited by social restrictions, logistic barriers, and the sheer demand of high-acuity care for the sickest of individuals, many turned to CIH for alternative ways to self-treat and prevent illness.4 Hijazi et al cite study findings reporting the efficacy of natural immune boosters to prevent COVID-19 or nutritional supplements that may prevent or support therapy for respiratory illnesses.5
Although there may be beneficial effects to the use of CIH, it is important to know that any success from dietary and nutritional supplement products is likely due to the effects of pharmacologically active ingredients. As such, there is an inherent risk of possible interactions with other nonprescription and prescription medications.6 This risk is increased among older adults, who generally have a higher rate of comorbidities for which they are prescribed concomitant therapies, including those with narrow therapeutic indexes.4,5
Pharmacists are some of the most accessible health care providers, uniquely positioned to provide sound counsel on safe and proper medication consumption. The provision of evidence-based drug information is not limited to prescription drugs but extends to CIH as well. The role of the pharmacist’s scope of practice is widely accepted and trusted by the public, and it is explicitly described by many professional pharmacy organizations such as the American Society of Health-System Pharmacists and the American College ofClinical Pharmacy.1,4,7 Community pharmacies are the most common retail providers of CIH, where patients can easily access these therapies OTC, often as they simultaneously pick up their prescriptions from their pharmacist.8 At this intersection, pharmacists are commonly asked to provide information on these products as well as recognize any potential harmful drug interactions.8 Patients report feeling more comfortable disclosing their use of CIH to their pharmacist compared with their physicians. Unfortunately, there is a mismatch between services patients request and what pharmacists are comfortable providing. Research shows that pharmacists rarely ask about, document, or monitor patients’ use of CIH.8 Additionally, pharmacists report feeling uncomfortable answering questions about CIH.8 When surveyed about barriers to pharmacists’ ability to incorporate CIH instruction in their daily practice, pharmacists listed lack of knowledge, insufficient access to adequate resources, inadequate proficiency in interpreting accessible evidence, and a poorly outlined professional role related to CIH education.8,9
Stella Baribault, BSN, is a PharmD candidate at the Taneja College of Pharmacy at the University of South Florida, pursuing a dual Master of Science degree in pharmaceutical nanotechnology. Her interests include innovation in pharmacotherapy, safe transitions of care and drug access, and improving patient outcomes through quality health care information.
Although the majority of pharmacy schools in the United States offer some kind of elective or required CIH education, findings from many studies reflect that this education is unsuccessful or incomplete, resulting in pharmacist graduates who report feeling unprepared to engage in discussions about CIH with their patients.9 A systemic review on CIH instruction in pharmacy school by Lam Ung et al finds that pharmacists have received little if any training on CIH in their curriculum. Pharmacist knowledge about CIH was evaluated as fair to average. The review highlighted the need for CIH education in undergraduate and graduate pharmacy programs to best equip pharmacists to meet their professional responsibilities. Finally, the review concluded there is a need for research about the impact of CIH training in pharmacy schools to determine the best teaching modalities to positively influence pharmacist competencies and patient outcomes.8
Given the popularity and staying power of CIH as a regular part of health care in the United States, it behooves pharmacy educational institutions to incorporate robust CIH training in their curriculums. Pharmacists who take CIH education courses report feeling more competent and comfortable discussing CIH with patients.8 An additional incentive to include this education longitudinally in pharmacy programs is the inclusion of CIH-related questions in the North American Pharmacist Licensure Examination, administered by the National Association of Boards of Pharmacy.1 Professional pharmacy organizations can also work toward developing clearly defined professional roles to provide guidance in providing adequate CIH counseling. Pharmacists can take advantage of continuing medical education on CIH topics to bolster their knowledge base on evidence-based CIH therapies.1 The NCCIH also provides a wealth of health information and specific CIH products, active ingredients, and research for health care professionals.10 Improvement in this area of health care is possible with the intentional and concerted efforts of multiple players and agencies for the sake of our patients.
