Community pharmacists’ recommendations for natural products for stress in Melbourne, Australia: a simulated patient study

Abstract

Background: Community pharmacists are often the first health professional approached to provide treatment for health issues, including the important mental health challenge, stress. Over-the-counter products for stress almost always are complementary and alternative medicines (CAM) and in Australia no protocol exists for their recommendation and sale in community pharmacies. Objective: To assess the quality and relevance of community pharmacists' information gathering (questioning), counselling and product selection when interacting with customers requesting a CAM product for stress and consequently determine whether Australian pharmacy practice indicates the need for guidelines similar to those provided for 'pharmacy only' (S2) and 'pharmacist only' (S3) medicines. Methods: A covert simulated patient was used to investigate the response of pharmacists to a request for a natural product for stress. The SPs documented the details of the pharmacist-simulated patient interaction immediately on leaving the pharmacy and then reentered the pharmacy to debrief the pharmacist. The quality of the interaction was scored as a Total CARE (check, assess, respond, explain) Score, based on anticipated questions and counselling advice. The appropriateness of the product was scored as a Product Efficacy Score, based on evidence-based literature. Results: Data from 100 pharmacies was provided. Information gathering illustrated by the questioning components Check and Assess (C and A) of the total CARE score by pharmacists was poor. The number of questions asked ranged from zero (13 pharmacists) to 7 (four pharmacists), the average being 3.1 (SD 1.9). Provision of advice was generally better (a description of the suggested product was offered by 87 pharmacists) but was lacking in other areas (duration of use and side effects were explained by only 41 and 16 pharmacists respectively). The most common product suggested was B-group vitamins (57 pharmacists) followed by a proprietary flower essence product (19 pharmacists). A two-step cluster analysis revealed two sub-groups of pharmacists: one cluster (74 pharmacists) with a high Total CARE score provided an appropriate product. The other cluster (20 pharmacists) had a low total CARE score and provided an inappropriate product. Conclusions: The pharmacy visits revealed major shortcomings in questioning, counselling and product recommendation. There is a need to develop guidelines for pharmacists to make evidence-based decisions in recommending complementary and alternative medicine.

Community pharmacists’ use, perception and knowledge on dietary supplements: a cross sectional study

“… 7 A simulated patient study conducted in Australian pharmacies showed numerous shortcomings in their practices regarding CAM recommendation and dispensing, including advising use of products with unproven efficacy and safety. 13 Another study, by McKee et al , also revealed that pharmacists’ decision on over-the-counter (OTC) drugs was not influenced by evidence. 14 Moreover, the authors concluded that if community pharmacists aim to be considered as scientific health care professionals, they should discuss evidence with their patients.…”

Evaluation of simulated drug dispensing and patient counseling in the course of pharmaceutical improvement: 2009 to 2015

“… 31 A study conducted in Iran identified low-quality counseling practice on vitamin supplementation and suggests that it is related to insufficient information gathering, inadequate knowledge and deficiencies in the communication skills of professionals. 32 Note that all these studies were conducted to check the performance in community pharmacies and their results showed also a poor scenario. 36 …”

“…Other studies have found that counseling on forgetting to take the medication and contraindications of the drugs are the least likely to be communicated to patients. 29,32 In the study of Paravattil, Kheir and Yousif (2017), the drug allergies, the offer of pharmaceutical follow-up, and the verification of understanding of the information provided to the patient were not met by any of the pharmacists and only 6.5% of the participants correctly explained all the steps in device management. 29 Between 10 and 20% of our pharmacists recommended non-pharmacological care measures, such as regular physical activity, reduced salt intake, or reduce exposure to allergens, among others.…”

“…29 International studies in countries such as Germany, Canada, Qatar, Jordan, and Iran as well as another national study also showed performances similar to or poorer to those found in this study. [29][30][31][32][33][34][35] Simulations conducted in Canada evaluated the performance of pharmacists in a mental health program for men, where the scores were divided into categories. The patient pre-assessment category, including name, age, medical and personal support, symptoms and duration of the disease, use of other medications, allergies, among others, obtained an average score of 5.7 out of a total of 13 points.…”

“…identified low-quality counseling practice on vitamin supplementation and suggests that it is related to insufficient information gathering, inadequate knowledge and deficiencies in the communication skills of professionals. 32 Note that all these studies were conducted to check the performance in community pharmacies and their results showed also a poor scenario. 36 Counseling times, which ranged from 2 to 18 minutes for drug dispensing and from 2 to 25 minutes for patient counseling scenarios, are similar to those found in Mesquita et al or Oh et al 36 In the systematic review by Mesquita et al, the time ranged from 30 seconds to 15 minutes.…”