Improving pharmacy practice in relation to complementary medicines: a qualitative study evaluating the acceptability and feasibility of a new ethical framework in Australia

Abstract

Background There is a need for clearer guidance for pharmacists regarding their responsibilities when selling complementary medicines. A recently published ethical framework provides guidance regarding the specific responsibilities that pharmacists need to meet in order to fulfil their professional obligations and make a positive contribution to health outcomes when selling complementary medicines. Objective Evaluate the acceptability and feasibility of a new ethical framework for the sale of complementary medicines in community pharmacy. Methods Australian community pharmacists were invited to participate in online focus groups and interviews. Participants were recruited via multiple methods, including social media and the professional networks of pharmacy groups. Participants were provided the ethical framework prior to the discussion. Discussions were transcribed verbatim and analysed using thematic analysis. Results Seventeen community pharmacists participated in the study (11 in 4 focus groups and 6 in individual interviews). There was good representation among participants in terms of gender, years of practice, pharmacy location and script volume. Participants differed in how proactive they were in relation to selling and providing advice on complementary medicines, how they interpreted evidence in relation to complementary medicines, and how they navigated their practice within the retail environment of community pharmacy. The majority of participants found the framework was acceptable for practice and was feasible for implementation with targeted support. Participants identified two important areas for targeted support in implementing the framework: improved access to evidence-based information resources on complementary medicines and independent evidence-based education and training on complementary medicine for pharmacists and pharmacy support staff. Conclusion The ethical framework addresses an important gap in providing specific professional guidance to pharmacists when selling complementary medicines. The results of the study suggest that the framework may be acceptable to community pharmacists and be feasible to implement with targeted support.

Development and Validation of a Tool to Improve Community Pharmacists’ Surveillance Role in the Safe Dispensing of Herbal Supplements

“…Such studies can also help to develop a more complete map of the routes via which fake herbal supplements are trafficked including concerns with free trade zones and their implications ( OECD and Office EUIP, 2018 ), as well as a better understanding of their effects on consumers, the industry, and key state-level groups. Furthermore, our tool should help community pharmacists address one of their key ethical responsibilities, that is being vigilant of any harm associated with herbal supplements and subsequently intervening in the case of any perceived significant risk of harm related to the dispensing of herbal supplements ( Popattia et al, 2021 ; Popattia and La Caze, 2021 ). Alongside this, the mass sale of counterfeit products via internet shopping channels also needs to be addressed However, this is outside the scope of the current project.…”

“…Overall, it is expected that the herbal medicine market will grow at an annual compounded growth rate of over 7.2% between 2021 and 2026 due to their lower costs, accessibility, and belief that herbal medicines can promote healthier life-styles, treat diseases such as the metabolic syndrome and gastrointestinal problems, and typically have less side-effects than prescribed medicines, which can be a concern with the toxicity of some prescribed medicines ( Calitz et al, 2015 ; Nuryunarsih, 2016 ; Alsayari et al, 2018 ; Bhat et al, 2019 ; Ekar and Kreft, 2019 ; Eddouks et al, 2020 ; Holleran et al, 2020 ; Market Data Forecast, 2021 ). This is despite concerns with the evidence base of some herbal medicines ( Geck et al, 2020 ; Holleran et al, 2020 ; Popattia et al, 2021 ), as well as potentially adverse effects including increased liver and kidney toxicity exacerbated by some herbal medicines containing heavy metals and naturally occurring organic toxins ( Calitz et al, 2015 ; Brown, 2017 ; Byard et al, 2017 ; Kum et al, 2021 ). However, there are relatively infrequent reports of adverse reactions with herbal medicines across countries ( Di Lorenzo et al, 2015 ).…”

“…This included their education and training to ensure high standards regarding the safety and quality assurance of supplements ( Harnett et al, 2019 ). However, until recently no formal framework appears to be in operation to describe the responsibilities of community pharmacists in dispensing herbal medicines, although this is now changing ( Popattia et al, 2018 ; Popattia et al, 2021 ; Popattia and La Caze, 2021 ).…”

Prevalence and Characteristics of Australians’ Complementary Medicine Product Use, and Concurrent Use with Prescription and Over-the-Counter Medications—A Cross Sectional Study

“…Conversely, community pharmacists in Australia represented a direct point of access for patients during the pandemic, thereby positioned at the frontline of healthcare provision and pharmaceutical care [ 12 ]. CM products are primarily accessed through pharmacies or retail outlets [ 13 ] and common sources of recommendation include general practitioners, pharmacists, store assistants, CM practitioners and self-selection/prescription [ 9 ]. The relationship between source of CM product recommendation and concurrent use with other medications has not been elucidated over the last five years or during the COVD-19 pandemic.…”

Ethics and Business in Community Pharmacies – A Framework for an Ethical Dialogue

“…Moreover, sometimes insufficient training for ethical decision-making in practice [1] makes them even more vulnerable to financial pressure, some of them being pushed into "moral distress" [8,11] or suffering a "crisis of professional identity" [9]. Indeed, a very competitive environment, such as that of community pharmacies, may exacerbate the pressure and conflicts between professional pharmaceutical ethics and employers' business interests [9,10,16,18,24,26]. The most frequent conflicts faced by pharmacists in the community pharmacies are related to the setting of sales targets by their employers [10,11,19,24], dispensing complementary medicines [9,11,16,17,19], making time for patient counselling [9,17,18] and collecting expired medicines from patients for proper disposal [3,21,24].…”