|Year : 2016 | Volume
| Issue : 3 | Page : 129-131
Herbal Use amongst Patients in a Tertiary Care Hospital: Pattern and Perceptions
Kritika Agrawal, Divya Goel
Department of Pharmacology, Maharishi Markandeshwar Institute of Medical Sciences and Research, Ambala, Haryana, India
|Date of Web Publication||7-Dec-2016|
Department of Pharmacology, Maharishi Markandeshwar Institute of Medical Sciences and Research, Ambala, Haryana
Source of Support: None, Conflict of Interest: None
Introduction: Herbal drug usage is very common in general population; their usage is much more in developing countries such as India. Many untoward instances have been reported either because of herbs per se or because of their interactions with other drugs. Aim: We lack the data showing the prevalence of herbal use, and to fill these gaps, the authors aimed to document the prevalence and perception of herbal drug usage in patients visiting the outpatient department (OPD) of a tertiary care hospital. Materials and Methods: This prospective cross-sectional study was conducted on 200 patients visiting various OPDs. After obtaining informed consent, patients were given questionnaires seeking their sociodemographic data, medical history and herbal drug intake and their perception about herbal drugs. Results: The study population consisted of 127 men and 117 women, out of these 107 (43.49%) patients reported the usage of herbal drugs. Seventy-three (68.2%) patients were taking these herbs on the advice of an alternate therapist. Among those who take herbs, majority of them i.e., 48 (44.9%) think that herbs cure the illness. Moreover, only 38.3% have disclosed herbal intake to the treating physician. While in non-herbal users, most of them i.e., 76 (71.3%) had never given a thought to herbal drugs as they lack knowledge. Conclusion: Herbal drug use is quite common and at the same time disclosure to healthcare professionals about it is very low. We conclude that for effective and safe usage of herbal drugs, we have to promote educational research for both consumers as well as for healthcare professionals.
Keywords: Herbs, pattern, prevalence
|How to cite this article:|
Agrawal K, Goel D. Herbal Use amongst Patients in a Tertiary Care Hospital: Pattern and Perceptions. Adv Hum Biol 2016;6:129-31
| Introduction|| |
The use of herbal drugs is very common in general population, and the last decade has seen a considerable surge in the herbal drug market. According to the WHO, herbal medicine is described as 'herbs, herbal materials, herbal preparations and finished herbal products that contain active ingredients i.e., parts of plants, or other plant materials, or combinations.' The WHO estimates that around 80% of the population of Asian and African countries use herbal medicine for some aspect of healthcare.  Their use is more rampant in developing countries because of easy accessibility, availability, affordability and acceptability among people. ,
Although the beneficial effects of traditional herbal therapy have been mentioned in various texts, their concomitant use with allopathic medicines may prove to be harmful. Co-use of herbs with conventional drugs is very common in pregnant females, elderly and cancer patients. , Simultaneous use of herbs and drugs can alter drug's pharmacokinetics/pharmacodynamics causing therapeutic failure or unexpected adverse effects of the drugs, for example, St. John's Wort (Hypericum perforatum) lowers blood concentrations of cyclosporine, amitriptyline, digoxin, indinavir, warfarin, etc., thus decreasing the efficacy of these drugs. Similarly, warfarin and aspirin have been found to interact with a number of herbal products such as garlic (Allium sativum), cranberry (Vaccinium oxycoccos), ginger (Zingiber officinale) and grapefruit (Citrus paradisi). 
Despite the fact that herbal drug use is common amongst patients and they can adversely interact with drugs, various studies have found low patient disclosure rate of herbal usage to the doctors.  This may be because of lack of communication between patients and doctors or because of patient's unawareness about their potential toxicities and possible drug interactions or because of underestimation of its use by the practicing physicians. Thus, to achieve the maximum therapeutic benefit of the drugs, the pattern of herbal use among the patients must be known.
Literature is deficient about the prevalence of herbal drug usage among Indian patients. This study was, therefore, planned to identify the pattern and perception of herbal intake among patients visiting tertiary care hospitals to provide quality medical care.
| Materials and Methods|| |
A questionnaire-based cross-sectional study was conducted in MMIMSR, Mullana, Ambala, Haryana. The protocol was approved by the Institutional Ethics Committee.
The study population was adult patients visiting various outpatient departments. The sample size was calculated assuming 80% prevalence of herbal drug as per the WHO in developing countries.  Using the following formula, the sample size came to 246 patients:
N = (Zα) 2× ([p (1 − p)]/d2)
Where: N = Estimated sample size
Zα at 5% level of significance = 1.96
d = level of precision and is estimated to be 0.05
p = prevalence rate of complementary and alternative medicine use in developing countries as per the WHO (80%).
N = [(1.96) 2 × (0.8 × 0.2)]/(0.05 × 0.05) = 246 patients.
Those who were unable to give informed consent were excluded from the study. After obtaining informed consent from the patients, data were collected by means of structured open-ended pre-validated questionnaire using face-to-face interview. The questionnaire included the sociodemographic characteristics, clinical information of patients and the self-reported use of herbal drugs, reasons for their use and non-use, source of herbal drugs information, their opinion about herbal drugs and costs of herbal drugs.
| Results|| |
A total of 246 patients were studied, of them, 119 were females and 127 were males. Out of these, 107 (43.49%) patients reported the usage of herbs/herbal medicines. The demographic details of patients who reported herbal usage are shown in [Table 1].
Majority of the patients i.e., 73 were taking these herbs on the advice of an alternate therapist, while 33 patients were taking these on the advice of an alternate therapist as well as by the advice of family and friends [Table 2].
Participants were asked the reason for using herbal medication; most (48) of the herbal drug users were of opinion that these herbs cure the illness.
Out of the 107 herbal users, only 10 (9.35%) patients were taking herbs for the same problem i.e., diabetes, for which they had came to the hospital whereas rest of them were taking for some other health problems such as constipation and acne. Out of the 107 herbal users, 77 (71.9%) had knowledge about the monthly cost of herbal drugs which ranges from Rs. 24 to Rs. 4000, with an average cost of Rs. 1313.40/month. Sixty-seven non-herbal users revealed the reason for not using herbs as a lack of knowledge about herbal drugs [Table 3].
| Discussion|| |
In the present study, 43.5% of the patients were herbal users, which is much lesser than other studies done in India and other countries and little more than one study done in urban India. It could be because of education status of patients in rural area. Most of the patients in our study had education status of <10 th class, and earlier studies have also shown that use of complementary and alternate medicine increased with higher educational status.  The number of female and male herbal user patients was comparable, but when we categorised the patients into different age categories, there were more female patients in all age categories except in the age group of more than 60 years. It might be because of lesser number of female patients of this age group came for healthcare.
Most of the patients were using herbs on the advice of an alternate therapist as most of the patients were of rural background, and in India, the number of alternate therapists as compared to allopathic practitioners is more in rural area. , Out of the 107 patients, 97 patients were taking herbs concurrently either for the same health problem for which they had came to hospital or for some other health problems. Out of these, only 39% of the patients had disclosed their herbal intake to the doctor. There is a lack of knowledge in patients regarding that herbal drugs can also produce adverse effects on their own and can cause potential drug interactions with the allopathic drugs as reported in earlier studies. , Patients are spending extra money for the health problems which is increasing the healthcare cost without having any evidence against any additional benefit.
Although the study population was small and represented only a part of northern region of India, based on our findings, we recommend the following:
- Herbal medicines, Ayurveda and Chinese medicine are our oldest healthcare systems, but still there is a lack of evidence-based efficacy and safety of these herbs, so we should encourage more research to know their efficacy and safety
- A stepping stone towards this will be to make budding doctors aware about these and to encourage them to be part of research activities in this direction
- To generate more data about herbal drug use in population, documentation of herbal use in patients by physicians should be promoted.
| Conclusion|| |
Many patients were taking herbal drugs concurrently along with allopathic drugs; out of these patients, only few had disclosed their herbal drug intake to their physician. As mostly patients were taking herbs as given by alternative therapist, there is a need to sensitise them also so that they can make the patients aware about potential side effects.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]